PROTON-BEAM IRRADIATION OF CHOROIDAL HEMANGIOMAS

PURPOSE: To present a large series of choroidal hemangiomas treated wi th proton beam irradiation and to describe the treatment outcomes, MET HODS: We treated 54 eyes of 53 patients with choroidal hemangioma. The lesions consisted of 48 circumscribed hemangiomas and six diffuse hem angiomas in patients with Sturge-Weber syndrome. The total applied dos e was 27.3 Gy in four eyes, 22.7 Gy in three eyes, and 16.4 Gy to 18.2 Gy in 47 eyes, RESULTS: The retina reattached within six months after treatment in all 54 eyes and no recurrence of the secondary retinal d etachment occurred within the follow-up period of 6 months to 9 years. Tumors treated with the higher doses regressed faster than tumors tre ated with the lower doses, but radiation-induced complications of the optic nerve appeared in all four eyes treated with a total dose of 27. 3 Gy. Of 31 eyes treated with 16.4 to 18.2 Gy and followed for more th an 1 year, 22 had an improvement in their visual acuity, and nine reta ined the same visual acuity, At the last follow-up examination, the be st-corrected visual acuity was 20/20 or better in nine eyes, 20/40 to 20/25 in 13 eyes, 20/100 to 20/50 in six eyes, and 20/200 or less in t hree eyes. CONCLUSIONS: Proton beam irradiation of choroidal hemangiom as appears to be a valid therapeutic alternative. A total proton dose ranging from 16.4 to 18.2 Gy applied in four daily fractions seems ade quate to ensure local control of both tumor and secondary retinal deta chment, (Am J Ophthalmol 1998;126:261-268, (C) 1998 by Elsevier Scienc e Inc. All rights reserved.).