@article {416966,
	title = {Long-term Risk of Melanoma-Related Mortality for Patients With Uveal Melanoma Treated With Proton Beam Therapy.},
	journal = {JAMA Ophthalmol},
	year = {2015},
	month = {2015 Apr 23},
	abstract = {Importance: Little is known about the long-term risk of dying of uveal melanoma after treatment with radiotherapy. Objective: To determine the long-term risk of dying of this disease, we evaluated melanoma-related mortality rates up to 25 years after proton beam therapy in a large series of patients with uveal melanoma. Design, Setting, and Participants: In this analysis, we included 3088 patients with uveal melanoma, identified from a hospital-based cohort and treated with proton irradiation between January 1975 and December 2005. Vital status and cause of death were ascertained through active follow-up and searches of government databases (the Social Security Death Index and the National Death Index) through December 31, 2008. Cumulative rates of melanoma-related mortality were calculated using the Kaplan-Meier method. Patient and tumor characteristics of known prognostic significance for melanoma-associated death were evaluated, including patient age and tumor dimensions. Main Outcomes and Measures: The primary outcome measure was cumulative rates of melanoma-specific mortality, and secondary measures included annual melanoma-specific mortality hazard rates and cumulative all-cause mortality rates. Results: Of 1490 deceased patients, 620 (41.6\%) died of ocular melanoma. In addition, 19 patients were alive, but their melanoma metastasized, by the end of the observation period (mean follow-up after diagnosis of metastasis, 5.3 years). All-cause mortality rates in this cohort were 49.0\% (95\% CI, 47.0-51.1) at 15 years, 58.6\% (95\% CI, 56.4\%-60.8\%) at 20 years, and 66.8\% (95\% CI, 64.2\%-69.4\%) at 25 years. Melanoma-related mortality rates were 24.6\% (95\% CI, 22.8-26.4) at 15 years after treatment, 25.8\% (95\% CI, 24.0-27.8) at 20 years after treatment, and 26.4\% (95\% CI, 24.5-28.5) at 25 years after treatment. The 20-year mortality rate was 8.6\% (95\% CI, 6.2-11.9) for younger patients (<=60 years) with small tumors (<=11 mm) and 40.1\% (95\% CI, 36.1-44.3) for older patients (\&gt;60 years) with large tumors (\&gt;11 mm). Conclusions and Relevance: In this large series of patients with ocular melanoma treated conservatively with proton beam irradiation, the cumulative melanoma-related mortality rates continued to increase up to 23 years after treatment. Annual rates decreased considerably (to \&lt;1\%) 14 years after treatment. Information regarding the long-term risk of dying of uveal melanoma may be useful to clinicians when counseling patients.},
	issn = {2168-6173},
	doi = {10.1001/jamaophthalmol.2015.0887},
	author = {Lane, Anne Marie and Kim, Ivana K and Gragoudas, Evangelos S}
}
