Quantification of Orbital and Mid-facial Growth Retardation after Megavoltage External Beam Irradiation in Children with Retinoblastoma

Imhof, Saskia M.; Mourits, Maarten P.; Hofman, P.; Zonneveld, Frans W.; Schipper, J.; Moll, Annette C.; Tan, K. E. W. P.

doi:10.1016/s0161-6420(96)30706-9

Cited by 102 publications

(51 citation statements)

References 30 publications

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“…Despite its documented ability to obtain local control, conventional EBRT causes orbital hypoplasia with poor cosmetic outcome, especially in children <6 months of age. 13,14 The most devastating long-term side effect of EBRT, however, remains the induction of a second malignancy (generally sarcomas). In patients with hereditary retinoblastoma, this risk has been reported to be as high as 51% at 50 years.…”

Section: Retinoblastomamentioning

confidence: 99%

Current status of radiotherapy with proton and light ion beams

Greco

Wolden

2007

Cancer

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Several model studies have shown potential clinical advantages with charged particles (protons and light ions) compared with 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) in many disease sites. The newly developed intensity-modulated proton therapy (IMPT) often yields superior dose distributions to photon IMRT, with the added advantage of a significant reduction in the volume of healthy normal tissues exposed to low-to-medium doses. Initially, the major emphasis in clinical research for proton and light ion therapy was dose escalation for inherently radioresistant tumors, or for lesions adjacent to critical normal structures that constrained the dose that could be safely delivered with conventional x-ray therapy. Since the advent of IMRT the interest in particle therapy has gradually shifted toward protocols aimed at morbidity reduction. Lately the emphasis has mostly been placed on the potential for reduced risk of radiation-induced carcinogenesis with protons. Compared with 3D-CRT, a 2-fold increase has been theoretically estimated with the use of IMRT due to the larger integral volumes. In the pediatric setting, due to a higher inherent susceptibility of tissues, the risk could be significant, and the benefits of protons have been strongly emphasized in the literature. There is a significant expansion of particle therapy facilities around the world. Increasing public awareness of the potential benefits of particle therapy and wider accessibility for patients require that treating physicians stay abreast of the clinical indications of this radiotherapy modality. The article reviews the available literature for various disease sites in which particle therapy has traditionally been considered to offer clinical advantages and to highlight current lines of clinical research. The issue of radiation-induced second malignancies is examined in the light of the controversial epidemiological evidence available. The cost-effectiveness of particle therapy is also discussed. Cancer 2007;109: 1227-38. 2007 American Cancer Society.KEYWORDS: radiotherapy, proton therapy, light ions, intensity modulated radiotherapy, second cancers. C harged particles (protons and light ions) have a finite range in tissues. The interaction probability to cause ionization increases as they lose velocity traversing through tissues, so that a peak of dose occurs at a depth proportional to the energy of each particle. Beyond this peak no further dose deposition occurs. This phenomenon was described by William Bragg over 100 years ago.1 The dose peak may be 'spread out' to achieve a plateau of uniform dose to precisely cover the target while sparing adjacent normal structures. Passively scattered beams of a certain aperture can be produced by means of range-shifting modulators of variable thickness providing spread-out Bragg peaks (SOBP) for clinical use. The recent introduction of the spot scanning method represents a major advance in particle therapy.2 In this method, small pencil beams of a certain

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Section: Retinoblastomamentioning

confidence: 99%

Current status of radiotherapy with proton and light ion beams

Greco

Wolden

2007

Cancer

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“…40 In the study by Oehmann et al 41 , the first growth spurts in the orbita was observed at ages between 6 and 8 years (25% increase in volume). Likewise, Imhof et al 30 reported more damage to the orbital growth in children younger than 6 months of age (p< 0.01).…”

Section: Orbital Growth Retardationmentioning

confidence: 86%

“…16 Factors associated with the severity of RT-induced abnormalities in bone growth include age, growth potential, total dose, dose per fraction, beam energy, treated site, and treatment volume. [28][29][30][31][32][33][34] The clinical literature suggests a steeper dose-effect relationship particularly with the doses ranging from 15 to 30 Gy. In children, treated to entire spine for medulloblastoma, acute lymphoblastic leukaemia, and Hodgkin's disease, Probert and Parker 35 showed growth arrest, which was strikingly noticeable in those receiving high doses (>35 Gy) of axial skeletal irradiation.…”

Section: Orbital Growth Retardationmentioning

confidence: 99%

Role and Alternative Modalities of External Beam Radiotherapy in the Management of Retinoblastoma

Pehlivan¹

2012

UHOD

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Retinoblastoma (RB) is the most common orbital tumor of childhood. Treatment strategy depends on number, loalization and extent of disease (unilateral vs bilateral) involvement. Currently, significant improvements in treatment and long survival rates have been achieved in management of this tumor group that mandates for search of more sophisticated novel treatment modalities to reduce the risks of treatment related side effects and secondary malignancies. In recent years, both the role and techniques of radiation therapy (RT) have significantly changed in parallel to the improvements in technology. Present review aims to discuss the current treatment modalities in RB, and the role and alternative techniques of RT in the light of recent literature.Keywords: Retinoblastoma, External beam radiotherapy, Toxicity, Chemotherapy, Secondary malignancy ÖZET Retinoblastoma Tedavisinde Eksternal Radyoterapinin Rolü ve Radyoterapi SeçenekleriRetinoblastoma (RB) çocukluk ça¤›n›n en s›k orbital tümörü olup hastal›¤›n tedavisi tümörün say›s›, büyüklü¤ü, lokalizasyonu ve tutulu göz say›s›na göre farkl›l›klar göstermektedir. Uzayan yaflam süresi ile belirginleflen radyoterapi (RT) ve/veya kemoterapiye ba¤-l› yan etkilerle ikincil tümör riskini en aza indirebilecek tedavi alternatiflerinin aranmas›n› zorunlu k›lm›flt›r. Di¤er tedavi seçeneklerinde elde edilen baflar›lar sonucu eksternal RT'nin tedavideki rolündeki de¤iflimin yan› s›ra, RT tekniklerinde de teknolojiye paralel ilerlemeler kaydedilmifltir. Dolay›s›yla güncel derlemede, RB tedavisinde kullan›lan de¤iflik tedavi seçenekleri ve özellikle RT'nin de¤iflen rolü ile tekniklerinin ayr›nt›l› olarak tart›fl›lmas› amaçlanm›flt›r.

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“…External-beam radiotherapy is considered a last-resort option because of its devastating local and systemic consequences, including cataract formation, ocular dryness, facial dysmorphism, and secondary cancers. 13 The success of intravenous chemotherapy…”

Section: -3mentioning

confidence: 99%