Proton Beam Therapy for Advanced Periocular Skin Cancer: An Eye-Sparing Approach
by
,
Yingying Zhang
1,2,
Isabela C. S. Lima
1,
Alessandra A. Woo
1,
Stephen Zieminski
1,
Judith A. Adams
1,
Megan A. Hughes
1 and
Annie W. Chan
1,* 1
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Cox 308, Boston, MA 02114, USA
2
Department of Oncology, Xiangya Hospital of Central South University, No. 87 Xiangya Road, Changsha 410078, China
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(2), 327; https://doi.org/10.3390/cancers17020327
Submission received: 7 December 2024
/
Revised: 15 January 2025
/
Accepted: 16 January 2025
/
Published: 20 January 2025
(This article belongs to the Special Issue Advances in Proton Pencil Beam Scanning Therapy)
Simple Summary
The standard of care for the treatment of locally advanced periocular skin cancer is surgical resection, which commonly involves orbital exenteration, albeit normal vision in the majority of patients. The current study reports the long-term outcomes of using proton beam therapy as an eye-sparing approach in the treatment of locally advanced periocular skin cancer. Our findings suggest that proton beam therapy is an effective treatment, allowing tumor control while preserving functional vision in this group of patients.
Abstract
Background/Objectives: The management of periocular skin malignancies presents a unique challenge. Proton beam therapy, due to its sharp dose fall-off, allows for the delivery of a tumoricidal dose to the tumor while sparing adjacent normal tissues. Methods: Thirteen patients with a median age of 76.5 years received protons at our institution to a median dose of 66.6 Gy (RBE). Sixty-four percent of the lesions were basal cell carcinoma, and 22% were squamous cell carcinoma. Eighty-six percent of patients underwent biopsy only or partial resection. Fifty-seven percent of the lesions were located in the medial or lateral canthus. There was orbital invasion in 93% of the cases. Locoregional control probability and overall survival were estimated with the Kaplan–Meier method. Treatment toxicity was scored using the CTCAE 4.0. Results: At a median follow-up of 96 months, there was no local recurrence. The rate of orbital preservation was 100%. Functional vision was maintained in all the patients. There was no acute or late grade 3 or higher toxicity. Conclusions: Protons allow for long-term tumor control with eye preservation in patients with locally advanced periocular skin cancers. Larger prospective multi-institutional trials with standardized ophthalmological assessments are needed to confirm our findings.
