Ocular Risks From Orbital and Periorbital Radiation Therapy: A Critical Review

Jeganathan, V Swetha E; Wirth, Andrew; MacManus, Michael

doi:10.1016/j.ijrobp.2010.09.056

Cited by 121 publications

(118 citation statements)

References 53 publications

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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%

“…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]. In extreme cases, enucleation is necessary, which is both cosmetically disfiguring and causes a significant loss of function [8].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Meanwhile, in the cohort of bulky carcinomas, local adverse effects to be evaluated included necrosis, fistula formation, scarring and cheloids, and distant adverse effects included tumor lysis syndrome and thromboembolism 16, 17, 18, 19, 20, 21. Although late toxicities have been described for radiation therapy, this issue has not been clarified to date for ECT both in human and veterinary oncology, especially because limited information is available regarding possible damage inflicted by electric pulses to different ocular regions 22, 24. One concern when working with ECT is the involuntary induction of cardiac arrhythmia and this concern warrants cardiac monitoring during ECT treatment 25.…”

Section: Methodsmentioning

confidence: 99%

Electroporation Enhances Bleomycin Efficacy in Cats with Periocular Carcinoma and Advanced Squamous Cell Carcinoma of the Head

Spugnini¹,

Pizzuto²,

Filipponi

et al. 2015

Veterinary Internal Medicne

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BackgroundAdvanced carcinoma of the head represents a substantial health problem in cats for local control and overall survival.ObjectivesEvaluate the capability of electrochemotherapy (ECT) to improve bleomycin efficacy in cats with periocular carcinoma and advanced carcinoma of the head.AnimalsTwenty‐one cats with periocular carcinoma (17 squamous cell carcinoma [SCC] and 4 anaplastic carcinoma) and 26 cats with advanced SCC of the head.MethodsNonrandomized prospective controlled study. Periocular carcinoma cohorts: 12 cats were treated with bleomycin (15 mg/m2 IV) coupled with ECT under anesthesia; 9 cats were treated with bleomycin alone. Advanced head SCC cohorts: 14 cats were treated with bleomycin (15 mg/m2 IV) coupled with ECT administered under sedation; 12 control cats were treated with bleomycin alone. ECT treatments (2–8) were performed every other week until complete remission (CR) or tumor progression occurred.ResultsToxicities were minimal and mostly treated symptomatically. Overall response rate in the ECT treated animals was 89% (21 Complete Response [CR] and 2 Partial Response [PR]) whereas controls had response rate of 33% (4 CR and 3 PR). Median time to progression in ECT group was 30.5 months, whereas in controls it was 3.9 months (P < .0001). Median time to progression for ECT cohorts was 24.2 months for periocular cohort and 20.6 in advanced head SCC cohort, respectively.ConclusionsElectrochemotherapy is well tolerated for advanced SCC of the head in cats; its use may be considered among loco‐regional strategies for cancer therapy in sensitive body regions such as periocular region.

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“…Emami et al (2) estimated that there is a 5% and 50% risk of cataract formation at five years from 10 and 18 Gy considering dose incident on the lens of the eye. Alternate studies have proposed deterministic threshold doses of as low as 2 Gy acute doses and 4 Gy conventionally fractionated doses with further estimates that onset of cataract formation may occur after only 0.5 Gy suggesting a linear, no‐threshold complication model with a time to onset that is dose‐related 3 , 4 , 5 , 6 . As such, sparing of the lens during treatment is an important objective when preparing a patient's radiotherapy plan.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of lens dose from anterior electron beams: comparison of Pinnacle and Gafchromic EBT3 film

Sonier

Wronski

Yeboah

2015

J Applied Clin Med Phys

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Lens dose is a concern during the treatment of facial lesions with anterior electron beams. Lead shielding is routinely employed to reduce lens dose and minimize late complications. The purpose of this work is twofold: 1) to measure dose profiles under large‐area lead shielding at the lens depth for clinical electron energies via film dosimetry; and 2) to assess the accuracy of the Pinnacle treatment planning system in calculating doses under lead shields. First, to simulate the clinical geometry, EBT3 film and 4 cm wide lead shields were incorporated into a Solid Water phantom. With the lead shield inside the phantom, the film was positioned at a depth of 0.7 cm below the lead, while a variable thickness of solid water, simulating bolus, was placed on top. This geometry was reproduced in Pinnacle to calculate dose profiles using the pencil beam electron algorithm. The measured and calculated dose profiles were normalized to the central‐axis dose maximum in a homogeneous phantom with no lead shielding. The resulting measured profiles, functions of bolus thickness and incident electron energy, can be used to estimate the lens dose under various clinical scenarios. These profiles showed a minimum lead margin of 0.5 cm beyond the lens boundary is required to shield the lens to ≤10% of the dose maximum. Comparisons with Pinnacle showed a consistent overestimation of dose under the lead shield with discrepancies of ∼25% occurring near the shield edge. This discrepancy was found to increase with electron energy and bolus thickness and decrease with distance from the lead edge. Thus, the Pinnacle electron algorithm is not recommended for estimating lens dose in this situation. The film measurements, however, allow for a reasonable estimate of lens dose from electron beams and for clinicians to assess the lead margin required to reduce the lens dose to an acceptable level.PACS number(s): 87.53.Bn, 87.53.Kn, 87.55.‐x, 87.55.D‐

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Ocular Risks From Orbital and Periorbital Radiation Therapy: A Critical Review

Cited by 121 publications

References 53 publications

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

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

Electroporation Enhances Bleomycin Efficacy in Cats with Periocular Carcinoma and Advanced Squamous Cell Carcinoma of the Head

Evaluation of lens dose from anterior electron beams: comparison of Pinnacle and Gafchromic EBT3 film

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