Puyao C Li1, Norbert J Liebsch2, Andrzej Niemierko3, Drosoula Giantsoudi4, Simmons Lessell5, Barbara C Fullerton6, Judith Adams7, Helen A Shih8. 1. Massachusetts General Hospital, Boston, USA. Electronic address: pcli@partners.org. 2. Massachusetts General Hospital, Boston, USA. Electronic address: nliebsch@mgh.harvard.edu. 3. Massachusetts General Hospital, Boston, USA. Electronic address: aniemierko@mgh.harvard.edu. 4. Massachusetts General Hospital, Boston, USA. Electronic address: dgiantsoudi@mgh.harvard.edu. 5. Massachusetts Eye and Ear Infirmary, Boston, USA. 6. Massachusetts General Hospital, Boston, USA. Electronic address: bfullerton@mgh.harvard.edu. 7. Massachusetts General Hospital, Boston, USA. Electronic address: jadams3@mgh.harvard.edu. 8. Massachusetts General Hospital, Boston, USA. Electronic address: hshih@mgh.harvard.edu.
Abstract
INTRODUCTION: Radiation-induced optic neuropathy (RION) is a complication of radiation therapy (RT) that causes blindness. We aimed to define the tolerance of the anterior optic pathway to fractionated RT and identify risk factors for RION. MATERIALS/ METHODS: Patients with chordoma or chondrosarcoma of the skull base treated with proton and photon therapy between 1983 and 2013, who received a minimum of 30 Gy (relative biologic effectiveness [RBE]) to the anterior optic pathway were assessed. Optic neuropathy with radiographic correlation occurring ≥6 months after completion of RT in the absence of tumor recurrence or other probable cause was diagnosed as RION. RESULTS: Of 514 patients, 17 developed RION. With median follow-up of 4.8 years, cumulative incidence of RION was 1% among patients receiving <59 Gy (RBE) and 5.8% among patients receiving ≥60 Gy (RBE) to the optic pathway. Higher maximum point dose to the optic pathway (subhazard ratio [SHR] = 1.2, 95% CI 1.05-1.2, p = 0.001), older age (SHR = 1.1, 95% CI 1.02-1.08, p < 0.0005), and female sex (SHR = 16.3, 95% CI 2.2-122.4, p = 0.007) were statistically significant risk factors for RION in multivariate analysis. CONCLUSION: In our study cohort, rates of RION were very low with conventionally fractionated RT up to 59 Gy. At doses ≥60 Gy, there is an increased risk of RION, with greater risk for women and older patients.
INTRODUCTION: Radiation-induced optic neuropathy (RION) is a complication of radiation therapy (RT) that causes blindness. We aimed to define the tolerance of the anterior optic pathway to fractionated RT and identify risk factors for RION. MATERIALS/ METHODS:Patients with chordoma or chondrosarcoma of the skull base treated with proton and photon therapy between 1983 and 2013, who received a minimum of 30 Gy (relative biologic effectiveness [RBE]) to the anterior optic pathway were assessed. Optic neuropathy with radiographic correlation occurring ≥6 months after completion of RT in the absence of tumor recurrence or other probable cause was diagnosed as RION. RESULTS: Of 514 patients, 17 developed RION. With median follow-up of 4.8 years, cumulative incidence of RION was 1% among patients receiving <59 Gy (RBE) and 5.8% among patients receiving ≥60 Gy (RBE) to the optic pathway. Higher maximum point dose to the optic pathway (subhazard ratio [SHR] = 1.2, 95% CI 1.05-1.2, p = 0.001), older age (SHR = 1.1, 95% CI 1.02-1.08, p < 0.0005), and female sex (SHR = 16.3, 95% CI 2.2-122.4, p = 0.007) were statistically significant risk factors for RION in multivariate analysis. CONCLUSION: In our study cohort, rates of RION were very low with conventionally fractionated RT up to 59 Gy. At doses ≥60 Gy, there is an increased risk of RION, with greater risk for women and older patients.
Authors: J Jacob; L Feuvret; J-M Simon; M Ribeiro; L Nichelli; C Jenny; D Ricard; D Psimaras; K Hoang-Xuan; P Maingon Journal: Neurol Sci Date: 2022-02-11 Impact factor: 3.307
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