C. Zur

Results of proton therapy of uveal melanomas treated in Nice

PURPOSE To present the first results of uveal melanomas treated with the Medicyc Cyclotron 65 MeV proton beam facility in Nice, analyzing the factors that affect the cause-specific survival (CSS), metastatic rate, and reporting the visual outcome. METHODS AND MATERIALS This study concerns 538 patients referred by French institutions between June 1991 and December 1996. The eye and tumor parameters were measured using ultrasonography and angiography. Since 1994, CT scans were performed in most patients to help determine the axial length and the shape of the ocular globe. Tantalum clips were inserted around the tumor by the referring ophthalmologist. There were 349 posterior pole tumors (64.9%), 130 equatorial tumors (24.1%), and 59 ciliary body tumors (11%). Two hundred four patients (37.9%) had T1 or T2 tumors, and 334 patients (62.1%) had T3 or T4 tumors. The median tumor diameter was 14.6 mm, and the median tumor height was 5.1 mm. All patients received 52 Gy (57.20 Gy Co-equivalent dose) on 4 consecutive days. The data were analyzed by December 1997. RESULTS The CSS was 77.4% at 78 months, the overall survival was 73.8% and the local control was 89.0%. The CSS was not influenced by the patient age or the site of the tumor. It was 81.5% for T1 and T2 tumors, versus 75% for T3 and T4 tumors (P = 0.035). It was found that the tumor diameter, rather than the height, was the most important parameter affecting outcome. The metastatic rate was 8%. It depended on the T stage, tumor diameter and thickness, but not the tumor site. Thirty-eight enucleations were performed, most of them due to tumor progression and/or glaucoma. One-third of the patients in whom visual acuity was adequately scored before and after treatment had a stable, if not improved vision, and half the patients retained useful vision after treatment. CONCLUSION The outcome of patients suffering from uveal melanoma and treated with high-energy protons compares favorably with other techniques of treatment. The tumor dimensions affected CSS and metastatic rate. Even though two-thirds of patients had posterior pole tumors, half of them retained useful vision.

780 Traitement des tumeurs malignes conjonctivales par protonthérapie : technique et résultats

Introduction Les tumeurs malignes de la conjonctive sont des tumeurs rares et potentiellement letales necessitant un traitement adjuvant a l’exerese chirurgicale. La protontherapie fait partie des outils therapeutiques a notre disposition. Objectifs et Methodes Nous nous proposons de presenter les specificites techniques imaginees et appliquees dans notre Centre de radiotherapie afin d’adapter la protontherapie, dont l’efficacite a deja ete etablie pour les melanomes choroidiens, au traitement des tumeurs conjonctivales. Le protocole mis en place demande une cooperation etroite entre ophtalmologiste et radiotherapeute. Un reperage par clips scleraux est realise en premier lieu par le chirurgien ; puis l’adaptation d’un compensateur personnalise et un schema d’irradiation fractionne permettent de traiter au mieux la conjonctive bulbaire et palpebrale ainsi que la sclere sur une epaisseur de 2 mm. Resultats Nous appuierons notre presentation sur les resultats obtenus chez les patients presentant un melanome malin – 33 patients dont 12 melanomes primitifs et 21 melanomes recidivant — ou un carcinome invasif – 11 patients dont 4 carcinomes primitifs et 7 carcinomes recidivants- et qui ont beneficie de cette strategie therapeutique depuis 1992. Discussion Notre protocole de protontherapie semble apporter une amelioration dans le traitement des tumeurs malignes de la conjonctive. Les resultats sont neanmoins dependants du type de tumeur et des possibilites d’intervention des la premiere exerese chirurgicale. Conclusion La protontherapie, deja utilisee pour de nombreuses tumeurs malignes oculaires, peut, grâce a notre technique, etre adaptee a la prise en charge des tumeurs malignes de la conjonctive avec une amelioration notable du pronostic, surtout lorsqu’elle est prescrite en premiere intention.

Topiramate et myopie avec crise aiguë de fermeture de l'angle irido-cornéen: cas clinique et revue de la littérature.

Topiramate, an antiepileptic medication, has been widely used since its recent indication for migraine prophylaxis. We report a case of bilateral angle-closure glaucoma and acute myopia in a 44-year-old woman on oral topiramate therapy initiation for migraine prophylaxis. Intraocular pressure was 31 mmHg right and 32 mmHg left, myopia was 4 diopters. Topiramate was interrupted and general and local hypotensive treatment begun and rapidly stopped after improvement. Iridotomy was also performed. Fifteen days later, complete resolution was observed on ophthalmologic examination: anterior chambers were deep, myopia fully regressed, intraocular pressure returned to normal, and the visual field was complete. This new case prompts discussion on current reports in the literature and French drug monitoring database cases in this context.