Radiation Cataract following Fractionated Radium Therapy in Childhood

Qvist, G. F.; Zachau-Christiansen, B

doi:10.1177/028418515905100306

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…In agreement, Quist and Zachau-Christiansen7 found, in their follow up of cases treated 20–30 years earlier with radium therapy during childhood, that the radiation cataract as a rule does not essentially impair vision. In their investigation they point out that a relatively high number had an ametropia exceeding +2D.…”

Section: Discussionsupporting

confidence: 65%

A clinical study of radiation cataract formation in adult life following gamma irradiation of the lens in early childhood

Wilde

Sjöstrand

1997

British Journal of Ophthalmology

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Aims-To analyse long term eVects on the lens of radium irradiation during infancy. Methods-An infant cohort (n = 20, median age 6 months) treated for skin haemangioma with one or two radium-226 needles located at or within the orbital rim was examined 30 to 45 years after radiation. Detailed information about the treatment procedure was available for all cases. Subcapsular opacities were graded semiquantitatively according to a scale based on extent and density of the opacities. Results-A high prevalence of light to moderate posterior, subcapsular, and cortical cataract formation was found in the lenses on the treated side irradiated with a mean dose ranging from approximately 1 to 8 Gy. The cataract formation increased as a function of dose. The presence of subcapsular punctate opacities and vacuoles in the lenses on the untreated side receiving irradiation of an estimated dose varying around 0.1 Gy indicates a higher sensitivity than expected. Conclusion-The growing lens during infancy is sensitive to radium irradiation at doses lower than those previously stated. The eye lens seems suitable for studies of eVects of low dose radiation since damaged cells are retained in the lens for a lifetime. (Br J Ophthalmol 1997;81:261-266) Ocular complications are encountered following ionising radiation on the eye.1 The lens has a relatively high radiosensitivity and a major ocular complication associated with irradiation is posterior subcapsular cataract formation.

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Section: Discussionsupporting

confidence: 65%

A clinical study of radiation cataract formation in adult life following gamma irradiation of the lens in early childhood

Wilde

Sjöstrand

1997

British Journal of Ophthalmology

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“…Treatments Cogan and Dreisler (1953) 40 15-70 7 (1-14) 0.23-24 1-n 5 cataracts, none <5 Gy Small case series, short follow-up Merriam and Focht (1957) 100 0.9-84 5-9 0.25-69 1-n All cataracts >2 Gy or fractions >5 Gy Clinical series, n = 33 at <200 rad, short followup Qvist and Zachau-Christiansen (1959) 56…”

Section: Authormentioning

confidence: 99%

ICRP PUBLICATION 118: ICRP Statement on Tissue Reactions and Early and Late Effects of Radiation in Normal Tissues and Organs — Threshold Doses for Tissue Reactions in a Radiation Protection Context

Stewart¹,

Akleyev²,

et al. 2012

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This report provides a review of early and late effects of radiation in normal tissues and organs with respect to radiation protection. It was instigated following a recommendation in Publication 103 (ICRP, 2007), and it provides updated estimates of 'practical' threshold doses for tissue injury defined at the level of 1% incidence. Estimates are given for morbidity and mortality endpoints in all organ systems following acute, fractionated, or chronic exposure. The organ systems comprise the haematopoietic, immune, reproductive, circulatory, respiratory, musculoskeletal, endocrine, and nervous systems; the digestive and urinary tracts; the skin; and the eye. Particular attention is paid to circulatory disease and cataracts because of recent evidence of higher incidences of injury than expected after lower doses; hence, threshold doses appear to be lower than previously considered. This is largely because of the increasing incidences with increasing times after exposure. In the context of protection, it is the threshold doses for very long follow-up times that are the most relevant for workers and the public; for example, the atomic bomb survivors with 40-50years of follow-up. Radiotherapy data generally apply for shorter follow-up times because of competing causes of death in cancer patients, and hence the risks of radiation-induced circulatory disease at those earlier times are lower. A variety of biological response modifiers have been used to help reduce late reactions in many tissues. These include antioxidants, radical scavengers, inhibitors of apoptosis, anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, growth factors, and cytokines. In many cases, these give dose modification factors of 1.1-1.2, and in a few cases 1.5-2, indicating the potential for increasing threshold doses in known exposure cases. In contrast, there are agents that enhance radiation responses, notably other cytotoxic agents such as antimetabolites, alkylating agents, anti-angiogenic drugs, and antibiotics, as well as genetic and comorbidity factors. Most tissues show a sparing effect of dose fractionation, so that total doses for a given endpoint are higher if the dose is fractionated rather than when given as a single dose. However, for reactions manifesting very late after low total doses, particularly for cataracts and circulatory disease, it appears that the rate of dose delivery does not modify the low incidence. This implies that the injury in these cases and at these low dose levels is caused by single-hit irreparable-type events. For these two tissues, a threshold dose of 0.5Gy is proposed herein for practical purposes, irrespective of the rate of dose delivery, and future studies may elucidate this judgement further.

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“…Several of the early cataract studies were specifically associated with RT (Cogan and Dreisler, 1953;Merriam and Focht, 1957;Qvist and Zachauchristiansen, 1959), with a wide range of ages (infants to 84 years), time to follow-up (1-40 years), and doses (0.23-69 Gy). Most were small case series or had short follow-up.…”

Section: Ocular Effects In Radiotherapymentioning

confidence: 99%

Radiotherapeutic implications of the updated ICRP thresholds for tissue reactions related to cataracts and circulatory diseases

et al. 2018

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Radiation therapy of cancer patients involves a trade-off between a sufficient tumour dose for a high probability of local control and dose to organs at risk that is low enough to lead to a clinically acceptable probability of toxicity. The International Commission on Radiological Protection (ICRP) reviewed epidemiological evidence and provided updated estimates of 'practical' threshold doses for tissue injury, as defined at the level of 1% incidence, in ICRP Publication 118. Particular attention was paid to cataracts and circulatory diseases. ICRP recommended nominal absorbed dose threshold for these outcomes as low as 0.5 Gy. Threshold doses for tissue reactions can be reached in some patients during radiation therapy. Modern treatment planning systems do not account for such low doses accurately, and doses to therapy patients from associated imaging procedures are not generally accounted for. While local control is paramount, the observations of ICRP Publication 118 suggest that radiation therapy plans and processes should be examined with particular care. The research needs are discussed in this paper.

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Radiation Cataract following Fractionated Radium Therapy in Childhood

Cited by 5 publications

References 6 publications

A clinical study of radiation cataract formation in adult life following gamma irradiation of the lens in early childhood

A clinical study of radiation cataract formation in adult life following gamma irradiation of the lens in early childhood

ICRP PUBLICATION 118: ICRP Statement on Tissue Reactions and Early and Late Effects of Radiation in Normal Tissues and Organs — Threshold Doses for Tissue Reactions in a Radiation Protection Context

Radiotherapeutic implications of the updated ICRP thresholds for tissue reactions related to cataracts and circulatory diseases

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