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Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways.

Publication ,  Journal Article
Milano, MT; Grimm, J; Soltys, SG; Yorke, E; Moiseenko, V; Tomé, WA; Sahgal, A; Xue, J; Ma, L; Solberg, TD; Kirkpatrick, JP; Constine, LS ...
Published in: Int J Radiat Oncol Biol Phys
May 1, 2021

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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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

May 1, 2021

Volume

110

Issue

1

Start / End Page

87 / 99

Location

United States

Related Subject Headings

  • Visual Fields
  • Visual Acuity
  • Skull Base Neoplasms
  • Re-Irradiation
  • Radiotherapy Dosage
  • Radiosurgery
  • Radiation Tolerance
  • Radiation Dose Hypofractionation
  • Pituitary Neoplasms
  • Organs at Risk
 

Citation

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MLA
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Milano, M. T., Grimm, J., Soltys, S. G., Yorke, E., Moiseenko, V., Tomé, W. A., … El Naqa, I. (2021). Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways. Int J Radiat Oncol Biol Phys, 110(1), 87–99. https://doi.org/10.1016/j.ijrobp.2018.01.053
Milano, Michael T., Jimm Grimm, Scott G. Soltys, Ellen Yorke, Vitali Moiseenko, Wolfgang A. Tomé, Arjun Sahgal, et al. “Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways.Int J Radiat Oncol Biol Phys 110, no. 1 (May 1, 2021): 87–99. https://doi.org/10.1016/j.ijrobp.2018.01.053.
Milano MT, Grimm J, Soltys SG, Yorke E, Moiseenko V, Tomé WA, et al. Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways. Int J Radiat Oncol Biol Phys. 2021 May 1;110(1):87–99.
Milano, Michael T., et al. “Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways.Int J Radiat Oncol Biol Phys, vol. 110, no. 1, May 2021, pp. 87–99. Pubmed, doi:10.1016/j.ijrobp.2018.01.053.
Milano MT, Grimm J, Soltys SG, Yorke E, Moiseenko V, Tomé WA, Sahgal A, Xue J, Ma L, Solberg TD, Kirkpatrick JP, Constine LS, Flickinger JC, Marks LB, El Naqa I. Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways. Int J Radiat Oncol Biol Phys. 2021 May 1;110(1):87–99.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

May 1, 2021

Volume

110

Issue

1

Start / End Page

87 / 99

Location

United States

Related Subject Headings

  • Visual Fields
  • Visual Acuity
  • Skull Base Neoplasms
  • Re-Irradiation
  • Radiotherapy Dosage
  • Radiosurgery
  • Radiation Tolerance
  • Radiation Dose Hypofractionation
  • Pituitary Neoplasms
  • Organs at Risk