Abstract
Intraosseous hemangiomas are rare, benign tumors, predominantly affecting the vertebrae, calvarium and other bones. These lesions, although slow progressing, can lead to complications such as visual disturbances and structural deformities. Standard management includes surgical interventions and more recently, advanced radiation therapies such as proton beam therapy (PBT) have been explored due to their precision and minimized damage to surrounding tissues. The current study presents a compelling case of a 10-year-old female patent diagnosed with a giant calvarial hemangioma located at the cranio-orbital junction. Although it was initially managed with surgery and chemotherapy, the tumor recurred. Given the recurrence and proximity to critical structures, PBT was employed. The treatment was administered over 28 fractions, with a total dose of 50.4 Gy. The patient exhibited good tolerance to the treatment, experiencing only minor acute side effects such as hair loss and skin pigmentation. At 14 months post-PBT, a marked reduction in tumor size was revealed with no further progression, indicating effective local control of the hemangioma. In addition, the side effects had improved markedly, highlighting the long-term benefits and efficacy of PBT in managing this challenging case. This is the first case in which PBT has been used to manage a calvarial hemangioma in children to the best of the authors' knowledge. The current case highlights the potential of PBT in treating complex intraosseous hemangiomas where conventional therapies are ineffective. Further research into long-term outcomes is necessary to establish PBT as a crucial approach for similar cases.