Predictive factors of radio‐induced complications in 194 eyes undergoing gamma knife radiosurgery for uveal melanoma

Abstract

Background and purpose: To report the factors predictive of radio-induced complications (i.e. radiation retinopathy [RR], radiation papillopathy [RP] and neovascular glaucoma [NVG]) in uveal melanoma (UM) patients undergoing gamma knife radiosurgery (GKR). Materials and methods: Longitudinal cohort study on patients with UM treated at

Ocular leukemic mass‐like relapse treated with CyberKnife stereotactic radiosurgery

“…The risk of radio-induced complications, potentially leading to irreversible visual loss, should be anticipated in patients undergoing ocular radiotherapy. Our patient experienced visual loss (from hand motion to no light perception) after SRT; previous reports have reported the considerable risk of visual loss for tumour lesions close to the optic nerve after SRT (Gigliotti et al 2018;Cicinelli et al 2021).…”

Ocular Complications of Radiotherapy in Uveal Melanoma

“…The reported incidence and risk factors for some of the most important complications are summarized in Tables 1 and 2, respectively. --increased tumor thickness [33] Neovascular glaucoma -LBD > 15 mm -TNM class T3 and T4 [28] -increased tumor height [29] -proximity to the papilla [34] -increased tumor thickness >7.4 mm [6]/> 8.7 mm [35] -less pigmented UM -Bruch's membrane rupture -the volume of the posterior pole receiving > 20 Gy -peripapillary location -anteriorly located tumor [4] Radiation retinopathy -increased radiation dose to tumor apex [27] -increased tumor thickness -tumor location -higher radiation dose -younger age [26,29] -tumor less than 2.5 mm from macula -increased tumor thickness [36] -tumor located in the macular region -reduced distance between tumor and optic disc -radiation dose > 14.9 Gy -diabetes mellitus -younger age [6,35,37] Radiation maculopathy -mushroom-like shape -increased tumor height and volume -distance between tumor margin and fovea < 2 mm -radiation dose to fovea >50 Gy -subretinal fluid -diabetes mellitus [27,28,38] -tumor height > 4 mm -increased LBD -radiation dose to macula > 90 Gy -proximity of tumor to foveola -male gender -younger age [26,29] -tumor proximity to fovea -high radiation dose to fovea [36] Table 2. Cont.…”

“…Optic neuropathy -distance between tumor and disc < 1.5 mm/1 DD -increased LBD [27,28] -dose to optic nerve > 55 Gy -distance between tumor and optic disc < 4 mm -increased LBD -ciliary body involvement [21,29] -tumor proximity to papilla -high radiation dose to the optic disc [36] -tumor close to the papilla -high radiation dose to the optic nerve -distance of the optic nerve from the prescription isodose [6,35] DD = disc diameter; I = iodine; Gy = Gray; IOP = intraocular pressure; LBD = largest basal diameter (of the tumor); PBT = proton beam therapy; Ru = ruthenium; SRS = stereotactic radiosurgery.…”

“…All types of radiotherapy, if used as indicated, achieve good local tumor control and eye preservation rates [3][4][5]. However, the incidence of radiation-related complications is elevated, estimated to be between 61 and 78% [6,7]. Some complications lead to significant ocular morbidity, visual loss, and, in some cases, even secondary enucleation.…”

Non-Cancer Effects following Ionizing Irradiation Involving the Eye and Orbit

“…The main risk factor for developing RION is the localization of the tumor near the optic nerve, increasing the surface and the dose given to optic fibers ( Figure 4 ) [ 75 , 76 ]. Other risk factors include younger age, male sex [ 77 , 78 ], and diabetes [ 79 ]. The use of concurrent chemotherapy (infrequent in the management of ocular tumors) is also associated with a higher risk of RION, although chemotherapeutic drugs may themselves be associated with optic nerve toxicity [ 67 , 80 ].…”