Analysis of Long-term Outcomes of Radiotherapy and Verteporfin Photodynamic Therapy for Circumscribed Choroidal Hemangioma

Vasilios P Papastefanou; P Nicholas Plowman; Ehud Reich; Efthymia Pavlidou; Marie Restori; John L Hungerford; Amit K Arora; Victoria M L Cohen; Mandeep S Sagoo

doi:10.1016/j.oret.2017.12.002

Analysis of Long-term Outcomes of Radiotherapy and Verteporfin Photodynamic Therapy for Circumscribed Choroidal Hemangioma

Ophthalmol Retina. 2018 Aug;2(8):842-857. doi: 10.1016/j.oret.2017.12.002. Epub 2018 Jan 12.

Authors

Vasilios P Papastefanou¹, P Nicholas Plowman², Ehud Reich³, Efthymia Pavlidou³, Marie Restori⁴, John L Hungerford³, Amit K Arora³, Victoria M L Cohen³, Mandeep S Sagoo⁵

Affiliations

¹ Ocular Oncology Service, London, UK. Electronic address: vasilios.papastefanou@moorfields.nhs.uk.
² Department of Radiation Oncology, St. Bartholomew's Hospital, London, UK.
³ Ocular Oncology Service, London, UK.
⁴ Ultrasound Department, Moorfields Eye Hospital, London, UK.
⁵ Ocular Oncology Service, London, UK; UCL Institute of Ophthalmology, London, UK.

PMID: 31047538
DOI: 10.1016/j.oret.2017.12.002

Abstract

Purpose: To determine the long-term therapeutic outcome for different treatments of circumscribed choroidal hemangioma (CCH).

Design: Retrospective observational study.

Subjects: Patients with newly diagnosed CCH.

Methods: Observation, verteporfin (Visudyne) photodynamic therapy (PDT), lens-sparing external beam radiotherapy (LS-EBRT), or plaque brachytherapy.

Main outcome measures: Best-corrected visual acuity (BCVA) at baseline and throughout follow-up, tumor dimensions, and OCT central thickness (where available) at baseline and throughout follow-up were recorded.

Results: There were 60 treatment-naïve consecutive cases with CCH between January 2000 and June 2014; 42 (70%) received treatment. These were LS-EBRT (23/60 [38%]; mean follow-up, 45.5 months), PDT (16/60 [27%]; mean follow-up, 38 months), and plaque radiotherapy (3/60 [5%]; mean follow-up, 92 months). Macular location, mottled or orange pigment, and absence of drusen were significantly more frequent in the treatment group. In the LS-EBRT group, median thickness reduction on ultrasound B scan was 1.6 mm (mean ± standard deviation, 1.65±1.6; range, -6.5 to +0.7). The mean ± standard deviation BCVA gain was 0.22±0.34, with >3 Snellen lines in 48% of cases. Kaplan-Meier estimates were 80% for any gain and 40% for >3 Snellen lines gain at 5 years. In the PDT group, the median decrease in thickness was 0.95 mm (mean ± standard deviation, 1.0±0.8; range, -2.5 to +0.2). The mean ± standard deviation BCVA gain was at 0.3±0.51, with >3 Snellen lines in 30% of cases. Kaplan-Meier estimates were 93% for any gain and 68% for >3 Snellen lines at 5 years. Double versus single duration PDT had more favorable outcomes with a greater reduction in tumor thickness (P = 0.04), central retinal thickness (P = 0.02), and improvement in visual acuity (median, 0.33 vs -0.05). There was no difference in decrease in tumor thickness or BCVA gain between the LS-EBRT and PDT groups. With plaque brachytherapy, the mean decrease in thickness was 2.5 mm, but BCVA loss of >2 Snellen lines was noted in all 3 cases at the end of follow-up. Radiation complications developed in 10 of 23 cases (43.5%) from the LS-EBRT group and 2 of 3 cases (67%) from the plaque brachytherapy group.

Conclusions: LS-EBRT is equivalent to PDT in CCH management for post-treatment BCVA and tumor thickness reduction. The risk of LS-EBRT and plaque brachytherapy was late radiation-related complications. Double duration PDT was more favorable than single duration.