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Int J Radiat Oncol Biol Phys. 2016 May 1;95(1):336-43. doi: 10.1016/j.ijrobp.2016.01.040. Epub 2016 Jan 28.

Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey.

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Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. Electronic address:
Ocular Tumor Proton Therapy Program, University of California San Francisco, San Francisco, California.
National Proton Therapy Centre, Clatterbridge Cancer Centre, Bebington, United Kingdom.
Centre de Protonthérapie d'Orsay, Institut Curie, Orsay, France.
Centre Lacassagne, Nice, France.
F. H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Protons for Therapy, Helmholtz-Zentrum Berlin, Berlin, Germany.
BerlinProtonen am HZB, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Institute of Nuclear Physic, Polish Academy of Sciences, Krakow, Poland.
BC Cancer Agency - TRIUMF, Vancouver, Canada.
Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.



To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs.


Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow.


Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post-radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers.


The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades, increased use of MRI, development of clinical protocols, systematic patient-centered data acquisition, and publishing guidelines on QA, staffing, treatment, and follow-up parameters by dedicated ocular programs to ensure the highest level of care for ocular patients.

[Indexed for MEDLINE]

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