Proton therapy for ocular melanoma: 3D imaging-driven treatment planning based on patient preferences

Principal Investigator: Prof. dr. Coen Rasch (LUMC)

Funding: KWF 2020


Choroidal melanoma is the most common ocular malignancy in adults, incidence is around 1:100.000 in the Netherlands. Care for this group of patient is centralised, with over 90% of patients being treated at Leiden University Medical Center (LUMC), the remaining patients are mainly treated at Erasmus Medical Center. For small choroidal melanomas (prominence <7mm and largest basal diameter <16mm) Ruthenium-106 plaque brachytherapy is the standard of care, which is only performed at LUMC. Larger choroidal melanomas or those ineligible for brachytherapy (e.g. tumours in close proximity to the optic nerve) were traditionally treated with surgical removal of the eye; enucleation. Eye-preserving treatment by proton therapy (PT) was only available for patients willing and able to go abroad. At EMC, patients could also receive eye-sparing treatment by stereotactic external beam radiotherapy (EBRT) using photons. Since January 2020 PT has become available at the Holland Proton Therapy Center in Delft. Compared to EBRT, PT delivers radiation dose with higher precision, reducing side-effects and undesired dose to the rest of the body. Choroidal melanoma is now a standard indication for PT and is reimbursed for all Dutch patients. Because there is no evidence for PT superiority from randomised controlled trials, Dutch PT centres are obliged to evaluate their outcomes of treatment.

The aim of the project is to determine the outcomes of PT and enucleation for choroidal melanoma in the Netherlands, to better understand patient preferences and treatment decision-making, and to determine whether 3D image-guided proton therapy planning can improve patient-preferred treatment outcomes. The project plan is to:

  • Perform a prospective observational cohort study among 150 patients with large choroidal melanomas will be conducted wherein oncological outcomes, treatment morbidity, visual outcomes and quality of life will be registered up to 36 months after PT or enucleation.
  • Investigate patient treatment preferences and treatment decision-making process regarding the choice between enucleation and PT; to gain insight into patients’ treatment satisfaction, regret and coping with side-effects.
  • Explore the possibilities of the 3D image-guided PT planning to reduce and personalize the risk of side-effects and compare to the current FDA approved software.