title: Radiogenic side effects after hypofractionated stereotactic photon radiotherapy of choroidal melanoma in 212 patients treated between 1997 and 2007.
abstract: OBJECTIVE
  To evaluate side effects of hypofractionated stereotactic photon radiotherapy for patients with choroidal melanoma.
  
  
  METHODS
  Two hundred and twelve patients with choroidal melanoma unsuitable for ruthenium-106 brachytherapy or local resection were treated stereotactically at the Medical University of Vienna between 1997 and 2007 with a Linac with 6-MV photon beams in five fractions with 10, 12, or 14 Gy per fraction. Examinations for radiogenic side effects were performed at baseline and every 3 months in the first 2 years, then every 6 months until 5 years and then once a year thereafter until 10 years after radiotherapy. Adverse side effects were assessed using slit-lamp examination, funduscopy, gonioscopy, tonometry, and, if necessary, fundus photography and fluorescein angiography. Evaluations of incidence of side effects are based on an actuarial analysis.
  
  
  RESULTS
  One hundred and eighty-nine (89.2%) and 168 (79.2%) of the tumors were within 3 mm of the macula and the optic disc, respectively. The five most common radiotherapy side effects were retinopathy and optic neuropathy (114 cases and 107 cases, respectively), cataract development (87 cases), neovascular glaucoma (46 cases), and corneal epithelium defects (41 cases). In total, 33.6%, 38.5%, 51.2%, 75.5%, and 77.6% of the patients were free of any radiation retinopathy, optic neuropathy, cataract, neovascular glaucoma, or corneal epithelium defects 5 years after radiotherapy, respectively.
  
  
  CONCLUSIONS
  In centrally located choroidal melanoma hypofractionated stereotactic photon radiotherapy shows a low to moderate rate of adverse long-term side effects comparable with those after proton beam radiotherapy. Future fractionation schemes should seek to further reduce adverse side effects rate while maintaining excellent local tumor control.
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Roman
authors.initials: R
authors.lastname: Dunavoelgyi
authors.forename: Karin
authors.initials: K
authors.lastname: Dieckmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Gleiss
authors.forename: Stefan
authors.initials: S
authors.lastname: Sacu
authors.forename: Karl
authors.initials: K
authors.lastname: Kircher
authors.forename: Michael
authors.initials: M
authors.lastname: Georgopoulos
authors.forename: Dietmar
authors.initials: D
authors.lastname: Georg
authors.forename: Martin
authors.initials: M
authors.lastname: Zehetmayer
authors.forename: Richard
authors.initials: R
authors.lastname: Poetter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D002386:Cataract / Q000209:etiology; D002830:Choroid Neoplasms / Q000473:pathology / Q000601:surgery*; D003315:Cornea / Q000528:radiation effects*; D003320:Corneal Ulcer / Q000209:etiology / Q000473:pathology; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D015355:Glaucoma, Neovascular / Q000209:etiology; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009898:Optic Disk / Q000528:radiation effects; D017785:Photons / Q000627:therapeutic use; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology; D011855:Radiodermatitis / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D012160:Retina / Q000528:radiation effects*; D013997:Time Factors; D014605:Uveitis / Q000209:etiology / Q000473:pathology; D055815:Young Adult