Emma B Holliday1, Bita Esmaeli2, Jamie Pinckard3, Adam S Garden1, David I Rosenthal1, William H Morrison1, Merrill S Kies4, G Brandon Gunn1, C David Fuller1, Jack Phan1, Beth M Beadle1, Xiarong Ronald Zhu5, Xiaodong Zhang5, Steven J Frank6. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2. Orbital Oncology and Ophthalmic Plastic Surgery Program, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. 3. School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas. 4. Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 5. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: sjfrank@mdanderson.org.
Abstract
PURPOSE: Postoperative radiation is often indicated in the treatment of malignant epithelial tumors of the orbit and ocular adnexa. We present details of radiation technique and toxicity data after orbit-sparing surgery followed by adjuvant proton radiation therapy. METHODS AND MATERIALS: Twenty patients underwent orbit-sparing surgery followed by proton therapy for newly diagnosed malignant epithelial tumors of the lacrimal gland (n=7), lacrimal sac/nasolacrimal duct (n=10), or eyelid (n=3). Tumor characteristics, treatment details, and visual outcomes were obtained from medical records. Acute and chronic toxicity were prospectively scored using Common Terminology Criteria for Adverse Events version 4.0. RESULTS: The median radiation dose was 60 Gy(RBE) (relative biological effectiveness; [range 50-70 Gy]); 11 patients received concurrent chemotherapy. Dose to ipsilateral anterior optic structures was reduced in 13 patients by having them gaze away from the target during treatment. At a median follow-up time of 27.1 months (range 2.6-77.2 months), no patient had experienced local recurrence; 1 had regional and 1 had distant recurrence. Three patients developed chronic grade 3 epiphora, and 3 developed grade 3 exposure keratopathy. Four patients experienced a decrease in visual acuity from baseline but maintained vision sufficient to perform all activities of daily living without difficulty. Patients with grade ≥3 chronic ocular toxicity had higher maximum dose to the ipsilateral cornea (median 46.3 Gy[RBE], range 36.6-52.7 Gy[RBE] vs median 37.4 Gy[RBE], range 9.0-47.3 Gy(RBE); P=.017). CONCLUSIONS: Orbit-sparing surgery for epithelial tumors of the orbit and ocular adnexa followed by proton therapy successfully achieved disease control and was well tolerated. No patient required orbital exenteration or enucleation. Chronic grade 3 toxicity was associated with high maximum dose to the cornea. An eye-deviation technique can be used to limit the maximum corneal dose to <35 Gy(RBE).
PURPOSE: Postoperative radiation is often indicated in the treatment of malignant epithelial tumors of the orbit and ocular adnexa. We present details of radiation technique and toxicity data after orbit-sparing surgery followed by adjuvant proton radiation therapy. METHODS AND MATERIALS: Twenty patients underwent orbit-sparing surgery followed by proton therapy for newly diagnosed malignant epithelial tumors of the lacrimal gland (n=7), lacrimal sac/nasolacrimal duct (n=10), or eyelid (n=3). Tumor characteristics, treatment details, and visual outcomes were obtained from medical records. Acute and chronic toxicity were prospectively scored using Common Terminology Criteria for Adverse Events version 4.0. RESULTS: The median radiation dose was 60 Gy(RBE) (relative biological effectiveness; [range 50-70 Gy]); 11 patients received concurrent chemotherapy. Dose to ipsilateral anterior optic structures was reduced in 13 patients by having them gaze away from the target during treatment. At a median follow-up time of 27.1 months (range 2.6-77.2 months), no patient had experienced local recurrence; 1 had regional and 1 had distant recurrence. Three patients developed chronic grade 3 epiphora, and 3 developed grade 3 exposure keratopathy. Four patients experienced a decrease in visual acuity from baseline but maintained vision sufficient to perform all activities of daily living without difficulty. Patients with grade ≥3 chronic ocular toxicity had higher maximum dose to the ipsilateral cornea (median 46.3 Gy[RBE], range 36.6-52.7 Gy[RBE] vs median 37.4 Gy[RBE], range 9.0-47.3 Gy(RBE); P=.017). CONCLUSIONS: Orbit-sparing surgery for epithelial tumors of the orbit and ocular adnexa followed by proton therapy successfully achieved disease control and was well tolerated. No patient required orbital exenteration or enucleation. Chronic grade 3 toxicity was associated with high maximum dose to the cornea. An eye-deviation technique can be used to limit the maximum corneal dose to <35 Gy(RBE).
Authors: Nicholas J Damico; Anna K Wu; Michael Z Kharouta; Tal Eitan; Rajesh Pidikiti; Frederick B Jesseph; Mark Smith; Christian Langmack; Diana L Mattson; Donald Dobbins; David B Mansur; Mitchell X Machtay; Jennifer A Dorth; Serah Choi; Min Yao; Aashish D Bhatt Journal: Int J Part Ther Date: 2021-03-26
Authors: G Brandon Gunn; Adam S Garden; Rong Ye; Noveen Ausat; Kristina R Dahlstrom; William H Morrison; C David Fuller; Jack Phan; Jay P Reddy; Shalin J Shah; Lauren L Mayo; Stephen G Chun; Gregory M Chronowski; Amy C Moreno; Jeffery N Myers; Ehab Y Hanna; Bita Esmaeli; Maura L Gillison; Renata Ferrarotto; Katherine A Hutcheson; Mark S Chambers; Lawrence E Ginsberg; Adel K El-Naggar; David I Rosenthal; Xiaorong Ronald Zhu; Steven J Frank Journal: Int J Part Ther Date: 2021-06-25
Authors: Robert H Press; Richard L Bakst; Sonam Sharma; Rafi Kabarriti; Madhur K Garg; Brian Yeh; Daphna Y Gelbum; Shaakir Hasan; J Isabelle Choi; Chris A Barker; Arpit M Chhabra; Charles B Simone; Nancy Y Lee Journal: Int J Part Ther Date: 2021-06-25