The following is a summary of “PTCOG Ocular Statement: Expert Summary of Current Practices and Future Developments in Ocular Proton Therapy,” published in the July 2024 issue of Oncology by Hrbacek et al.

Though rare, ocular tumors pose significant risks to vision, quality of life, and life expectancy. Ocular proton therapy (OPT) is a highly effective treatment for these conditions. The Particle Therapy Co-Operative Ocular Group (PTCOG Ocular) has formulated an Evidence and Expert-Based Executive Summary detailing current practices and future developments in OPT. A comparative dosimetric and clinical analysis of different OPT systems is critical to establishing planning guidelines, implementing best practices, and setting benchmarks for eye preservation, vision, and quality of life measures. Contemporary prospective trials in specific patient subsets, such as those with tumors near the optic disc or macula, can provide valuable data on the differences in radiation delivery and penumbra between various radiation modalities and beamline systems, as well as the resultant tumor control, normal tissue complication rates, and overall clinical cost-effectiveness.

Successful treatment has relied on the combination of multimodal imaging (including fundus photography and ultrasound), ophthalmologist assessment, and clip surgery with radiation planning. The increased use of 3D imaging (CT/MRI) is anticipated, although its spatial resolution may be a limiting factor, particularly in detecting flat diffuse tumor parts. The development of commercially produced ocular treatment planning systems is underway, and their future use is expected to expand across OPT centers.

OPT’s future continuity will depend on several factors: maintaining and upgrading existing older dedicated low-energy facilities, maintaining shared, degraded beamlines at large proton therapy centers, and developing adapted gantry beams of sufficient quality to preserve the clinical benefits of sharp beam conformity. The first option offers the sharpest beams, minimizing the impact on healthy tissues. In contrast, the latter two options provide the advantages of substantial long-term technical support, development, and the introduction of new approaches.

Ensuring significant patient throughputs and fostering close cooperation between medical physics, ophthalmology, and radiotherapy—underpinned by mutual understanding—is crucial for a successful OPT service. This integrated approach will help advance the field and ensure that patients continue to receive the highest quality of care.

Source: sciencedirect.com/science/article/pii/S036030162400748X