Low-Dose Proton Beam Therapy for Circumscribed Choroidal Hemangiomas | Oncology | JAMA Ophthalmology | JAMA Network
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Clinical Sciences
October 2004

Low-Dose Proton Beam Therapy for Circumscribed Choroidal Hemangiomas

Author Affiliations

From the Institut Gustave-Roussy, Villejuif, France (Drs Frau and Habrand);Service d'Ophtalmology, Centre Hospitalier et Universitaire de Bicêtre,Paris, France (Drs Frau, Rumen, and Offret); and the Centre de Protonthérapied'Orsay, Campus Universitaire, Orsay, France (Drs Noel and Delacroix). Theauthors have no relevant financial interest in this article.

Arch Ophthalmol. 2004;122(10):1471-1475. doi:10.1001/archopht.122.10.1471

Objective  To evaluate the efficacy and safety of proton beam therapy for complicatedcircumscribed choroidal hemangiomas.

Methods  The study was a retrospective nonrandomized investigation. Seventeenconsecutive patients, referred to the Institut Gustave-Roussy, Villejuif,France, for circumscribed choroidal hemangioma associated with serous retinaldetachment were studied. Each eye received a total dose of 20 cobalt grayequivalents (CGEs) delivered in 15-second fractions of 5 CGEs over 4 days.Functional tests included the initial and final best-corrected visual acuity,slitlamp examination, intraocular pressure, fundus examination, fluoresceinangiography, and indocyanine green angiography. Tumor thickness was determinedon B-scan ultrasonography.

Results  The macula was involved in 7 eyes and the lesion was juxtapapillaryin 2 eyes. The mean (SD) tumor thickness was 3.06 (9.0) mm. The mean initialtumor diameter was 6.82 mm (range, 3.2-12.1 mm). The right eye was involvedin 7 cases and the left eye in 10 cases. The mean (SD) follow-up period was52 (58) months (range, 36-90 months). Retinal reattachment was obtained inall cases after a mean period of 2 months (range, 1-12 months; median, 1 month).Tumor regression was obtained in all cases. One recurrence occurred 1 yearafter the initial treatment in an undertreated area. After re-treatment, however,resolution of the retinal detachment occurred, and flattening of the choroidallesion was obtained. Final visual acuity improved to 2 Snellen lines or morein 16 eyes (94%), was stable in 1 eye, and attained 20/40 or more in 12 eyes(70.6%). No radiation therapy complications occurred during follow-up.

Conclusions  Proton beam therapy for choroidal hemangiomas seems to be an effectiveand safe alternative option. A total dose of 20 CGEs delivered in 4 daily15-second fractions of 5 CGEs seems adequate for local control of both thetumor and serous retinal detachment.