Journal Mobile Options
Table of Contents
Vol. 38, No. 5, 2006
Issue release date: October 2006
Ophthalmic Res 2006;38:255–260

Combined Proton Beam Radiotherapy and Transpupillary Thermotherapy for Large Uveal Melanomas: A Randomized Study of 151 Patients

Desjardins L. · Lumbroso-Le Rouic L. · Levy-Gabriel C. · Dendale R. · Delacroix S. · Nauraye C. · Estève M. · Plancher C. · Asselain B.
Institut Curie, Paris, France

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Introduction: Exudation from the tumour scar and glaucoma can be major problems after proton beam irradiation of uveal melanoma and can sometimes lead to secondary enucleation. We conducted a randomized study to determine whether systematic transpupillary thermotherapy (TTT) after proton beam radiotherapy could have a beneficial effect. Patients and Method:Between February 1999 and April 2003, all the patients treated by proton beam radiotherapy for uveal melanomas ≧7 mm thick or ≧15 mm in diameter were included in this study after giving their informed consent. One half of the patients received proton beam radiotherapy alone (60 Gy in 4 fractions) and the other half received the same dose of proton beam radiotherapy followed by TTT at 1, 6 and 12 months. All the information concerning the initial tumour parameters, treatments and follow-up was recorded and a statistical analysis was performed. Results: We randomized 151 patients. The median follow-up was 38 months. The 2 groups of patients were similar in terms of age, gender and tumour characteristics. The patients treated with TTT showed a greater reduction of tumour thickness (p = 0.06), less retinal detachment at the latest follow-up (p = 0.14) and a lower secondary enucleation rate (p = 0.02). Discussion: The present study is the first randomized analysis to demonstrate a significant decrease in the secondary enucleation rate in patients treated with TTT after proton beam radiotherapy. Further studies should be performed to determine whether TTT could be beneficial to smaller tumours and to define its optimal dose.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Desjardins L, Levy C, d’Hermies F, Frau E, Schlienger P, Habrand JL, Mammar H, Schwartz L, Mazam A, Delacroix S, Nauraye C, Ferrand R, Asselain B: Initial results of proton therapy in choroidal melanoma at the d’Orsey Center for Proton Therapy: the first 464 cases. Cancer Radiother 1997;1:222–226.
  2. Desjardins L, Lumbroso L, Levy C, Mazal A, Delacroix S, Rosenwald JC, Dendale R, Plancher C, Asselain B: Treatment of uveal melanoma with iodine-125 plaques or proton beam therapy: indications and comparison of local recurrence rates. J Fr Ophtalmol 2003;26:269–276.
  3. Egger E, Zografos L, Munkel G, Bohringer T, Bercher L, Chamot L: Results of proton radiotherapy for uveal melanomas. Front Radiat Ther Oncol 1997;30:111–122.
  4. Gragoudas ES, Seddon JM, Egan KM, Glynn R, Munzenrider JE, Austin-Seymour M, Goiten M, Verhey L, Urie M, Koehler A: Long-term results of proton beam irradiated uveal melanomas. Ophthalmology 1987;94:349–353.
  5. Gragoudas ES, Li W, Goitein M, Lane AM, Munzenrider JE, Egan KM: Evidence-based estimates of outcome in patients irradiated for intraocular melanoma. Arch Ophthalmol 2002;120:1665–1671.
  6. Oosterhuis JA, Journee-de Korver HG, Kakebeeke-Kemme HM, Bleeker JC: Transpupillary thermotherapy in choroidal melanomas. Arch Ophthalmol 1995;113:315–321.
  7. Midena E, Pilotto E, de Belvis V, Zaltron S, Doro D, Segato T, et al: Choroidal vascular changes after transpupillary thermotherapy for choroidal melanoma. Ophthalmology 2003;110:2216–2222.
  8. Shields CL, Naseripour M, Cater J, Shields JA, Demirci H, Youseff A, Freire J: Plaque radiotherapy for large posterior uveal melanomas (≥8 mm thick) in 354 consecutive patients. Ophthalmology 2002;109:1838–1849.
  9. Gunduz K, Shields CL, Shields JA, Cater J, Freire JE, Brady LW: Plaque radiotherapy of uveal melanoma with predominant ciliary body involvement. Arch Ophthalmol 1999;117:170–177.
  10. Boyd SR, Gittos A, Richter M, Hungerford JL, Errington RD, Cree IA: Proton beam therapy and iris neovascularisation in uveal melanoma. Eye 2005;16:16.
  11. Boyd SR, Tan D, Bunce C, Gittos A, Neale MH, Hungerford JL, Charnock-Jones S, Cree IA: Vascular endothelial growth factor is elevated in ocular fluids of eyes harbouring uveal melanoma: identification of a potential therapeutic window. Br J Ophthalmol 2002;86:448–452.
  12. Egger E, Zografos L, Schalenbourg A, Beati D, Bohringer T, Chamot L, Goiten G: Eye retention after proton beam radiotherapy for uveal melanoma. Int J Radiat Oncol Biol Phys 2003;55:867–880.
  13. Munzenrider JE, Gragoudas ES, Seddon JM, Sisterson J, McNulty P, Birnbaum S, et al: Conservative treatment of uveal melanoma: probability of eye retention after proton treatment. Int J Radiat Oncol Biol Phys 1988;15:553–558.
  14. Egan KM, Gragoudas ES, Seddon JM, Glynn RJ, Munzenreider JE, Goitein M, Verhey L, Urie M, Koehler A: The risk of enucleation after proton beam irradiation of uveal melanoma. Ophthalmology 1989;96:1377–1382, discussion 1382–1383.
  15. Damato B, Lecuona K: Conservation of eyes with choroidal melanoma by a multimodality approach to treatment: an audit of 1,632 patients. Ophthalmology 2004;111:977–983.
  16. Harbour JW, Meredith TA, Thompson PA, Gordon ME: Transpupillary thermotherapy versus plaque radiotherapy for suspected choroidal melanomas. Ophthalmology 2003;110:2207–2214, discussion 2215.
  17. Shields CL, Shields JA, Perez N, Singh AD, Cater J: Primary transpupillary thermotherapy for small choroidal melanoma in 256 consecutive cases: outcomes and limitations. Ophthalmology 2002;109:225–234.
  18. Damato B, Patel I, Campbell IR, Mayles HM, Errington RD: Local tumor control after 106Ru brachytherapy of choroidal melanoma. Int J Radiat Oncol Biol Phys 2005;20:20.
  19. Bartlema YM, Oosterhuis JA, Journee-de Korver JG, Tjho-Heslinga RE, Keunen JE: Combined plaque radiotherapy and transpupillary thermotherapy in choroidal melanoma: 5 years’ experience. Br J Ophthalmol 2003;87:1370–1373.
  20. Shields CL, Cater J, Shields JA, Chao A, Krema H, Materin M, Brady LW: Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: tumor control and treatment complications in 270 consecutive patients. Arch Ophthalmol 2002;120:933–940.
  21. Stoffelns BM, Kutzner J, Schopfer K, Frising M: Prospective nonrandomised analysis of ‘sandwich therapy’ for malignant melanoma of the choroid. Klin Monatsbl Augenheilkd 2002;219:211–215.
  22. Char DH, Bove R, Phillips TL: Laser and proton radiation to reduce uveal melanoma-associated exudative retinal detachments. Trans Am Ophthalmol Soc 2003;101:53–56, discussion 56–57.

    External Resources

  23. Bechrakis NE, Hocht S, Martus P, Kreusel KM, Heese J, Foerster MH: Endoresection following proton beam irradiation of large uveal melanomas. Ophthalmologe 2004;101:370–376.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50