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Low-Dose Proton Beam Therapy for Circumscribed Choroidal Hemangiomas
Eric Frau, MD;
Frank Rumen, MD;
George Noel, MD;
Sabine Delacroix, PhD;
Jean-Louis Habrand, MD;
Hervé Offret, MD
Arch Ophthalmol. 2004;122:1471-1475.
Objective To evaluate the efficacy and safety of proton beam therapy for complicated circumscribed choroidal hemangiomas.
Methods The study was a retrospective nonrandomized investigation. Seventeen consecutive patients, referred to the Institut Gustave-Roussy, Villejuif, France, for circumscribed choroidal hemangioma associated with serous retinal detachment were studied. Each eye received a total dose of 20 cobalt gray equivalents (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, fluorescein angiography, and indocyanine green angiography. Tumor thickness was determined on B-scan ultrasonography.
Results The macula was involved in 7 eyes and the lesion was juxtapapillary in 2 eyes. The mean (SD) tumor thickness was 3.06 (9.0) mm. The mean initial tumor diameter was 6.82 mm (range, 3.2-12.1 mm). The right eye was involved in 7 cases and the left eye in 10 cases. The mean (SD) follow-up period was 52 (58) months (range, 36-90 months). Retinal reattachment was obtained in all 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 year after the initial treatment in an undertreated area. After re-treatment, however, resolution of the retinal detachment occurred, and flattening of the choroidal lesion was obtained. Final visual acuity improved to 2 Snellen lines or more in 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 effective and safe alternative option. A total dose of 20 CGEs delivered in 4 daily 15-second fractions of 5 CGEs seems adequate for local control of both the tumor and serous retinal detachment.
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 Protonthérapie d'Orsay, Campus Universitaire, Orsay, France (Drs Noel and Delacroix). The authors have no relevant financial interest in this article.
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