Spandidos Publications Acta Medica Okayama 2049-9450 16 1 2021 Proton beam therapy followed by pembrolizumab for giant ocular surface conjunctival malignant melanoma: A case report 12 EN Toshihiko Matsuo Regenerative and Reconstructive Medicine (Ophthalmology), Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems Osamu Yamasaki Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takehiro Tanaka Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kuniaki Katsui Division of Radiation Oncology, Department of Radiology, Kawasaki Medical School Takahiro Waki Department of Radiology, Tsuyama Chuo Hospital The present study describes proton beam therapy as a clinical option to achieve local control of giant conjunctival melanoma in an aged person, instead of orbital exenteration. An 80‑year‑old woman with one‑year history of left‑eye injection and hemorrhage experienced rapid growth of the ocular surface black mass. At the initial visit, a black, elastic hard, hemorrhage‑prone, thickened mass in the size of 30x40 mm with a presumed wide stalk covered the total area of the lid fissure on the left side. Biopsy of the mass demonstrated anomalous melanin‑containing cells in fibrin and hemorrhage, which were positive for cocktail‑mix antibodies against tyrosinase, melanoma antigen recognized by T cells‑1 and human melanoma black‑45, indicative of malignant melanoma. One month after the initial visit, the patient underwent proton beam therapy at the total dose of 70.4 Gy (relative biological effectiveness) in 32 fractions (~10 min each) in one and a half months. One month after the end of proton beam therapy, 3.5 months from the initial visit, the patient was found by computed tomographic scan to have multiple metastatic lesions in bilateral lung fields. With the evidence of absent BRAF mutation, the patient underwent intravenous administration of pembrolizumab 77.2 mg every three weeks five times in total. Then, three months after proton beam therapy, ocular surface melanoma almost subsided and the clear cornea allowed visualization of the intraocular lens inside the eye. In three weeks, spontaneous corneal perforation was plugged with iris incarceration. The patient died suddenly of unknown cause 7.5 months from the initial visit. The local control of giant conjunctival melanoma was achieved by proton beam therapy, leading to patient's satisfaction and better quality of life. Proton beam therapy, followed by immune checkpoint inhibitors, would become the future standard of care for unresectable giant conjunctival melanoma. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 0360-3016 73 4 2009 Analysis of Factors Associated With Radiation-Induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome After Breast-Conserving Therapy 1049 1054 EN Norihisa Katayama Department of Radiology, Okayama University Hospital Shuhei Sato Department of Radiology, Okayama University Hospital Kuniaki Katsui Department of Radiology, Okayama University Hospital Mitsuhiro Takemoto Department of Radiology, Okayama University Hospital Toshihide Tsuda Department of Radiology, Okayama University Hospital Atsushi Yoshida Department of Radiology, Okayama University Hospital Tsuneharu Morito Department of Radiology, Okayama University Hospital Tomio Nakagawa Department of Radiology, Okayama University Hospital Akifumi Mizutani Department of Radiology, Okayama University Hospital Takahiro Waki Department of Radiology, Okayama University Hospital Harutaka Niiya Department of Radiology, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Hospital Purpose: To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy.<br/> Methods and materials: A total of 702 women with breast cancer who received radiotherapy after breast-conserving surgery at seven institutions between July 1995 and December 2006 were analyzed. In all patients, the whole breast was irradiated with two tangential photon beams. The criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months, (2) general and/or respiratory symptoms lasting for >or=2 weeks, (3) radiographs showing lung infiltration outside the radiation port, and (4) no evidence of a specific cause.<br/> Results: Radiation-induced BOOP syndrome was seen in 16 patients (2.3%). Eleven patients (68.8%) were administered steroids. The duration of steroid administration ranged from 1 week to 3.7 years (median, 1.1 years). Multivariate analysis revealed that age (>or=50 years; odds ratio [OR] 8.88; 95% confidence interval [CI] 1.16-67.76; p = 0.04) and concurrent endocrine therapy (OR 3.05; 95% CI 1.09-8.54; p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was >or=50 years and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome.<br/> Conclusions: Age (>or=50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy. Physicians should carefully follow patients who received breast-conserving therapy, especially those who are older than 50 years and received concurrent endocrine therapy during radiotherapy. No potential conflict of interest relevant to this article was reported.