title: Proton or photon irradiation for hemangiomas of the choroid? A retrospective comparison.
abstract: OBJECTIVE
  The aim of this study was to compare, on a retrospective basis, the results of therapy in patients with uveal hemangioma treated with photon or proton irradiation at a single center.
  
  
  METHODS
  From 1993 to 2002 a total of 44 patients were treated. Until 1998 radiotherapy was given with 6 MV photons in standard fractionation of 2.0 Gy 5 times per week. In 1998 proton therapy became available and was used since then. A dose of 20 to 22.5 Cobalt Gray Equivalent (CGE) 68 MeV protons was given on 4 consecutive days. Progressive symptoms or deterioration of vision were the indications for therapy.
  
  
  RESULTS
  Of the 44 patients treated, 36 had circumscribed choroidal hemangiomas and 8 had diffuse choroidal hemangiomas (DCH) and Sturge-Weber syndrome. Of the patients, 19 were treated with photons with a total dose in the range of 16 to 30 Gy. A total of 25 patients were irradiated with protons. All patients with DCH but 1 were treated with photons. Stabilization of visual acuity was achieved in 93.2% of all patients. Tumor thickness decreased in 95.4% and retinal detachment resolved in 92.9%. Late effects, although generally mild or moderate, were frequently detected. In all, 40.9% showed radiation-induced optic neuropathy, maximum Grade I. Retinopathy was found in 29.5% of cases, but only 1 patient experienced more than Grade II severity. Retinopathy and radiation-induced optic neuropathy were reversible in some of the patients and in some resolved completely. No differences could be detected between patients with circumscribed choroidal hemangiomas treated with protons and photons. Treatment was less effective in DCH patients (75%).
  
  
  CONCLUSIONS
  Radiotherapy is effective in treating choroidal hemangiomas with respect to visual acuity and tumor thickness but a benefit of proton therapy could not be detected. Side effects are moderate but careful monitoring for side effects should be part of the follow-up procedures.
authors.affiliation: Clinic for Radiation Oncology and Radiotherapy, Department for Ophthalmology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. stefan.hoecht@charite.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Höcht
authors.forename: Joachim
authors.initials: J
authors.lastname: Wachtlin
authors.forename: Nikolaos E
authors.initials: NE
authors.lastname: Bechrakis
authors.forename: Christiane
authors.initials: C
authors.lastname: Schäfer
authors.forename: Jens
authors.initials: J
authors.lastname: Heufelder
authors.forename: Dino
authors.initials: D
authors.lastname: Cordini
authors.forename: Heinz
authors.initials: H
authors.lastname: Kluge
authors.forename: Michael
authors.initials: M
authors.lastname: Foerster
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hinkelbein
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy / Q000209:etiology; D002386:Cataract / Q000209:etiology; D002830:Choroid Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006391:Hemangioma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D009900:Optic Nerve / Q000473:pathology / Q000528:radiation effects; D017785:Photons / Q000009:adverse effects / Q000627:therapeutic use*; D061766:Proton Therapy; D011522:Protons / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013341:Sturge-Weber Syndrome / Q000532:radiotherapy; D016896:Treatment Outcome; D014792:Visual Acuity / Q000528:radiation effects
chemical_list: D011522:Protons