A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery

Stafford, Scott L.; Pollock, Bruce E.; Leavitt, Jacqueline A.; Foote, Robert L.; Brown, Paul D.; Link, Michael J.; Gorman, Deborah A.; Schomberg, Paula J.

doi:10.1016/s0360-3016(02)04380-8

Cited by 330 publications

(131 citation statements)

References 30 publications

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“…42, 49 Girkin, et al, 15 reported four cases of RON following SRS, two of which occurred in patients treated for pituitary adenoma, of 2400 radiosurgical cases; it is unclear how many patients in the treatment group had pituitary tumors. Three of the four patients received more than 8 Gy to the anterior optic apparatus, prompting the authors to agree with previous reports that the optic nerves and chiasm can tolerate a maximal radiation dose of 8 Gy, 15,31,52 although others have reported safe doses in the range of 10 to 12 Gy.…”

Section: Complications Of Srsmentioning

confidence: 99%

“…Three of the four patients received more than 8 Gy to the anterior optic apparatus, prompting the authors to agree with previous reports that the optic nerves and chiasm can tolerate a maximal radiation dose of 8 Gy, 15,31,52 although others have reported safe doses in the range of 10 to 12 Gy. 26,34,36,49 Other risk factors for the development of RON include previous radiation therapy, 10 pretherapy visual loss, 25 tumor size greater than 10 mm, 12,50 and isocenters within 5 mm of the visual pathways. 50 Stafford, et al, 49 have estimated that the incidence of RON following SRS is 1.7% if the dose to the chiasm is less than 8 Gy, 1.8% if it is between 8 and 10 Gy, and 6.9% if it is greater than 12 Gy.…”

Section: Complications Of Srsmentioning

confidence: 99%

“…26,34,36,49 Other risk factors for the development of RON include previous radiation therapy, 10 pretherapy visual loss, 25 tumor size greater than 10 mm, 12,50 and isocenters within 5 mm of the visual pathways. 50 Stafford, et al, 49 have estimated that the incidence of RON following SRS is 1.7% if the dose to the chiasm is less than 8 Gy, 1.8% if it is between 8 and 10 Gy, and 6.9% if it is greater than 12 Gy. The proximity of the optic chiasm to the tumor is not an issue in radiosurgical planning, because the typical microadenoma of Cushing disease is well separated from the optic chiasm.…”

Section: Complications Of Srsmentioning

confidence: 99%

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Stereotactic radiosurgery for Cushing disease

Hentschel¹,

McCutcheon²

2004

FOC

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The most common cause of Cushing syndrome is Cushing disease, in which hypercortisolism is produced by a functional adrenocorticotropic hormone–producing adenoma of the anterior pituitary gland. The common therapies available include microsurgical resection, conventional fractionated radiotherapy, and stereotactic radiosurgery (SRS). In this article the authors review the indications, results, and complications associated with SRS in the treatment of Cushing disease. In as many as 90% of patients SRS results in disease remission, which is defined as a normal 24-hour urinary free cortisol level and a normal or subnormal morning serum cortisol level. Although in most patients who are subsequently cured a marked decrease in the serum cortisol level is demonstrated within 3 months after treatment, a biochemical cure may be delayed up to 3 years in some cases. Complications following SRS for pituitary adenomas are uncommon, particularly in patients with microadenomas, which are most commonly seen in Cushing disease. The most common complication is hypopituitarism, which occurs in up to 50% of patients with a mean latency period of 5 years. Radiation-induced optic neuropathy has been reported in less than 2% of cases and induction of a secondary neoplasm in less than 1% of cases. For patients with Cushing disease, the rate of endocrinological cure following SRS appears to be similar to that attained using microsurgical resection. In contrast to surgery, SRS has the benefit of being noninvasive and associated with a very low incidence of diabetes insipidus, although hypopituitarism may be more common with SRS. With continued follow-up patient reviews and additional experience with SRS, it may become possible to make more definitive statements regarding SRS as the initial treatment for patients with Cushing disease.

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Section: Complications Of Srsmentioning

confidence: 99%

Section: Complications Of Srsmentioning

confidence: 99%

Section: Complications Of Srsmentioning

confidence: 99%

See 1 more Smart Citation

Stereotactic radiosurgery for Cushing disease

Hentschel¹,

McCutcheon²

2004

FOC

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“…1) are usually characterized by 5yr actuarial tumor control rates (87%-96%) much higher than those with atypic (49%-77%) or anaplastic (0%-19%) lesions (21,24,37,49,63,73,77). As shown in (TABLE 4), the still limited number of reports with a mean follow up period of 7-10 years have consistently confirmed these differential LTC levels (3,15,41,63,70) Table 4.…”

Section: Gamma Knife Radiosurgerymentioning

confidence: 70%

“…(6,20,22,56,72,83,86) However, recent reports have emphasized the extremely high chances to maintain adequate LTC rates -without increasing side effects-by treating larger meningiomas with either fractionated schedules or reduced dosages (3,13,18,19,22,24,31,32). b. the controversial or disappointing results obtained in atypic and anaplastic lesions (17,25,27,30,51,73), sometimes characterized by intra-or extraneuraxis metastatization (17) or by enhanced growth after radiosurgery (6,14,42); c. the still pronounced morbidity rate of this technique on sensory nerves (6,14,77). d. finally, potential problems with undue hotspots on strategic vessels within the dosimetry area (1,15).…”

Section: Anaplastic (Gr 3) Meningiomamentioning

confidence: 99%