69 A new study has revealed that proton beam therapy can successfully treat advanced periocular skin cancer while preserving vision, potentially sparing patients from the traumatic experience of losing an eye. Conducted by researchers at Massachusetts General Hospital and Harvard Medical School, the long-term findings offer new hope for individuals whose only treatment option might otherwise be orbital exenteration. The findings were published in the journal Cancers. In cases of advanced skin cancer around the eye, surgery often means removing the entire eye socket, a procedure known as orbital exenteration. This radical approach, while sometimes necessary, can have devastating consequences for a patient’s appearance, vision, and quality of life. The new research instead proposes a gentler but equally effective alternative. The study examined 13 patients with advanced cancers located near the eye, most of whom had tumours invading the orbit. Many had already undergone previous surgeries, including Mohs procedures and local excisions, but their cancers had returned. Traditional radiotherapy was considered too risky due to the delicate nature of surrounding tissues like the cornea and optic nerve. However, proton beam therapy, known for its precision, offered a safer route. Proton beams can be finely controlled, delivering radiation that stops precisely at the tumour and minimises exposure to nearby healthy tissues. In this study, patients received high-dose proton therapy designed to eradicate the tumour while protecting the eye’s vital structures. The treatment was personalised for each individual, using detailed imaging scans and custom-fitted equipment to ensure pinpoint accuracy. Results were remarkable. All patients retained their eyes, and more importantly, their vision. No recurrences of the cancer were observed over a median follow-up period of eight years. Even among those with aggressive tumour types or previous failed treatments, the control rate remained at 100 percent. In terms of side effects, no one experienced serious complications. Minor issues, such as mild dry eye or eyebrow hair loss, were noted but considered manageable. The study also compared proton beam therapy to other common methods such as electron therapy and IMRT. These traditional treatments were found to deliver higher doses of radiation to healthy eye tissues, increasing the risk of long-term complications. Proton therapy, by contrast, reduced radiation exposure to the lens and retina to nearly zero in some cases. Although the number of patients was small, this research is the first of its kind to report such long-term outcomes for proton therapy in periocular skin cancers. The authors called for larger trials to validate their findings but stressed the potential this treatment has to change the current standard of care. For patients with locally advanced periocular cancers who are facing the possibility of losing an eye, this study offers a new pathway that balances effective tumour control with preservation of sight and dignity.