Frameless Multisession Radiosurgery for Symptomatic Circumscribed Choroidal Hemangioma.

Purpose/objective(s) Choroidal hemangioma (CH) is a benign vascular tumor that induces exudative retinal detachment and consequent visual symptoms. Current standard treatments for CH include cryotherapy, diathermy, photocoagulation, PDT, transpupillary thermotherapy, and Radiation. SRS is preferred in the treatment of CH because of its characteristic stiff dose-fall-off and accuracy. Current retrospective study evaluated tumor volume reductions and improvements to visual acuity following multisession Radiosurgery in the treatment of symptomatic circumscribed choroidal hemangioma. Materials/methods Study comprised of Thirteen patients with symptomatic circumscribed CHs diagnosed between August 2012 to December 2019 (8 Male & 5 female). 3 pts. had Sturge-Weber syndrome. All patients underwent frameless SRS following retrobulbar block, Thermoplastic immobilization & Imaging (CT & MRI). A total of 15-18gy / 3 frcs was planned using a 5mm collimator, prescribed to 90% isodose and treatment delivered on a frameless robotic radiosurgery system with skull tracking or C arm Linac equipped with hexapod robotics. Best corrected visual acuity, funduscopic findings, basal tumor diameter and tumor thickness were recorded at baseline and at follow-up visits every 6 -month intervals. Results The mean age of patients was 33 years (range: 12-61 years) and the mean duration of clinical or radiological follow-up was 33 months (range: 16-80 months). The mean volume, Basal diameter, tumor height & tumor thickness at baseline were 533.5 mm3 (range: 124-1150 mm3); 8 mm (range: 5-12mm, ± 2.3); 2.8mm (range, 2.0 - 4.5mm); tumor thickness was 5.1 (range: 3.0-11.0, ± 2.7) mm respectively. 6 tumors were subfoveolar, 4 were juxtafoveolar, and 3 were extrafoveolar. Exudative retinal detachment resolved within a median of 5.5 months (response rate, 100%; 95% CI, 48%-100%). Median best-corrected visual acuity was 20/50 (range, 20/22-20/90) at diagnosis and 20/25 (range, 20/20-20/60) 18 months after treatment. The visual acuity of the affected eye had improved at the latest follow-up examination (P = .018) in all patients. Tumor height had decreased a median of 32% (range, 10-40%) by 6 months and 41% (range, 17%-59%) by 20 months. No recurrence of exudative RD occurred. Thinning of the CHs was observed in most patients; however, symptomatic radiation toxicity had not developed in any of the patients. Conclusion Multisession radiosurgery could be an acceptable alternative treatment for symptomatic circumscribed CH with resolution of exudative RD being achieved within 5-6mo.