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Background and Purpose: Radiation myelopathy is a serious late toxicity after radiotherapy (RT) of metastatic spinal cord compression (MSCC). The risk of myelopathy depends on the equivalent dose in 2-Gy fractions (EQD2). Many radiation oncologists are concerned about spinal Re-RT, because it may result in a high cumulative EQD2. This study investigates effectiveness and feasibility of Re-RT for in-field recurrence of MSCC., Patients and Methods: 74 patients, irradiated between 01/1995 and 12/2003 for MSCC, were reirradiated for in-field recurrence of MSCC (Table 1). Primary RT was performed with 1 x 8 Gy (n = 34), 5 x 4 Gy (n = 28), 10 x 3 Gy (n = 4), 15 x 2.5 Gy (n = 4), or 20 x 2 Gy (n = 4). Recurrence occurred after median 6 months (2-40 months). Re-RT was performed with 1 x 8 Gy (n = 35), 5 x 3 Gy (n = 16), 5 x 4 Gy (n = 13), 10 x 2 Gy (n = 4), 12 x 2 Gy (n = 3), or 17 x 1.8 Gy (n = 3). Cumulative EQD2 (alpha/beta = 2 Gy) was 39-40 Gy (n = 21), 49-50 Gy (n = 41), 56-60 Gy (n = 6), or > 60 Gy (n = 6). Follow-up after Re-RT was median 9 months (2-52 months)., Results: Re-RT led to an improvement of motor function in 29/74 patients (39%; Figures 1 to 3). On multivariate analysis, outcome was significantly influenced by type of primary tumor (p = 0.013) and by the time of developing motor deficits before Re-RT (p = 0.037), but not by radiation schedule (p = 0.560), by ambulatory status before Re-RT (p = 0.471), by cumulative EQD2 (p = 0.795), nor by the interval between primary RT and Re-RT (p = 0.420; Table 2). Radiation myelopathy was not observed in the whole series., Conclusion: Re-RT is an effective treatment for an in-field recurrence of MSCC. After a cumulative EQD2 < or = 50 Gy, radiation myelopathy appears unlikely.

Background: Central neurocytomas are described as uncommon benign CNS lesions. Uncertainty exists about the most appropriate treatment regimen. This retrospective analysis compares four therapies for local control and overall survival: complete resection alone (KR), complete resection plus radiotherapy (KR-RT), incomplete resection alone (IR), and incomplete resection plus radiotherapy (ITR-RT)., Material and Methods: The cases published in the literature since 1982 were reviewed for age, gender, extent of resection, atypical neurocytoma, radiotherapy, local control, and overall survival (minimum follow-up 12 months). From direct contact with the authors additional data were obtained providing more detailed information about the patients and a longer follow-up. Statistical analysis was performed with the Kaplan-Meier analysis and the log-rank test., Results: Complete data were obtained from 358 patients (KR 118, KR-RT 35, IR 91, IR-RT 114). Local control was significantly better after KR, KR-RT and IR-RT than after IR (Figure 1). No significant difference was found between KR, KR-RT and IR-RT. Median time to progression was 36 (KR), 39 (KR-RT), 21 (IR) and 32 (IR-RT) months. The comparison of the four groups for overall survival demonstrated that KR provided a significantly better overall survival than IR (Figure 2). Overall survival rates were 99.2% and 86.1%, respectively., Conclusions: Complete resection is much more effective for the treatment of central neurocytoma than incomplete resection. After complete resection the additional benefit of postoperative radiotherapy remains unclear. After incomplete resection postoperative radiotherapy significantly improved local control, but not overall survival.

Pityrosporum ovale appears to play an important role in the pathogenesis of dandruff as a symptom of seborrheic dermatitis. Climbazole is an antimycotic agent with a high in vitro and in vivo efficacy against P. ovale. In the presented work we investigated the efficacy and safety of a climbazole 0.65% shampoo on seborrheic dermatitis of 30 volunteers. Subjects were diagnosed as having moderate to severe seborrheic dermatitis of the scalp. After a 1-week washout and a 4-week treatment the clinical evaluation showed a successful reduction of dandruff, skin redness and itching in 80% of the volunteers and a mild improvement in 20% of the volunteers. The cosmetic acceptability was very good by the majority. It is concluded that the formulation tested is effective in the treatment of moderate to severe dandruff.

Anaphylactic reactions to food containing allergens in the consumption or preparation of food are well known. However, allergy in the preparation of sausages have rarely been described. In the present study a 26-year-old butcher was investigated who had a severe anaphylactic reaction developing sneezing, rhinitis, conjunctivitis, generalised pruritus, followed by widespread urticaria, Quincke's oedema and dyspnoe after starting to prepare sausages containing red yield rice. Red yield rice is produced from polished and washed rice by means of the fungus Monascus purpureus. It was the first time that Monascus purpureus could be shown as allergic agent by means of prick-to-prick test, Cellular Antigen Stimulation Test (CAST) and different other immunoblots.

History and Admission Findings: A 59-year-old woman had for 3 weeks been suffering from painful, moist skin changes on the external genitals, for 3 months having noticed vegetations in the anogenital and perineal region. She had been fatigued and lacking in energy since then. Her last gynecological examination had been 20 years ago. Examination of the skin on admission revealed extensive plaque and cauliflower-like warts and large areas of maceration in the anogenital region, the labia and perineum, with large areas of maceration. Nodules were clearly palpable in the left labium majora: the inner aspects were markedly reddened and had some cutaneous erosions. These findings suggested giant condyloma (GC; Buschke-Löwenstein tumour)., Investigations: Biopsy showed marked condylomatous epithelial proliferations which, with the formation of markedly thickened epithelial cones, had reached the stage of a verrucous carcinoma., Treatment and Course: Under local anti-inflammatory and adstringent medications the inflammatory reaction quickly subsided. Vulvectomy was performed to remove the tumour., Conclusion: Giant condyloma (Buschke-Löwenstein tumour) is a rare pseudocancereous lesion. If human papilloma viruses of type 16 or 18 is demonstrated in the lesions, malignant degeneration should be considered. Histological examination is essential to differentiate it from squamous cell carcinoma.

Purpose: Assessment of treatment results of symptomatic vertebral hemangiomas and review of the literature (Table 3)., Patients and Methods: Ten patients treated between 1974 to 1997 were retrospectively analyzed. Efficacy of treatment was determined according to improvement of pain and/or neurological symptoms (Table 1)., Results: Improvement was achieved in 8 of 10 patients. The initially existing neurological symptoms of 3 patients disappeared completely in 2 cases and improved in 1 case. Acute side effects were slight. Late side effects were not seen. A dose-effect relationship could not be assessed. There was no relapse., Conclusion: Radiotherapy with 30 Gy for symptomatic vertebral angioma as primary therapy is indicated. In case of neurological symptoms a radiotherapy after operative therapy is recommendable even if the patient is free of symptoms to prevent progress or relapse.

Despite promising efficacy data for protective creams and many scientifically proven advances that have been achieved concerning the prevention of irritative contact dermatitis, protection against sensitising substances remains a particular problem due to the minimal amounts of allergen that trigger allergic contact dermatitis. Therefore, specific allergen-blocking substances have been tested which are designed to prevent sensitising processes and in particular avoid occurrence of contact dermatitis in already sensitised individuals. In this review, we present the results of current studies mainly focussed on preventing occupational contact dermatitis caused by metal salts, using different chelating agents. In the United States allergic contact dermatitis is often due to strongly sensitising plant allergens of Toxicodendron species, a factor of importance in outdoor professions. Therefore, attempts have been made to use linoleic acid dimers and organoclay materials such as quaternium-18 bentonite for prophylaxis in topical treatments. Most studies investigate effectiveness against experimentally induced allergic contact dermatitis in sensitised volunteers using standardised allergen extracts. Although several preparations showed some benefit by possibly preventing certain quantities of allergen from penetrating the epidermis, further effort will be required before sufficient protective creams with allergen-blocking properties are available for workplaces.

History and Admission Findings: A 70-year-old woman with type 2B diabetes mellitus was referred to the dermatology department because of inflammatory skin changes of unknown origin over the trunk and limbs. On admission follicular and parafollicular livid-red papulae with central crusts and reddened margins were noted over the lower legs and the lumbosacral region., Investigations: Further physical examination revealed no additional abnormalities. Erythrocyte sedimentation rate was 41/79 mm. The day-time blood-glucose profile was raised (10.2, 12.6 and 8.6 mmol/l), as was the glycosylated haemoglobin HbA1c (9.0%). Swabs from fresh lesions gave no evidence of fungal or bacterial infection. Biopsies revealed areas of widened epidermis with central ulceration filled with fibrin, granulocytes and collagen fibres., Diagnosis, Treatment and Course: The clinical and histological findings indicated an acquired reactive perforating collagenosis (dermatosis) which should be judged in relation to the long-standing diabetes mellitus. The cutaneous changes were covered with salicylate- and steroid-containing preparations, while individual lesions were excised or removed by curettage., Conclusion: The condition of acquired reactive perforating collagenosis is, like Kyrle's disease (perforating follicular and parafollicular hyperkeratotic dermatosis), perforating serpiginous elastosis and perforating folliculitis classified among the perforating dermatoses. In the presence of renal failure and (or) diabetes mellitus these dermatoses must be thought of in the differential diagnosis, in addition to the more frequent pruriginous conditions, if there are corresponding skin changes.

Melatonin (N-acetyl-5-methoxytryptamine) is a hormone with multiple functions in humans, produced by the pineal gland and stimulated by beta-adrenergic receptors. Serum melatonin levels exhibit a circadian rhythm with low levels during the day, rise in the evening and maximum levels at night between 2 and 4 a.m. Melatonin participates in the regulation of several physiological processes such as seasonal biological rhythm, daily sleep induction, aging and modulation of immunobiological defence reactions. Furthermore, melatonin has a highly lipophilic molecular structure facilitating penetration of cell membranes and serving as an extra- and intracellular free radical scavenger. Melatonin seems to quench mainly hydroxyl radicals, the most damaging of all free radicals. Melatonin may play a role in the etiology and treatment of several dermatoses e.g. atopic eczema, psoriasis and malignant melanoma. The influence of melatonin on hair growth is another aspect. Topical application of melatonin inhibits the development of UV-erythema. Penetration through skin after topical application and oral bioavailability auxit further investigations on the pharmacokinetic and pharmacodynamic actions of melatonin.

Soft tissue sarcomas are uncommon neoplasms that represent approximately 1% of all malignancies. It is clear that sarcomas require a therapeutic approach that establishes local control and thereby eliminates the potential of metastasis for patients with truly limited disease. Localized sarcomas are generally treated by surgery. Excision must be complete, with a wide margin of normal tissue, and along anatomic planes, or recurrence will almost certainly follow. Amputations are still occasionally required, although limb salvage procedures are being used increasingly, particularly in the context of multimodality therapy with irradiation or chemotherapy. Radiotherapy can be highly effective for improving local control and is used as adjuvant therapy, either preoperatively or postoperatively. In case of non-in-sano-resection a salvage surgery is indicated. Use of adjuvant postoperative radiotherapy allows for more conservative surgery without compromising local control, and therefore often may allow limb salvage where amputation might otherwise be necessary, e.g. in case of R1- or R2-resection without a new resection, a close margin or large tumors with histologic G2 or G3 grading and in case of local relapses. Local control rate of 90% are reported for the combination of pre- and postoperative radiotherapy. Prognosis is still limited by distant metastases. In case of unresectable tumors neutron radiotherapy results in 50% local control. New approaches e.g. hyperfractionated-accelerated radiotherapy, interoperative radiotherapy and chemoradiotherapy are promising perspectives, which are being evaluated in clinical studies. Desmoid tumors benefit of postoperative radiotherapy in case of R1-resection or relapse.

The invisible long-wave ultraviolet radiation (340-450 nm, max.365 nm) produced by a Wood lamp can help to diagnose dermatoses with a characteristic fluorescence (tinea capitis, erythrasma, tinea versicolor, Pseudomonas infections, porphyrians, and pigmentary alterations). It is also used in the detection of medications that are taken systemically (tetracycline) or that are applied to the skin. Recently, a fluorescence technique with Wood light has been used as a preventive measure to monitor and quantify skin protection at the workplace and to teach workers in high-risk occupations the proper use of protective creams.

Questions Under Study: In high-risk workplaces, primary and secondary measures to prevent occupational dermatoses are necessary. Therefore, protective creams as useful tools in prevention have to be applied adequate. The purpose of the present study was to determine whether a protective cream is adequately applied to the hands by patients with occupational dermatoses after self-application, and to quantify what areas are covered or missed., Methods: 50 patients of the Department of Dermatology of the University Hospital, Zurich, suffering from job-related skin diseases were recruited for a questionnaire and self-application of a cream as they would typically apply it. The cream contained 1% vitamin A acetate in order to fluoresce bright yellow when irradiated with Wood's light., Results: 84% believed that their symptoms were occupationally-related. However, only 44% were occasional or regular users of protective creams and only 36% had previously been informed about skin protection at the workplace. Self-application of a fluorescent preparation resulted in many areas shown as skipped when viewed under Wood's lamp. Only 60% applied the test preparation sufficiently and the application was incomplete, especially in the dorsal aspects of the hands., Conclusions: Our results underline the necessity of educational efforts in the prevention of occupational dermatoses and present an effective approach to teaching patients the proper use of protective creams.

Background: Clinically relevant heterotopic bone formation (HBF) following total hip arthroplasty (THA) occurs in about one third of all high risk patients. HBF can reduce the functional result of surgery by pain and limited range of motion. The experience with patients treated with postoperative radiation therapy after THA with or without removal of HBF is reported., Patients and Method: Between November 1986 und June 1993, postoperative irradiation was performed on 238 hips of 216 patients (117 men, 99 women, median age 66 years, range 38-86 years) with defined risk factors using 10 Gy in 5 fractions (n = 176) or 7 Gy in one fraction (n = 62) with a cobalt unit. In general, irradiation was performed during the first four postoperative days after primary THA alone in 182 hips or removal of HTB in 56 hips with (n = 28) or without (n = 28) revision surgery. Risk factors for HBF were preexisting ipsi- or contralateral HBF in 105 hips (group 1) or hypertrophic osteoarthritis, previous operative procedures of the hip and others in 134 hips (group 2). After a follow-up of at least 6 months patients were examined and radiographs of the hip were performed to classify HBF., Results: New or progressive ossifications had developed in the interval in 15 of 104 hips of group 1 (14.4%), compared with 19 of 134 hips in group 2 (14.2%). Clinically significant new HBF (grade 3 or 4) occurred in none of group 2, and in 3 hips of group 1 (2.9%). After radiation with 10 Gy HBF of all grades occurred in 23 of 176 hips (13.1%), and in nine of 62 hips after 7 Gy (14.5%). The lowest number of treatment failures was found in patients irradiated during the first 4 postoperative days., Conclusion: These results demonstrate that immediate postoperative radiation is efficacious for prevention of clinically relevant HBF following THA and removal of HBF.

Purpose: Technical progress in the development of radiation therapy simulators provided valuable addition of electronically stored images and monitor indicators for individual radiation parameters. One can store as well as print these data as a treatment plan. The possibility of supplementing older simulators with these technical options will be reported in the following paper., Methods: The modification of our simulator installation was done simply. The new equipment needed to expand our simulator facility was almost exclusively derived from the fields of entertainment and home electronics (Visualizer/video camera, video tape recorder, video mixer, additional monitor; personal computer and printer)., Results: With these modifications we reached the technical standards of the latest simulator generation. In addition, we succeeded in implementing additional technical options: e.g. image inversion with contrast alignment to diagnostic displays, complete magnetic tape recording of the entire x-ray process with possible repetition, electronic overlapping of the simulator image and the diagnostic image (e.g. NMR; angiograms) to determine the treatment volume, automation in x-ray documentation., Conclusion: Increased precision and rational work steps employing readily available equipment will lead to further improvement in the quality of radiotherapy.

Due to the low gamma energy (27-35 ke V), iodine 125 is especially suitable for brachytherapy of intraocular tumors. 125I is available as encapsulated seeds. Applicators can be individually loaded with these seeds to accommodate the shape of the tumor as much as possible. To measure the depth-dose distribution LiF thermoluminence detectors (TLDs, 1 mm3) are embedded in an RW-1 eye phantom at various distances and directions from the high active plaque positioned at the top of the phantom. To obtain the three-dimensional dose distribution, the TLDs are read after exposure for the appropriate time period. Based on experimental measurements of the 125I plaque, a computer program is developed to calculate the dose distribution within the eye and the radiation time for intraocular tumors. These results are very similar to those obtained when using mathematical equations published in the literature. In summary, three-dimensional dose distribution at various distances from an 125I eye plaque has been experimentally determined using a new method. This is an important prerequisite for introducing 125I plaques into the treatment of intraocular tumors.

Between 1970 and 1980, 339 patients with Hodgkin's disease in stages IA to IIIB were treated at the Department of Radiotherapy, University of Essen, FRG. 65 patients (group A) were irradiated using a multiple-field-technique with cobalt-60, 110 patients (group B) with mantle fields, inverted Y or paraaortic extended fields given with 5.7 MeV photons. There were no significant differences between the cumulative survival times, local and marginal recurrences. However, the recurrence rates of unirradiated lymph node regions were different, mainly due to absent or given paraaortic treatment. The presence of initially normal blood parameters (BSR, relatively lymphocyte count, haptoglobin, copper, iron) is of high prognostic value. Combined, they allow a correct prognosis as to the five year recurrence rate in up to 98% of cases. The prognostic precision of initially pathologic values was considerably reduced, even if a normalization had occurred after one year from the initiation of treatment.

For the first time, a report is given on the percutaneous radiotherapy of hemangiomas of the choroid which could not be treated by photocoagulation. Diagnosis and control examinations of these tumors were performed by ophthalmoscopy, fluorescence angiography, and ultrasonography. Ten eyes (nine patients, three out of them with Sturge-Weber's disease) were treated between 1967 and 1982. A first group (five eyes, five patients) treated until 1974 received a target volume dose of 1,65 to 6,5 Gy combined with subsequent photocoagulation. All these eyes could be preserved. In addition, the second group (five eyes, four patients) treated since 1975 with unique radiotherapy showed better results with respect to visual acuity. The average follow-up period was four years (seven months up to nine years). Late effects were not observed. Even in case of advanced disease with retinal ablation and secondary glaucoma, an inactivation of the hemangioma of the choroid and a simultaneous regression of the secondary alterations could be achieved. According to our experiences, enucleations can be prevented by an irradiation with a target volume dose of 20 to 30 Gy.

Compared to the other chemotherapeutic preparations discussed today, cyclophosphamide in combination with radiotherapy is a relatively unproblematic substance. Despite the great number of experimental and clinical data, the evaluation does not prove an advantage of the combined therapy with cyclophosphamide and irradiation as against radiotherapy alone in local tumor treatment. This should give occasion to further experimental investigations in adequate models. On the other hand, the practice of combined treatment with irradiation and preparations containing cyclophosphamide should be reconsidered for those cases where local control of a tumor is the principal therapeutic aim.

Postoperative irradiation was done in 12 female patients with granulosa cell tumours between 1962 and 1981. The average follow-up period was 10 years and 10 females were alive without evidence of renewed tumour growth. A further patient died of cardiac infarction after 7 years. At the time of death she was free of recurrence or metastases. Only in one case multiple filiae developed in the lung, liver and skeleton 8 months after cessation of irradiation. The progression of these could not be arrested. Following the first therapeutic step, i.e. abdominal hysterectomy and bilateral adnectomy , radiotherapy represents an important additional therapeutic measure. Thus the unfavourable long-term prognosis of granulosa cell tumours can be beneficially influenced particularly in far-advanced cases or in recurrences.

The authors present histopathology, clinical course, and therapy results of seven patients with epithelial thymomas who have been irradiated subsequently to operation between 1971 and 1981. Four patients are alive without tumors two to twelve years after radiotherapy. One patient died ten years after treatment without any sign of recurrence, two patients died from a local recurrence or metastases eight months and four years after diagnosis, respectively. The therapy of choice is a resection of tumorous tissues performed as completely as possible which succeeds mostly in sano in case of encapsulated thymomas. Our experiences show that an irradiation is indicated for inoperable or incompletely resected thymomas in order to decrease the high risk of local recurrences and to obtain favorable long-term results.

Even though 106Ru/106Rh applicators have been in clinical use over more than two decades for the radiotherapy of malignant uveal melanomas, the dosimetry of emitted beta radiation is still a physical problem. The dose rate at the applicator surface and the depth dose in tissue equivalent material can be determined only within +/- 30% error. Using new cubic-shaped thermoluminescence detectors (TLD) with small volume the dose distribution is examined in water equivalent material (RW-1). The spatial resolution is 14 times better compared to the previous technique. From dose measurements in an eye phantom the homogeneity of nuclide deposition and the depth dose distribution of a 106Ru/106Rh applicator are determined.

Bone-marrow transplantations were performed in 71 patients, 11 with panmyelopathy, 17 with recurrence of acute leukaemia, 25 with acute leukaemia and remission, 18 with chronic myeloid leukaemia. The transplantation was allogenic in 67, autologous in 2, isologous in 2. Eight patients each survived in the panmyelopathy and chronic myeloid leukaemia groups. In the group of patients with acute leukaemia only one patient of those in a recurrence survived the transplantation for several years, but after 6 years there was another recurrence. Of the 20 patients with acute myeloid leukaemia who received the transplantation during their first remission, 11 are still alive. Retransplantation because of the recurrence was employed in one case each of acute and chronic myeloid leukaemia. Main cause of death was interstitial pneumonia with an overall risk of 23%. Only 5% of patients developed severe acute graft-versus-host reaction, grades III-IV. The low incidence of this reaction is possibly due to the strict gnotobiotic measures which in most of the patients led to decontamination of the intestinal tract.

In a 47-year-old patient, the father of a child with bilateral retinoblastoma, three retinomas or retinocytomas were observed in the right eye, which had never been treated, in the course of a routine checkup. The left eye had been enucleated at age three-and-a-half because of a tumor of unknown etiology. At age 55 the patient died of lung cancer. The autopsy revealed a metastasized small-cell bronchial carcinoma. Histopathological examination of the right eye showed, in the region where the tumors had been observed clinically, merely disorganized retinal tissue with proliferations of pigment epithelium in some areas, and well-differentiated retinoblastomas in others. Tumor regression and differentiation appear to be the mechanisms responsible for spontaneous healing of the retinoblastoma. This case also emphasizes the threat posed by non-ocular secondary tumors to carriers of retinoblastoma genes.

A 12 year old patient was treated for Sturge-Weber syndrome with choroidal haemangioma and total exsudative retinal detachment. The diagnosis was supported by echography and thin-layer computed tomography. Because of the exsudative retinal detachment photocoagulation could not be performed. Treatment by percutaneous radiotherapy with Caesium 137 was performed. The retina was reattached by application of 30 Gray. A flat pigmented scar developed in the area of the haemangioma at the posterior pole of the eye. No side effects appeared. The follow-up time is 26 months.

Thin-layer computed tomography of the orbit together with contrast representation by computed tomography in form of circulation studies is the only non-invasive method to represent intraocular hemangiomatous tumors hidden under an exsudative detachment of the retina. This method allows to establish exact tumor parameters which are necessary for an efficient therapy. In this case, radiotherapy with Cs137 is applied.

In case of carcinoma of the epipharynx , the superfractionated and computer-optimized intracavitary radiotherapy with a highly active radiation source moved by steps of 5 mm is an easily tolerated local measure to boost teletherapy. This field of irradiation and application techniques, of dosage and optimization represents an improvement of methods well-known since some thirty years.

Between 1968 and 1979, 132 patients with squamous cell carcinomas of the vulva were submitted to a more or less radical operation. Then they were irradiated at the Radiologic Center of the GHS Essen. All patients received irradiations of the vulvar region with high energy electrons combined with photons (n = 78) as well as photons or electrons alone (n = 15 and 39, respectively). The dose was generally 40 to 60 Gy. 81 patients (61.4%) were additionally irradiated in the inguinal region. The overall three-year and five-year survival rate is 48.5 and 34.1%, respectively. The median survival time is 31.5 months. Contrary to expectation there were no significantly different recurrence rates after radical vulvectomy and large excision combined with postoperative irradiation. This is attributed to the favorable effect of radiotherapy. A graduated conception has been elaborated based on the results of our retrospective analysis and the communications of literature. Radical vulvectomy and inguinal lymphadenectomy is the therapy of choice. Radiotherapy in the vulvar region should be applied if radical surgery seems problematic or is not possible. Irradiation of lymph node regions is indicated if they are involved or if a resection is not possible.

Twenty-seven eyes harboring a choroidal melanoma which could not be treated by other methods were treated with external beam radiation using a linear accelerator. After a mean follow-up period of 15.6 months 3 eyes had to be enucleated. In two eyes fresh tumors developed, which were successfully treated with local beta-radiation. In the remaining 22 eyes the tumor growth was stopped or the tumor regressed. External beam therapy for choroidal melanomas seems to be an effective alternative to enucleation in eyes with tumors not accessible for other methods of treatment and which cannot be enucleated, e.g., single eyes.