Proton beam irradiation using a light-field technique for the treatment of choroidal hemangiomas.
OBJECTIVE
To describe the clinical outcomes of patients with circumscribed and diffuse choroidal hemangiomas treated by proton beam irradiation using a nonsurgical light-field technique.


METHODS
A retrospective chart review was performed on a series of 19 patients (19 eyes) with choroidal hemangiomas treated with proton beam therapy between July 1988 and August 2005. Choroidal hemangiomas were treated with proton beam irradiation using a light-field technique and doses ranging from 15 to 30 cobalt Gray equivalents (CGE; CGE = proton Gy x relative biological effectiveness 1.1) in 4 fractions. Patients with at least 6 months' follow-up were included in the study. Tumor regression, visual acuity, absorption of subretinal fluid, and treatment-associated complications were evaluated by clinical examination and ultrasonography.


RESULTS
Visual acuity improved or remained stable in 14 of 18 eyes (78%). Subretinal fluid was initially present in 16 of 19 eyes (84%), and completely resolved in all 16 eyes. Tumor height, as measured by B-scan ultrasonography, decreased in 18 of 19 eyes and remained stable in 1 of 19, as of the last examination. Complications of radiation developed in 9 of 19 eyes (47%) with the total applied dose ranging from 15 to 30 CGE for these 9 eyes.


CONCLUSIONS
Proton beam irradiation using a light-field technique without surgical tumor localization is an effective treatment option in managing both circumscribed choroidal hemangiomas and diffuse hemangiomas associated with Sturge-Weber syndrome. A total proton dose as low as 15 CGE applied in 4 fractions appears to be sufficient to reduce tumor size, promote absorption of subretinal fluid, and improve or stabilize vision in most patients.
Chan
R V Paul
RV
Retina Service, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
Yonekawa
Yoshihiro
Y
Lane
Anne Marie
AM
Skondra
Dimitra
D
Munzenrider
John E
JE
Collier
J Michael
JM
Gragoudas
Evangelos S
ES
Kim
Ivana K
IK
D000293:Adolescent; D000328:Adult; D002648:Child; D002830:Choroid Neoplasms / Q000532:radiotherapy*; D005260:Female; D006391:Hemangioma / Q000532:radiotherapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000528:radiation effects; D011522:Protons
D011522:Protons