BACKGROUND AND PURPOSE: : Proton radiation has been used for the treatment of uveal melanoma since 1975, but few studies have been conducted to assess its efficacy and safety. This paper aims to systematically review the effects and side effects of proton therapy for any indication of the eye. MATERIAL AND METHODS: : A range of databases were searched from inception to 2007. All studies that included at least ten patients and that assessed the efficacy or safety of proton therapy for any indication of the eye were included. RESULTS: : The search generated 2,385 references, of which 37 met the inclusion criteria. Five controlled trials, two comparative studies and 30 case series were found, most often reporting on uveal melanoma, choroidal melanoma and age-related macular degeneration (AMD). Methodological quality of these studies was poor. Studies were characterized by large differences in radiation techniques applied within the studies, and by variation in patient characteristics within and between studies. Results for uveal melanoma and choroidal melanoma suggest favorable survival, with, however, significant rates of side effects. Results for choroidal hemangioma and AMD did not reveal beneficial effects from proton radiation. CONCLUSION: : There is limited evidence on the effectiveness and safety of proton radiation due to the lack of well-designed and well-reported studies. There is a need to lift evidence on proton therapy to a higher level by performing dose-finding randomized controlled trials (RCTs), comparative studies of proton radiation versus standard given alternatives and prospective case studies enrolling only patients treated with up-to-date techniques, allowing extrapolation of results to similar patient groups.
BACKGROUND AND PURPOSE: : Proton radiation has been used for the treatment of uveal melanoma since 1975, but few studies have been conducted to assess its efficacy and safety. This paper aims to systematically review the effects and side effects of proton therapy for any indication of the eye. MATERIAL AND METHODS: : A range of databases were searched from inception to 2007. All studies that included at least ten patients and that assessed the efficacy or safety of proton therapy for any indication of the eye were included. RESULTS: : The search generated 2,385 references, of which 37 met the inclusion criteria. Five controlled trials, two comparative studies and 30 case series were found, most often reporting on uveal melanoma, choroidal melanoma and age-related macular degeneration (AMD). Methodological quality of these studies was poor. Studies were characterized by large differences in radiation techniques applied within the studies, and by variation in patient characteristics within and between studies. Results for uveal melanoma and choroidal melanoma suggest favorable survival, with, however, significant rates of side effects. Results for choroidal hemangioma and AMD did not reveal beneficial effects from proton radiation. CONCLUSION: : There is limited evidence on the effectiveness and safety of proton radiation due to the lack of well-designed and well-reported studies. There is a need to lift evidence on proton therapy to a higher level by performing dose-finding randomized controlled trials (RCTs), comparative studies of proton radiation versus standard given alternatives and prospective case studies enrolling only patients treated with up-to-date techniques, allowing extrapolation of results to similar patient groups.
Authors: Laura Marucci; Anne M Lane; Wenjun Li; Kathleen M Egan; Evangelos S Gragoudas; Judy A Adams; John M Collier; John E Munzenrider Journal: Int J Radiat Oncol Biol Phys Date: 2006-01-10 Impact factor: 7.038
Authors: K M Egan; E S Gragoudas; J M Seddon; R J Glynn; J E Munzenreider; M Goitein; L Verhey; M Urie; A Koehler Journal: Ophthalmology Date: 1989-09 Impact factor: 12.079
Authors: L Desjardins; L Lumbroso-Le Rouic; C Levy-Gabriel; R Dendale; S Delacroix; C Nauraye; M Estève; C Plancher; B Asselain Journal: Ophthalmic Res Date: 2006-07-28 Impact factor: 2.892
Authors: C J Flaxel; E J Friedrichsen; J O Smith; S C Oeinck; P A Blacharski; C A Garcia; H H Chu Journal: Eye (Lond) Date: 2000-04 Impact factor: 3.775
Authors: E Egger; A Schalenbourg; L Zografos; L Bercher; T Boehringer; L Chamot; G Goitein Journal: Int J Radiat Oncol Biol Phys Date: 2001-09-01 Impact factor: 7.038
Authors: L Lumbroso; L Desjardins; C Levy; C Plancher; E Frau; F D'Hermies; P Schlienger; H Mammar; S Delacroix; C Nauraye; R Ferrand; C Desblancs; A Mazal; B Asselain Journal: Br J Ophthalmol Date: 2001-11 Impact factor: 4.638
Authors: V Vitale; T Scolaro; L Andreucci; F Foppiano; A Porta; C Mosci; L Ravazzoni; N Brassart; P Chauvel Journal: Radiol Med Date: 1992-11 Impact factor: 3.469