Oncologic and visual outcomes after postoperative proton therapy of localized conjunctival melanomas

International audienceIntroductionconjunctival melanomas have high local relapse rates. Oncologic and visual outcomes can be improved with proton therapy and no-touch surgery.Material and methodsa monocentric retrospective study of consecutive patients treated with surgery and proton therapy for conjunctival melanoma was conducted. Proton therapy was performed to a total dose of 45 Grays physical dose delivered in eight fractions over two weeks.ResultsNinety-two patients were included. The mean age was 63-year-old. 65.2% of patients had primary acquired melanosis. The mean tumor thickness and diameter was 2.5 mm and 7.0 mm respectively. The clinical stage was T1 in 71.6% of cases, with a quadrangular involvement of more than 90° in 69% of cases. Conjunctival melanomas were of epithelioid cell-type in 40% of cases. Mean follow-up was 4.7 years. Five-year local failure rate was 33.2%. Of 25 local recurrences, 14 were marginal/out-of-field, 4 in-field, others were undetermined. First surgery at expert center resulted in 24.3% of local failure at 5 years versus 38.7% if performed elsewhere (p = 0.41). Salvage exenteration was performed in 13 patients. Tumor stage and quadrangular involvement were significant factors for local failure. Five-year progression-free survival and cause-specific death rates were 61.5 and 3.6%. Stage and epithelioid type were associated with poorer progression-free survival. Trophic toxicity occurred in 22.9% of patients and was treated locally, with grafts in 7 patients. Glaucoma and cataract occurred in 13 and 22 patients respectively. Prognostic factors for visual deterioration were age, tumor extent (multifocality, quadrangular involvement > 180°) and cryotherapy.Conclusions5-year local failure rate after postoperative proton therapy for conjunctival melanoma was of 33.2%. Radiation-induced complications were overall manageable

COMPORTAMIENTO PSICOMÉTRICO DEL INVENTARIO DE SÍNTOMAS REVISADO SCL-90 R: Administración remota durante confinamiento por COVID-19 en el Gran Mendoza

The SCL-90-R test is used to evaluate and describe various psychopathological symptoms; Therefore, it is necessary to have a normative basis for clinical practice and research in a pandemic context. In the present investigation, this technique was administered remotely using an online form made on the SurveyHeart platform. The compilation of current data occurs in the context of social, preventive and compulsory isolation by COVID-19 in a general population made up of both sexes in Greater Mendoza, in order to provide an scale assessment for a more approximate orientation in the evaluation of clinical practice, research and inventory administration in this remote modality in a pandemic context or in any other situation in which its application be appropriate. The nine main dimensions of the SCL-90-R showed high levels of internal consistency, confirming the reliability of this statistical analysis.El test SCL-90-R es utilizado para evaluar y describir diversos síntomas psicopatológicos; es por tanto necesario contar con una base normativa para la práctica clínica e investigación en contexto pandémico. En la presente investigación, dicha técnica fue administrada a distancia mediante un formulario online realizado en la plataforma SurveyHeart. La recolección de los presentes datos se da en contexto de aislamiento social, preventivo y obligatorio por COVID-19 en una población general compuesta por ambos géneros en el Gran Mendoza. Se realiza, además, el baremo de valoración, cuyo objetivo es brindar una base de datos referencial para una orientación más aproximada en la evaluación de la práctica clínica, la investigación y la administración del inventario en esta modalidad remota en contexto pandémico o en cualquier otra situación en donde su aplicación pueda resultar procedente. Las nueve dimensiones principales del SCL-90-R mostraron elevados niveles de consistencia interna, lo que confirma la confiabilidad de la que fue objeto este análisis estadístico

LA RELAJACIÓN PERCIBIDA Y SU ROL COMO FACTOR PROTECTOR FRENTE A LA ANSIEDAD FÓBICA DURANTE EL TRANSCURSO DEL AISLAMIENTO SOCIAL, PREVENTIVO Y OBLIGATORIO POR COVID-19 EN EL GRAN MENDOZA

A crisis situation arises when an unprecedented event breaks into our reality, and the ways of coping that were used to solve similar problems are insufficient. This study is situated within the framework of "social, preventive and compulsory isolation", imposed by decree in the face of the COVID-19 pandemic, declared by the WHO. It was found that the perceived relaxation would have an incidence in favor of the reduction of phobic anxiety when comparing groups that perceive or not relaxation during the preventive and compulsory social isolation by COVID-19 in Greater Mendoza, thus behaving as a possible protective factor. Currently, very little is known about the psychological consequences that this type of measures, or this context, could produce, for which reason it is pertinent to analyze the factors that could be determining factors in the mental health and well-being of the population of Greater Mendoza.Una situación de crisis surge cuando irrumpe en nuestra realidad un evento sin precedentes, y los modos de afrontamiento que se utilizaban para solucionar problemas similares, resultan insuficientes. El presente estudio se sitúa en el marco de “aislamiento social, preventivo y obligatorio”, impuesto por decreto ante la pandemia de COVID-19, declarada por la OMS. Se encontró que la relajación percibida tendría una incidencia a favor de la reducción de la ansiedad fóbica al comparar grupos que perciben o no relajación durante el aislamiento social preventivo y obligatorio por COVID-19 en el Gran Mendoza, comportándose así, como un posible factor protector. Actualmente se conoce muy poco acerca de las consecuencias psicológicas que este tipo de medidas, o este contexto, podría producir, por lo cual resulta pertinente analizar los factores que podrían ser determinantes en la salud mental y el bienestar de la población del Gran Mendoza

COMPARATIVE EFFECTIVENESS OF PROTON BEAM VERSUS PHOTODYNAMIC THERAPY TO SPARE THE VISION IN CIRCUMSCRIBED CHOROIDAL HEMANGIOMA

International audienc

Dose-response and normal tissue complication probabilities after proton therapy for choroidal melanomas

Purpose Normal tissue complication probability (NTCP) models could aid the understanding of dose-dependence of radiation-induced toxicities after eye-preserving radiotherapy of choroidal melanomas. We performed NTCP-modelling and established dose-response relationships for visual acuity deterioration and common late complications after treatments with proton therapy (PT). Design Retrospective study from single large referral centre. Subjects We considered patients diagnosed with choroidal melanoma and primarily treated with hypo-fractionated PT (52 Gy physical dose in 4 fractions). 1020 patients had complete visual acuity deterioration information, 991 patients had complete information on late complications. Methods Treatment details and dose-volume histograms (DVHs) for relevant anatomical structures and patient and tumour characteristics were available from a dedicated ocular database. Lasso variable selection was used to identify variables with the strongest impact on each endpoint, followed by multivariable Cox regressions and logistic regressions to analyse the relationship between dose, clinical characteristics and clinical outcomes. Dose-response relationships were estimated, adjusting for relevant clinical variables. Main Outcome Measures Dose-response relationship for visual acuity deterioration and late complications Results Dose metrics for several structures (i.e. optic disc, macula, retina, globe, lens, ciliary body) correlated with clinical outcome. The near-maximum dose to the macula (macula D2%) showed the strongest correlation with visual acuity deterioration. Retina D20% was the only variable with clear impact on the risk of developing maculopathy; optic disc D20% had the largest impact on optic neuropathy; cornea D20% had the largest impact on neovascular glaucoma; ciliary body D20% had the largest impact on ocular hypertension; the volume of the ciliary body receiving 26 Gy (ciliary body V26Gy) was the only variable associated with the risk of cataract; and retina V52Gy was associated with the risk of retinal detachment. Optic disc-tumour distance was the only variable associated with dry eye syndrome in the absence of DVH for the lachrymal gland. Conclusions Visual acuity deterioration and specific late complications demonstrated dependence on dose delivered to normal structures in the eye after PT for choroidal melanoma. Visual acuity deterioration depended on dose to a range of structures, while more specific complications were primarily related to dose metrics for specific structures

Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study

Background To relate conjunctival melanoma characteristics to local control. Methods Retrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system. Results 288 patients had a mean initial age of 59.7 +/- 16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2-8.9%), 19.3% (14.4-25.5%) and 36.9% (26.5-49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence. Conclusion This multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.OV