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Newer Radiation Modalities for Choroidal Tumors

The treatment of choroidal melanomas with radiation began in 1929 with the use of radon seeds reported by Moore. Stallard expanded the indications and improved the technique using Co plaques. More recently, several other isotopes have been used. These techniques use direct visualization of the tumor location at surgery using transillumination and indirect ophthalmoscopy to accurately locate the plaque. The use of charged particles and their Bragg peak to treat uveal melanomas began at the Harvard Cyclotron in 1974 and was followed by the application of a similar technique at LBL using helium ions. In this presentation, we compare dose distributions with our current proton facility to proposed new modalities (Fig. 1). Details on proton techniques and treatment results can be found in chapter 2 in this issue. Over the past 20 years, there has been a rapid development of radiosurgery techniques for treating small intracranial lesions. The advances in these techniques have been based on improved computed tomography (CT) and magnetic resonance imaging (MRI), computerbased image-guided dose delivery, and very accurately aimed small beams of cobalt gamma rays or 6 MeV linear accelerator x-rays. These form the basis of new approaches to choroidal melanoma and are discussed in detail.