Eye Tumors

  • Helen A. Shih
  • Alexei V. Trofimov
  • John E. Munzenrider
Part of the Medical Radiology book series (MEDRAD)


Reirradiating the eye after ocular irradiation is a relatively rare occurrence since the eye is irradiated infrequently as a primary target. Because of the intrinsic sensitivity of the structures in the eye to radiation, significant efforts are made to minimize the dose received incidentally by the eye during treatment of tumors of the orbit or periorbital areas or of other head and neck or central nervous system sites. Capitalizing upon technological advances that enable increased radiation dose conformality to the primary disease with minimization of excess radiation dose to the nontargeted parts of the eye permits for safer radiation treatment, both at primary indication and at reirradiation. This chapter will discuss the need for radiation oncologists to be aware of the differing threshold doses for complications involving various parts of the eye, specifically the lens, optic nerve, macula, and retina, as well as the tolerance of the lacrimal gland and the tear-producing cells in the eyelids. Recommendations are provided for determining the advisability of attempting reirradiation of the eye after primary treatment with low, intermediate, or high doses. Advantages of focused radiation therapy techniques, specifically external beam proton therapy and episcleral radionuclide plaque brachytherapy for primary treatment or for reirradiation of discrete ocular tumors, are discussed. Finally, the existing literature on proton therapy used in reirradiation of ocular melanomas is described.


Macular Degeneration Uveal Melanoma Proton Therapy Beam Proton Therapy Ocular Melanoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Badiyan SN, Rao RC, Apicelli AJ et al (2014) Outcomes of iodine-125 plaque brachytherapy for uveal melanoma with intraoperative ultrasonography and supplemental transpupillary thermotherapy. Int J Radiat Oncol Biol Phys 88:801–805CrossRefPubMedGoogle Scholar
  2. Barak A, Hauser D, Yipp P et al (2005) A phase I trial of stereotactic external beam radiation for subfoveal choroidal neovascular membranes in age-related macular degeneration. Br J Radiol 78:827–831CrossRefPubMedGoogle Scholar
  3. Barker CA, Francis JH, Cohen GN et al (2014) 106Ru plaque brachytherapy for uveal melanoma: factors associated with local tumor recurrence. Brachytherapy 13:584–590CrossRefPubMedPubMedCentralGoogle Scholar
  4. Cardosa CC, Giordani AJ, Wolosker AM et al (2012) Protracted hypofractionated radiotherapy for Graves’ ophthalmopathy: a pilot study of clinical and radiologic response. Int J Radiat Oncol Biol Phys 82:1285–1291CrossRefGoogle Scholar
  5. Chan RV, Yonekawa Y, Lane AM et al (2010) Proton beam irradiation using a light-field technique for the treatment of choroidal hemangiomas. Ophthalmologica 224:209–216CrossRefPubMedGoogle Scholar
  6. Chen L, Kim IK, Lane AM et al (2014) Proton beam irradiation for non-AMD CNV: 2-year results of a randomised clinical trial. Br J Ophthalmol 98:1212–1217CrossRefPubMedGoogle Scholar
  7. Courdi A, Caujolle JP, Grange JD et al (2010) Results of proton therapy of uveal melanomas treated in Nice. Int J Radiat Oncol Biol Phys 45:5–11CrossRefGoogle Scholar
  8. Dendale R, Lumbroso-Le Rouic L, Noel G et al (2006) Proton beam radiotherapy for uveal melanoma: results of Curie Institut-Orsay proton therapy center (ICPO). Int J Radiat Oncol Biol Phys 65:780–787CrossRefPubMedGoogle Scholar
  9. Dusenbery KE, Alul IH, Holland EJ et al (1992) Beta-irradiation of recurrent pterygia: results and complications. Int J Radiat Oncol Biol Phys 24:315–320CrossRefPubMedGoogle Scholar
  10. Egger E, Schalenbourg A, Zografos L et al (2001) Maximizing local tumor control and survival after proton beam radiotherapy of uveal melanoma. Int J Radiat Oncol Biol Phys 151:138–147CrossRefGoogle Scholar
  11. Emami B, Lyman J, Brown A et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–122CrossRefPubMedGoogle Scholar
  12. Fasola CE, Jones CE, Huang DD et al (2013) Low-dose radiation therapy (2 Gy x 2) in the treatment of orbital lymphoma. Int J Radiat Oncol Biol Phys 86:930–935CrossRefPubMedGoogle Scholar
  13. Ferry AP, Font R (1974) Carcinoma metastatic to the eye and orbit: a clinicopathological study of 227 eyes. Arch Ophthalmol 92:276–286CrossRefPubMedGoogle Scholar
  14. Gragoudas E, Li W, Lane AM et al (2002) Evidence-based estimates of outcome in patients irradiated for intraocular melanoma. Arch Ophthalmol 120:1665–1671CrossRefPubMedGoogle Scholar
  15. Harada K, Murakami N, Kitaguchi M et al (2014) Localized ocular adnexal mucosa-associated lymphoid tissue lymphoma treated with radiation therapy: a long-term outcome in 86 patients with 104 treated eyes. Int J Radiat Oncol Biol Phys 88:650–654CrossRefPubMedGoogle Scholar
  16. Jackson TL, Chakravarthy U, Slakter JS et al (2015) Stereotactic radiotherapy for neovascular age-related macular degeneration: year 2 results of the INTREPID study. Ophthalmology 122:138–145CrossRefPubMedGoogle Scholar
  17. Kamran SC, Collier JM, Lane AM et al (2014) Outcomes of proton therapy for the treatment of uveal metastases. Int J Radiat Oncol Biol Phys 90:1044–1050CrossRefPubMedGoogle Scholar
  18. Lanciano R, Fowble B, Sergott RC et al (1990) The results of radiotherapy for orbital pseudotumor. Int J Radiat Oncol Biol Phys 18:407–411CrossRefPubMedGoogle Scholar
  19. Marucci L, Lane AM, Li W et al (2006) Conservation treatment of the eye: conformal proton reirradiation for recurrent uveal melanoma. Int J Radiat Oncol Biol Phys 64:1018–1022CrossRefPubMedGoogle Scholar
  20. Marucci L, Ancukiewicz M, Lane AM et al (2011) Uveal melanoma recurrence after fractionated proton beam therapy: comparison of survival in patients treated with reirradiation or with enucleation. Int J Radiat Oncol Biol Phys 79:842–846CrossRefPubMedGoogle Scholar
  21. Merchant T, Gould CJ, Hilton NE et al (2002) Ocular preservation after 36 Gy external beam radiation therapy for retinoblastoma. J Pediatr Hematol Oncol 224:246–249CrossRefGoogle Scholar
  22. Mourits MP, van Kempen-Harteveld ML, Garcia MBG et al (2000) Radiotherapy for Graves’ orbitopathy: randomised placebo-controlled study. Lancet 355:1505–1509CrossRefPubMedGoogle Scholar
  23. Mouw KW, Sethi RV, Yeap BY et al (2014) Proton radiation therapy for the treatment of retinoblastoma. Int J Radiat Oncol Biol Phys 90:863–869CrossRefPubMedPubMedCentralGoogle Scholar
  24. Munch-Petersen HD, Rasmussen PK, Coupland SE et al (2015) Ocular adnexal diffuse large B-cell lymphoma: a multicenter international study. JAMA Ophthalmol 133:165–173CrossRefPubMedGoogle Scholar
  25. Parsons JT, Fitzpatrick CJ, Hood CL et al (1983) The effects of irradiation on the eye and optic nerve. Int J Radiat Oncol Biol Phys 9:609–622CrossRefPubMedGoogle Scholar
  26. Paryani SB, Scotta WP, Wells JW et al (1994) Management of pterygium with surgery and radiation therapy. Int J Radiat Oncol Biol Phys 28:101–103CrossRefPubMedGoogle Scholar
  27. Petersen IA, Kriss JP, McDougall IR et al (1990) Prognostic factors in radiotherapy of Graves’ ophthalmopathy. Int J Radiat Oncol Biol Phys 19:259–264CrossRefPubMedGoogle Scholar
  28. Pradhan DG, Sandridge AL, Mullaney P et al (1997) Radiation therapy for retinoblastoma: a retrospective study of 120 patients. Int J Radiat Oncol Biol Phys 39:3–13CrossRefPubMedGoogle Scholar
  29. Riechardt AI, Cordini D, Dobnet B et al (2014) Salvage proton beam therapy in local recurrent uveal melanoma. Am J Ophthalmol 158:948–956CrossRefPubMedGoogle Scholar
  30. Rudoler SB, Shields CL, Corn BW et al (1997) Functional vision is improved in the majority of patients treated with external-beam radiotherapy for choroid metastases: a multivariate analysis of 188 patients. J Clin Oncol 15:1244–1251CrossRefPubMedGoogle Scholar
  31. Sagoo MS, Shields CL, Mashayekhi A et al (2011) Plaque radiotherapy for juxtapapillary choroidal melanoma. Tumor control in 650 consecutive cases. Ophthalmology 118:402–407CrossRefPubMedGoogle Scholar
  32. Semenova E, Finger PT (2013) Palladium-103 radiation therapy for small choroidal melanoma. Ophthalmology 120:2353–2357CrossRefPubMedGoogle Scholar
  33. The American Brachytherapy Society – Ophthalmic Oncology Task Force (2014) The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma. Brachytherapy 13:1–14CrossRefGoogle Scholar
  34. Tsina EK, Lane AM, Zacks DN et al (2005) Treatment of metastatic tumors of the choroid with proton beam irradiation. Ophthalmology 112:337–343Google Scholar
  35. Van den Brenk HA (1968) Results of prophylactic postoperative irradiation in 1300 cases of pterygium. Am J Roentgenol 103:723–727CrossRefGoogle Scholar
  36. Van Houtte P, Roelandts M, Devriendt D et al (2005) Radiation therapy of benign diseases. What’s new eight years after? Cancer Radiother 9:427–434CrossRefPubMedGoogle Scholar
  37. Wilder RB, Buatti JM, Kittleson JM et al (1992) Pterygium treated with excision and postoperative beta irradiation. Int J Radiat Oncol Biol Phys 23:533–537CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Helen A. Shih
    • 1
  • Alexei V. Trofimov
    • 2
  • John E. Munzenrider
    • 3
  1. 1.Central Nervous System and Eye Services, Department of Radiation OncologyMassachusetts General HospitalBostonUSA
  2. 2.Physics Division, Department of Radiation OncologyMassachusetts General HospitalBostonUSA
  3. 3.Department of Radiation OncologyMassachusetts General HospitalBostonUSA

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