|
May 2024 PROTON BEAM THERAPY FOR COMPLEX CHOROIDAL MELANOMAA 66-year-old female patient from Tennessee presented to her local optometrist with visual impairment in her left eye and was diagnosed with a retinal detachment. She was referred to a retina specialist, then to a local ocular oncologist who noted a melanocytic choroidal mass with overlying orange pigment with an exudative serous detachment, consistent with a choroidal melanoma. Given that the tumor was irregularly shaped and extended to 180 degrees around the optic nerve, the patient was referred to Chris Bowen, MD, director of Ocular Oncology at Northwestern Medicine. The health system is one of only a few in the U.S. to offer proton beam therapy for uveal melanoma.
The patient arrived for consultation with next-day tantalum clip placement and fine-needle aspiration biopsy for gene expression profiling and next-generation sequencing. The next week, she proceeded with CT-simulation and then received five days of definitive proton therapy. Dr. Bowen performed genetic testing on the biopsied tissue to identify the specific mutation responsible for the melanoma, allowing personalized surveillance management. Fortunately for this patient, the solid tumor genetics revealed a favorable prognosis. Next-generation sequencing confirmed a tumor mutation associated with a low risk of metastasis, which can guide post-proton therapy surveillance plans. The patient’s tumor is expected to shrink over time, with the retinal detachment resolving on its own. Ongoing surveillance, particularly of the liver (the common site of uveal melanoma spread), remains crucial. The patient’s condition was traced back to a seemingly innocuous freckle (choroidal nevus) located at the posterior segment of her eye. Over time, this freckle underwent a series of genetic mutations, ultimately leading to the development of choroidal melanoma. Remarkably, only one in 8,000 such freckles progress to melanoma. 
Dr. Bowen considered multiple treatment options, including plaque brachytherapy, proton beam therapy, and enucleation, but ultimately recommended proton therapy due to its precision and tissue-sparing benefits. Proton beam therapy is especially beneficial and has an advantage over plaque brachytherapy for uveal melanomas that are multi-lobulated, irregular in shape, span two rectus muscles, and wrap around the optic nerve 180 degrees or more. In this case, due to the inferonasal tumor extension and the tumor surrounding a part of the optic nerve, proton therapy allowed for more precise contouring of the treatment field while sparing nearby healthy retina.
This case highlights the importance of regular ophthalmic evaluations in the early detection and monitoring of choroidal nevi. It also demonstrates the efficacy of proton beam therapy as a precision-targeted treatment modality for complex ocular tumors. Moreover, integrating genetic analysis into the diagnostic process emphasizes its significance in personalized management. Northwestern Medicine’s commitment to such personalized care is key to our pursuit of the best-possible outcomes for each patient.
This story was also featured in TODAY.
|
Refer a PatientNorthwestern Medicine welcomes the opportunity to collaborate with you in caring for your patients.
|
You May Also Like
|
|
|