Original StudyCOMPARATIVE EFFECTIVENESS OF PROTON BEAM VERSUS PHOTODYNAMIC THERAPY TO SPARE THE VISION IN CIRCUMSCRIBED CHOROIDAL HEMANGIOMAMathis, Thibaud MD*,†; Maschi, Célia MD‡; Mosci, Carlo MD§; Espensen, Charlotte A. PhD¶; Rosier, Laurence MD**; Favard, Catherine MD††; Tick, Sarah MD‡‡; Remignon, Charles-Henry MD*; Ligorio, Paolo MD§; Bonin, Nicolas MD§§; Gambrelle, Joël MD¶¶; Nguyen, Anh-Minh MD*; Faber, Carsten MD¶; Meyer, Laurent MD***; Mouriaux, Frederic MD, PhD†††; Herault, Joël PhD¶¶¶; Baillif, Stéphanie MD, PhD‡; Kiilgaard, Jens-Folke MD, PhD¶; Kodjikian, Laurent MD, PhD*,†; Caujolle, Jean-Pierre MD‡; Salleron, Julia PhD‡‡‡; Thariat, Juliette MD, PhD§§§Author Information *Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, France; †Laboratoire UMR-CNRS 5510 Matéis, Villeurbane, France; ‡Service d'Ophtalmologie, Hôpital universitaire Pasteur 2, Nice, France; §Clinica Oculista, E.O. Ospedali Galliera, Genova, Italy; ¶Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; **Centre Galien, Centre d'Exploration et de Traitement de la Rétine et de la Macula, Bordeaux, France; ††Centre Odéon, Centre de rétine médicale, Paris, France; ‡‡Centre Hospitalier National Ophtalmologique des XV-XX, Paris, France; §§Centre d'ophtalmologie du Zénith, Cournon d'Auvergne, France; ¶¶Clinique Pasteur, Brest, France; ***Service d'Ophtalmologie, Hôpital Civil de Colmar, Colmar, France; †††Service d'Ophtalmologie, Hôpital Universitaire Pontchaillou, Rennes, France; ‡‡‡Service de Biostatistiques, Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France; §§§Service de Radiothérapie, Centre François Baclesse/ARCHADE-Normandie Université, Caen, France; and ¶¶¶Service de radiothérapie, Centre Antoine Lacassagne, Nice, France. Reprint requests: Thibaud Mathis, MD, Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69317 Lyon cedex 04, France; e-mail: [email protected] None of the authors has any financial/conflicting interests to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.retinajournal.com). Retina: February 2021 - Volume 41 - Issue 2 - p 277-286 doi: 10.1097/IAE.0000000000002843 Buy SDC Metrics AbstractIn Brief Purpose: The aim of this study was to compare the functional and anatomical effectiveness of photodynamic therapy (PDT) versus proton beam therapy (PBT) in a real-life setting for the treatment of circumscribed choroidal hemangioma. Methods: A total of 191 patients with a diagnosis of circumscribed choroidal hemangioma and treated by PBT or PDT were included for analyses. Results: The 119 patients (62.3%) treated by PDT were compared with the 72 patients treated by PBT. The final best-corrected visual acuity did not differ significantly between the two groups (P = 0.932) and final thickness was lower in the PBT compared with the PDT group (P = 0.001). None of the patients treated by PBT needed second-line therapy. In comparison, 53 patients (44.5%) initially treated by PDT required at least one other therapy and were associated with worse final best-corrected visual acuity (P = 0.037). In multivariate analysis, only an initial thickness greater than 3 mm remained significant (P = 0.01) to predict PDT failure with an estimated odds ratio of 2.72, 95% confidence interval (1.25–5.89). Conclusion: Photodynamic therapy and PBT provide similar anatomical and functional outcomes for circumscribed choroidal hemangioma ≤3 mm, although multiple sessions are sometimes required for PDT. For tumors >3 mm, PBT seems preferable because it can treat the tumor in only 1 session with better functional and anatomical outcomes. This study reviewed 230 patients with circumscribed choroidal hemangioma including 191 treated by proton beam or photodynamic therapy. We show that patients with tumor thickness <3 mm can be treated by either photodynamic therapy or proton beam therapy. However, tumors ≥3 mm should be treated by proton beam therapy, because photodynamic therapy failures are more frequent in this case.