Radiation Optic Neuropathy and Retinopathy with Low Dose (20 Gy) Radiation Treatment

Overview

Journal Am J Ophthalmol Case Rep

Specialty Ophthalmology

Date 2018 Mar 6

PMID 29503909

Citations 3

Authors

Crandall E Peeler

Dean M Cestari

Affiliations

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Abstract

Purpose: To report a case of optic neuropathy and retinopathy from a dose of radiation traditionally thought to be safe to the visual system and discuss strategies for preventing vision loss when using radiation to treat intraocular tumors.

Observations: A 44-year-old woman presented with new, painless vision loss in the left eye eighteen months after receiving proton beam radiotherapy (20 Gy dose delivered in two 10 Gy fractions) for a uveal metastasis of lung cancer. The dilated funduscopic examination revealed optic disc swelling and retinal hemorrhages and an MRI of the brain and orbits demonstrated enhancement of the left optic nerve head, findings consistent with radiation optic neuropathy (RON) and retinopathy. Risk factors for developing RON included coincident use of oral chemotherapy and relatively large fractionated doses of radiation.

Conclusions And Importance: Though cumulative radiation doses to the anterior visual pathway of less than 50 Gy are traditionally felt to be safe, it is important to consider not just the total exposure but also the size of individual fractions. The single-dose threshold for RON in proton beam treatment has yet to be defined. Our case suggests that fractions of less than 10 Gy should be delivered to minimize the risk of optic nerve injury.

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References

Kramer S . The hazards of therapeutic iradiation of the central nervous system. Clin Neurosurg. 1968; 15:301-18. DOI: 10.1093/neurosurgery/15.cn_suppl_1.301. View

Ove R, Kelman S, Amin P, Chin L . Preservation of visual fields after peri-sellar gamma-knife radiosurgery. Int J Cancer. 2001; 90(6):343-50. DOI: 10.1002/1097-0215(20001220)90:6<343::aid-ijc6>3.0.co;2-h. View

Gragoudas E, Li W, Lane A, Munzenrider J, Egan K . Risk factors for radiation maculopathy and papillopathy after intraocular irradiation. Ophthalmology. 1999; 106(8):1571-7; discussion 1577-8. DOI: 10.1016/S0161-6420(99)90455-4. View

Leber K, Bergloff J, Pendl G . Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg. 1998; 88(1):43-50. DOI: 10.3171/jns.1998.88.1.0043. View

Levin L, Gragoudas E, Lessell S . Endothelial cell loss in irradiated optic nerves. Ophthalmology. 2000; 107(2):370-4. DOI: 10.1016/s0161-6420(99)00054-8. View

Jiang G, Tucker S, Guttenberger R, Peters L, Morrison W, Garden A . Radiation-induced injury to the visual pathway. Radiother Oncol. 1994; 30(1):17-25. DOI: 10.1016/0167-8140(94)90005-1. View

Pollock B, Link M, Leavitt J, Stafford S . Dose-volume analysis of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Neurosurgery. 2014; 75(4):456-60. DOI: 10.1227/NEU.0000000000000457. View

Aristizabal S, CALDWELL W, Avila J . The relationship of time-dose fractionation factors to complications in the treatment of pituitary tumors by irradiation. Int J Radiat Oncol Biol Phys. 1977; 2(7-8):667-73. DOI: 10.1016/0360-3016(77)90046-3. View

Ross H, Rosenberg S, Friedman A . Delayed radiation necrosis of the optic nerve. Am J Ophthalmol. 1973; 76(5):683-6. DOI: 10.1016/0002-9394(73)90563-1. View

10.

Riechardt A, Cordini D, Willerding G, Georgieva I, Weber A, Seibel I . Proton beam therapy of parapapillary choroidal melanoma. Am J Ophthalmol. 2014; 157(6):1258-65. DOI: 10.1016/j.ajo.2014.02.032. View

11.

Omary R, Berr S, KAMIRYO T, Lanzino G, Kassell N, Lee K . 1995 AUR Memorial Award. Gamma knife irradiation-induced changes in the normal rat brain studied with 1H magnetic resonance spectroscopy and imaging. Acad Radiol. 1995; 2(12):1043-51. DOI: 10.1016/s1076-6332(05)80511-2. View

12.

Lessell S . Friendly fire: neurogenic visual loss from radiation therapy. J Neuroophthalmol. 2004; 24(3):243-50. DOI: 10.1097/00041327-200409000-00014. View

13.

Leavitt J, Stafford S, Link M, Pollock B . Long-term evaluation of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2013; 87(3):524-7. DOI: 10.1016/j.ijrobp.2013.06.2047. View

14.

Danesh-Meyer H . Radiation-induced optic neuropathy. J Clin Neurosci. 2007; 15(2):95-100. DOI: 10.1016/j.jocn.2007.09.004. View

15.

Girkin C, Comey C, Lunsford L, Goodman M, KLINE L . Radiation optic neuropathy after stereotactic radiosurgery. Ophthalmology. 1997; 104(10):1634-43. DOI: 10.1016/s0161-6420(97)30084-0. View

16.

Parsons J, Bova F, Fitzgerald C, Mendenhall W, Million R . Radiation optic neuropathy after megavoltage external-beam irradiation: analysis of time-dose factors. Int J Radiat Oncol Biol Phys. 1994; 30(4):755-63. DOI: 10.1016/0360-3016(94)90346-8. View

17.

Crompton M, LAYTON D . Delayed radionecrosis of the brain following therapeutic x-radiation of the pituitary. Brain. 1961; 84:85-101. DOI: 10.1093/brain/84.1.85. View