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Efficacy of Fractionated Proton Therapy (20 Gray Relative Biological Effectiveness in 8 Fractions)

Mahdjoubi, Amir, MD*; Dendale, Rémi, MD; Desjardins, Laurence, MD*; Lemaitre, Stéphanie, MD*; Lumbroso-Le Rouic, Livia, MD*; Goudjil, Farid; Cassoux, Nathalie, MD, PhD; Levy-Gabriel, Christine, MD*

doi: 10.1097/IAE.0000000000002002
Original Study: PDF Only

Purpose: To evaluate treatment of circumscribed choroidal hemangioma by hyperfractionated proton beam therapy protocol (20 gray relative biological effectiveness in 8 fractions) on tumor control, attachment of retina and visual function.

Methods: Retrospective review of patients treated between January 2010 and April 2015 with at least 6 months of follow-up.

Results: Forty-three patients with exudative and symptomatic circumscribed choroidal hemangioma were included. Before treatment, 41 (95%) presented an exudative retinal detachment, median visual acuity was 20/63 and median tumor thickness was 3.3 mm. Mean follow-up was 26 months (7–62). At last follow-up, all patients presented regression of ultrasound tumor thickness and 23/43 (53.5%) a totally flat scar. The mean time to achieve a flat scar was 20 months. Retina was reattached in all patients except one with 9 months of follow-up. Visual acuity was improved or stabilized in 37 patients (86%) and final median visual acuity was 20/25. No patient presented radiation maculopathy or papillopathy.

Conclusion: Proton beam therapy with a dose of 20 gray relative biological effectiveness delivered in 8 fractions provides excellent anatomical and functional results and are comparable with those obtained with the same dose delivered in 4 fractions. Longer follow-up is required to determine the long-term radiation sequelae.

Departments of *Ophtalmology, and

Radiation Oncology, Institut Curie, Paris, France; and

Department of Ophtalmology, Institut Curie, Université Paris-Descartes, Paris, France.

Reprint requests: Christine Levy-Gabriel, MD, Department of Ophtalmology, Institut Curie, Paris, France; e-mail:

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.