TY - JOUR
T1 - Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways
AU - Milano, Michael T.
AU - Grimm, Jimm
AU - Soltys, Scott G.
AU - Yorke, Ellen
AU - Moiseenko, Vitali
AU - Tomé, Wolfgang A.
AU - Sahgal, Arjun
AU - Xue, Jinyu
AU - Ma, Lijun
AU - Solberg, Timothy D.
AU - Kirkpatrick, John P.
AU - Constine, Louis S.
AU - Flickinger, John C.
AU - Marks, Lawrence B.
AU - El Naqa, Issam
N1 - Funding Information:
Conflict of interest: M.T.M. reports Royalties from UpToDate, outside the submitted work. J.G. reports grants from Accuray and NovoCure, outside the submitted work; J.G. also has a patent DVH Evaluator issued. S.G.S. reports personal fees from Inovio Pharmaceuticals, Inc., outside the submitted work. E.Y. acknowledges support of NIH Grant P30 CA008748 W.A.T. reports research grants from Varian Inc. and the WI Alumni Research Foundation outside the submitted work; royalties outside the submitted work; W.A.T. also serves on the Scientific Advisory Board for ViewRay Inc. A.S. reports past educational seminars with Elekta AB, Accuray Inc., and Varian medical systems; a research grant with Elekta AB; travel accommodations/expenses by Elekta and Varian; A.S. also belongs to the Elekta MR LINAC Research Consortium. T.D.S. reports “other” from Global Radiosurgery, LLC, and BrainLab AG, outside the submitted work. J.P.K. reports grants from Varian Medical Systems, outside the submitted work; J.P.K. also reports being a partner in ClearSight RT Products, LLP (novel bolus materials)—no direct application to the subject matter of this article. I.E.-N. reports grants from the National Institutes of Health (unrelated to the submitted work) during the conduct of the study.
Funding Information:
Conflict of interest: M.T.M. reports Royalties from UpToDate, outside the submitted work. J.G. reports grants from Accuray and NovoCure, outside the submitted work; J.G. also has a patent DVH Evaluator issued. S.G.S. reports personal fees from Inovio Pharmaceuticals, Inc., outside the submitted work. E.Y. acknowledges support of NIH Grant P30 CA008748 W.A.T. reports research grants from Varian Inc. and the WI Alumni Research Foundation outside the submitted work; royalties outside the submitted work; W.A.T. also serves on the Scientific Advisory Board for ViewRay Inc. A.S. reports past educational seminars with Elekta AB, Accuray Inc., and Varian medical systems; a research grant with Elekta AB; travel accommodations/expenses by Elekta and Varian; A.S. also belongs to the Elekta MR LINAC Research Consortium. T.D.S. reports “other” from Global Radiosurgery, LLC, and BrainLab AG, outside the submitted work. J.P.K. reports grants from Varian Medical Systems, outside the submitted work; J.P.K. also reports being a partner in ClearSight RT Products, LLP (novel bolus materials)—no direct application to the subject matter of this article. I.E.-N. reports grants from the National Institutes of Health (unrelated to the submitted work) during the conduct of the study.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Purpose: Dosimetric and clinical predictors of radiation-induced optic nerve/chiasm neuropathy (RION) after single-fraction stereotactic radiosurgery (SRS) or hypofractionated (2-5 fractions) radiosurgery (fSRS) were analyzed from pooled data that were extracted from published reports (PubMed indexed from 1990 to June 2015). This study was undertaken as part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy, investigating normal tissue complication probability (NTCP) after hypofractionated radiation. Methods and Materials: Eligible studies described dose delivered to optic nerve/chiasm and provided crude or actuarial toxicity risks, with visual endpoints (ie, loss of visual acuity, alterations in visual fields, and/or blindness/complete vision loss). Studies of patients with optic nerve sheath tumors, optic nerve gliomas, or ocular/uveal melanoma were excluded to obviate direct tumor effects on visual outcomes, as were studies not specifying causes of vision loss (ie, tumor progression vs RION). Results: Thirty-four studies (1578 patients) were analyzed. Histologies included pituitary adenoma, cavernous sinus meningioma, craniopharyngioma, and malignant skull base tumors. Prior resection (76% of patients) did not correlate with RION risk (P =.66). Prior irradiation (6% of patients) was associated with a crude 10-fold increased RION risk versus no prior radiation therapy. In patients with no prior radiation therapy receiving SRS/fSRS in 1-5 fractions, optic apparatus maximum point doses resulting in <1% RION risks include 12 Gy in 1 fraction (which is greater than our recommendation of 10 Gy in 1 fraction), 20 Gy in 3 fractions, and 25 Gy in 5 fractions. Omitting multi-fraction data (and thereby eliminating uncertainties associated with dose conversions), a single-fraction dose of 10 Gy was associated with a 1% RION risk. Insufficient details precluded modeling of NTCP risks after prior radiation therapy. Conclusions: Optic apparatus NTCP and tolerance doses after single- and multi-fraction stereotactic radiosurgery are presented. Additional standardized dosimetric and toxicity reporting is needed to facilitate future pooled analyses and better define RION NTCP after SRS/fSRS.
AB - Purpose: Dosimetric and clinical predictors of radiation-induced optic nerve/chiasm neuropathy (RION) after single-fraction stereotactic radiosurgery (SRS) or hypofractionated (2-5 fractions) radiosurgery (fSRS) were analyzed from pooled data that were extracted from published reports (PubMed indexed from 1990 to June 2015). This study was undertaken as part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy, investigating normal tissue complication probability (NTCP) after hypofractionated radiation. Methods and Materials: Eligible studies described dose delivered to optic nerve/chiasm and provided crude or actuarial toxicity risks, with visual endpoints (ie, loss of visual acuity, alterations in visual fields, and/or blindness/complete vision loss). Studies of patients with optic nerve sheath tumors, optic nerve gliomas, or ocular/uveal melanoma were excluded to obviate direct tumor effects on visual outcomes, as were studies not specifying causes of vision loss (ie, tumor progression vs RION). Results: Thirty-four studies (1578 patients) were analyzed. Histologies included pituitary adenoma, cavernous sinus meningioma, craniopharyngioma, and malignant skull base tumors. Prior resection (76% of patients) did not correlate with RION risk (P =.66). Prior irradiation (6% of patients) was associated with a crude 10-fold increased RION risk versus no prior radiation therapy. In patients with no prior radiation therapy receiving SRS/fSRS in 1-5 fractions, optic apparatus maximum point doses resulting in <1% RION risks include 12 Gy in 1 fraction (which is greater than our recommendation of 10 Gy in 1 fraction), 20 Gy in 3 fractions, and 25 Gy in 5 fractions. Omitting multi-fraction data (and thereby eliminating uncertainties associated with dose conversions), a single-fraction dose of 10 Gy was associated with a 1% RION risk. Insufficient details precluded modeling of NTCP risks after prior radiation therapy. Conclusions: Optic apparatus NTCP and tolerance doses after single- and multi-fraction stereotactic radiosurgery are presented. Additional standardized dosimetric and toxicity reporting is needed to facilitate future pooled analyses and better define RION NTCP after SRS/fSRS.
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U2 - 10.1016/j.ijrobp.2018.01.053
DO - 10.1016/j.ijrobp.2018.01.053
M3 - Article
C2 - 29534899
AN - SCOPUS:85082219996
SN - 0360-3016
VL - 110
SP - 87
EP - 99
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 1
ER -
