Ophthalmic and adnexal complications of radiotherapy

Durkin, Shane R.; Roos, Daniel; Higgs, Braden; Casson, Robert J.; Selva, Dinesh

doi:10.1111/j.1600-0420.2006.00822.x

Cited by 133 publications

(79 citation statements)

References 114 publications

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“…7 Tear film instability and dysfunction may lead to a temporary keratitis, often seen as punctate epithelial erosions. 8 However, in our experience, dry eye after I-125 brachytherapy is not more frequent than other procedures that involve alteration of the conjunctiva, such as scleral buckling. This may be due to the often posterior position of the plaque.…”

Section: Radiation-induced Dry Eye and Keratitismentioning

confidence: 98%

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Ocular complications following I-125 brachytherapy for choroidal melanoma

Wen

Oliver

McCannel

2009

Eye

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Uveal melanoma has traditionally been treated with enucleation, plaque brachytherapy, or external beam radiation. Following the results of the multicenter Collaborative Ocular Melanoma Study (COMS), which established no significant difference in mortality rates between enucleation and brachytherapy, plaque brachytherapy has become the favoured modality given its potential for preservation of vision and the eye. Among the radioisotopes that have been used, iodine-125 (I-125) has become the increasingly popular choice in the United States. However, I-125 brachytherapy is associated with complications, including keratitis, iris neovascularization, neovascular glaucoma, radiation retinopathy, and optic neuropathy. The purpose of this review is to discuss the pathogenesis, clinical presentation, and management of complications related to I-125 plaque brachytherapy for choroidal melanoma.

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Section: Radiation-induced Dry Eye and Keratitismentioning

confidence: 98%

“…Symptomatic treatment is recommended and includes topical lubricants and lacrimal punctual occlusion. 8 …”

Section: Radiation-induced Dry Eye and Keratitismentioning

confidence: 99%

Ocular complications following I-125 brachytherapy for choroidal melanoma

Wen

Oliver

McCannel

2009

Eye

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“…The incidence of these complications has been shown to increase with higher doses to the lacrimal gland, especially above a threshold level, and can be significant. Dry eye syndrome can be chronically painful and lead to corneal vascularisation and opacification, keratoconjunctivitis sicca and, ultimately, visual loss [3,17,18]. Treatment is largely conservative, and options include topical lubricants, moist chamber goggles, cautery to retain tears, and tarsorrhaphy, all of which are inconvenient to the patient, often only providing partial relief, and can have negative cosmetic outcomes [18].…”

Section: Discussionmentioning

confidence: 99%

Clinical-dosimetric relationship between lacrimal gland dose and ocular toxicity after intensity-modulated radiotherapy for sinonasal tumours

Batth

Sreeraman

Dienes

et al. 2013

BJR

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ME, Cui J, et al. Clinical-dosimetric Objective: To characterise the relationship between lacrimal gland dose and ocular toxicity among patients treated by intensity-modulated radiotherapy (IMRT) for sinonasal tumours. Methods: 40 patients with cancers involving the nasal cavity and paranasal sinuses were treated with IMRT to a median dose of 66.0 Gy. Toxicity was scored using the Radiation Therapy Oncology Group morbidity criteria based on conjunctivitis, corneal ulceration and keratitis. The paired lacrimal glands were contoured as organs at risk, and the mean dose, maximum dose, V 10 , V 20 and V 30 were determined. Statistical analysis was performed using logistic regression and the Akaike information criterion (AIC). Results:The maximum and mean dose to the ipsilateral lacrimal gland were 19.2 Gy (range, 1.4-75.4 Gy) and 14.5 Gy (range, 11.1-67.8 Gy), respectively. The mean V 10 , V 20 and V 30 values were 50%, 25% and 17%, respectively. The incidence of acute and late Grade 31 toxicities was 23% and 19%, respectively. Based on logistic regression and AIC, the maximum dose to the ipsilateral lacrimal gland was identified as a more significant predictor of acute toxicity (AIC, 53.89) and late toxicity (AIC, 32.94) than the mean dose (AIC, 56.13 and 33.83, respectively). The V 20 was identified as the most significant predictor of late toxicity (AIC, 26.81). Conclusion: A dose-response relationship between maximum dose to the lacrimal gland and ocular toxicity was established. Our data suggesting a threshold relationship may be useful in establishing dosimetric guidelines for IMRT planning that may decrease the risk of acute and late lacrimal toxicities in the future. Advances in knowledge: A threshold relationship between radiation dose to the lacrimal gland and ocular toxicity was demonstrated, which may aid in treatment planning and reducing the morbidity of radiotherapy for sinonasal tumours.

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“…If treatment of the 6.5-mm tumor with the CCB plaque were accepted with a dose to the sclera of 1,787 Gy, the entire tumor volume would receive the minimum prescribed dose of 100 Gy, but 40% of the tumor volume would absorb doses ranging from 1,000 to 1,500 Gy, with sight-threatening doses being delivered to the lens, optic disc and cornea (fig. 1b) [36,37,38,39]. The optic nerve would also receive a dose similar to that to the optic disc, whereas the lacrimal gland would receive a tolerable dose of only 3 Gy.…”

Section: Resultsmentioning

confidence: 99%

“…The cumulative dose-volume histograms of the lens, optic disc and cornea (fig. 2b) for a tumor 7 mm in apical height also reveal excessive doses to these structures at risk [35,36,37,38]. …”

Section: Resultsmentioning

confidence: 99%

Monte Carlo Simulation of the Treatment of Eye Tumors with <sup>106</sup>Ru Plaques: A Study on Maximum Tumor Height and Eccentric Placement

2014

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Background/Aims: Ruthenium plaques are used for the treatment of ocular tumors. There is, however, a controversy regarding the maximum treatable tumor height. Some advocate eccentric plaque placement, without a posterior safety margin, to avoid collateral damage to the fovea and optic disc, but this has raised concerns about marginal tumor recurrence. There is a need for quantitative information on the spatial absorbed dose distribution in the tumor and adjacent tissues. We have overcome this obstacle using an approach based on Monte Carlo simulation of radiation transport. Methods: CCA and CCB ¹⁰⁶Ru plaques were modeled and their geometry embedded in a computerized tomography scan of the eye of a patient. Different tumor sizes and locations were simulated with the general-purpose Monte Carlo code PENELOPE. Results: Cumulative dose-volume histograms were obtained for the tumors and the tissues at risk considered. Plots of isodose lines for both plaques were obtained in a computerized tomography study. Conclusions: Ruthenium eye plaques are an adequate treatment option for tumors up to around 5 mm in height. According to our results, assuming a correct placement of the plaque, a tumor of 6.5 mm apical height is about the maximum size that can be treated safely with the large CCB plaque.

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Ophthalmic and adnexal complications of radiotherapy

Cited by 133 publications

References 114 publications

Ocular complications following I-125 brachytherapy for choroidal melanoma

Ocular complications following I-125 brachytherapy for choroidal melanoma

Clinical-dosimetric relationship between lacrimal gland dose and ocular toxicity after intensity-modulated radiotherapy for sinonasal tumours

Monte Carlo Simulation of the Treatment of Eye Tumors with <sup>106</sup>Ru Plaques: A Study on Maximum Tumor Height and Eccentric Placement

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