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Dugandzic J, Hodgson K, Hussain A. Corneal deterioration following cataract surgery in patients with a history of orbital radiotherapy. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:e249-e250. [PMID: 37429435 DOI: 10.1016/j.jcjo.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/17/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
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Bennis A, Alami Z, AChraibi F, Abdellaoui M, Bouhafa T, Benatiya Andaloussi I. La kératite neurotrophique secondaire à la radiothérapie des UCNT du cavum (à propos de deux cas). J Fr Ophtalmol 2022; 45:e407-e410. [DOI: 10.1016/j.jfo.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
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Garcia GA, Charlson ES, Kolseth C, Kim N, Kossler AL. Ocular, Orbital, and Adnexal Toxicity With High-dose Volumetric Modulated Arc Radiation Therapy for Orbital Malignancies. Ophthalmic Plast Reconstr Surg 2022; 38:132-137. [PMID: 34284423 PMCID: PMC10838403 DOI: 10.1097/iop.0000000000002001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Conventional modalities of external-beam radiation therapy (EBRT) are associated with high incidences of severe vision-threatening ocular and orbital toxicities when used to treat orbital malignancies. We investigate toxicities associated with high-dose volumetric modulated arc therapy (VMAT), a commonly used contemporary treatment modality for these tumors. METHODS Retrospective analysis of malignant orbital tumors managed with adjuvant high-dose VMAT preceded by globe-salvaging surgical therapy (GST) or exenteration. Dosimetric quantitation of target volumes and critical structures was performed. Incidence and severity of ocular, orbital, and adnexal toxicities were evaluated and assessed with regard to conventional EBRT toxicities for orbital malignancies described in the literature. RESULTS Eighty-four subjects (mean age = 65.9 ± 9.7 years) were included (N = 48 and N = 36 in GST and exenteration subgroups, respectively). Mean dose was 64.8 ± 2.1 Gy to the planning target volume. Dosing to critical structures typically did not surpass known tissue tolerance limits. Median follow up was 18.3 months. Visual acuity in the GST subgroup was not significantly different after VMAT (0.25 ± 0.06) compared with baseline (0.23 ± 0.02; P = 0.302). Whereas severe toxicities reported by major systematic analyses in the literature with older EBRT modalities were relatively common-for example, retinopathy (16-40%), optic neuropathy (16%), and corneal perforation (13%)-toxicities with VMAT were typically mild and less common. The most common toxicities with VMAT were mild dry eye (81.3%; 39/48), cataract (21.1%; 8/38 phakic eyes), and periocular dermatitis (15.5%; 13/84). Vision-threatening toxicities, including severe corneal pathologies, retinopathy, or optic neuropathy, were rare. There were no contralateral ocular or adnexal toxicities. CONCLUSIONS High-dose VMAT for orbital malignancies demonstrated low incidence and severity of eye-related toxicity, in contradistinction to adverse events reported from conventional forms of radiotherapy.
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Affiliation(s)
- Giancarlo A Garcia
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California, U.S.A
| | - Emily S Charlson
- Department of Ophthalmology, Pacific Eye Associates and California Pacific Medical Center, San Francisco, California, U.S.A
| | - Clinton Kolseth
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California, U.S.A
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The european particle therapy network (EPTN) consensus on the follow-up of adult patients with brain and skull base tumours treated with photon or proton irradiation. Radiother Oncol 2022; 168:241-249. [DOI: 10.1016/j.radonc.2022.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/19/2022] [Indexed: 12/25/2022]
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Abstract
Dose constraints are essential for performing dosimetry, especially for intensity modulation and for radiotherapy under stereotaxic conditions. We present the update of the recommendations of the French society of oncological radiotherapy for the use of these doses in classical current practice but also for reirradiation.
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Affiliation(s)
- G Noël
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France.
| | - D Antoni
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France
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Ting DSJ, Rana-Rahman R, Ng JY, Wilkinson DJP, Ah-Kine D, Patel T. Clinical Spectrum and Outcomes of Ocular and Periocular Complications following External-Beam Radiotherapy for Inoperable Malignant Maxillary Sinus Tumors. Ocul Oncol Pathol 2020; 7:36-43. [PMID: 33796515 DOI: 10.1159/000511011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To highlight the clinical spectrum, management, and outcomes of ocular/periocular complications following high-dose external-beam radiotherapy (EBRT) for inoperable malignant maxillary sinus-involving tumors (MMST). Methods A retrospective, interventional case series. All patients who were diagnosed with inoperable MMST (with orbital involvement) and treated with high-dose fractionated EBRT (65 Gy in 30 fractions) at James Cook University Hospital, UK, were included. Results Seven patients with advanced MMST (T4aN0M0-T4bN2cM0) were included and were followed up for 23.8 ± 10.2 months. Severe lid margin disease, dry eye, and neurotrophic keratopathy were universally observed. Other complications included cicatricial conjunctivitis (71%), corneal perforation (57%), limbal stem cell deficiency (LSCD; 43%), glaucoma (29%), and superimposed candida keratitis (14%). Amniotic membrane transplant (AMT; 71%), tarsorrhaphy (43%), tectonic keratoplasty (29%), and evisceration (14%) were warranted. Intact corneal epithelium was observed in all patients and good corrected-distance visual acuity (≥20/60) was observed in 3 (43%) patients at final follow-up. Conclusion High-dose EBRT for inoperable MMST can lead to a wide array of severe ocular/periocular complications. AMT serves as a potentially useful treatment modality to restore the ocular surface integrity after severe radiation keratopathy. We advocate active monitoring for any evolving ophthalmic complications during and after EBRT to enable timely intervention.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Ophthalmology, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Romeela Rana-Rahman
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Jia Yu Ng
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, United Kingdom
| | - David J P Wilkinson
- Department of Radiotherapy and Oncology, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Desiree Ah-Kine
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Trushar Patel
- Department of Ophthalmology, James Cook University Hospital, Middlesbrough, United Kingdom
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Cranio-orbital Resection Does Not Appear to Improve Survival of Patients With Lacrimal Gland Carcinoma. Ophthalmic Plast Reconstr Surg 2019; 35:77-84. [PMID: 30130333 DOI: 10.1097/iop.0000000000001177] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To ascertain long-term outcome of treatment for primary epithelial malignancies of the lacrimal gland and compare outcomes after cranio-orbital resection or after macroscopic tumor resection with radiotherapy. METHODS Comparative case series of 79 patients (49 male; 62%) treated for primary epithelial malignancies of the lacrimal gland at Moorfields Eye Hospital between 1972 and 2014. Patients were identified from clinical and pathological databases and, where available, the clinical, pathological, and imaging records reviewed. The primary outcome measures were overall survival after diagnosis, disease-free survival, and final visual acuity for patients having cranio-orbital resection (exenteration plus local bone removal), compared with macroscopic tumor resection plus radiotherapy. RESULTS The mean age at presentation was 48 years (median: 50 years; range: 13-84 years), with 53 (67%) having adenoid cystic carcinoma, 15 (19%), primary adenocarcinoma, and 11 (14%) carcinoma ex-pleomorphic adenoma (malignant mixed tumor). The overall survival probability of the cohort (79 patients) was 0.59 at 5 years and 0.52 at 10 years, with 36/79 (46%) patients suffering tumor-related deaths; 14 patients died from other causes, and 4 patients were lost to follow up after the minimum follow-up period. The probability of disease-free survival at 5 years for patients with adenoid cystic carcinoma, adenocarcinoma, and malignant mixed tumor was 0.52, 0.4, and 0.64, respectively, with the comparable figures at 10 years being 0.44, 0.40, and 0.64. Most importantly, the 9 patients undergoing cranio-orbital resection and the 44 having solely macroscopic tumor resection plus radiotherapy had similar overall survival (p = 0.59) and disease-free survival (p = 0.89). Subgroup analysis of the 2 treatment modalities for patients with adenoid cystic carcinoma (8 cranio-orbital resection and 32 debulking and radiotherapy) demonstrated similar results for disease-free survival (p = 0.87). Likewise, there were no significant differences between rates of recurrences between the 2 different treatments. For the 50 patients who had eye-preserving surgery and long-term visual acuity data, the final acuity was better or equal to 0.6 logMAR (6/24 Snellen) in 25 (50%). DISCUSSION There is no difference in either survival or tumor recurrence for lacrimal gland carcinoma treated with cranio-orbital resection, or eye-preserving tumor excision and radiotherapy. The authors, therefore, continue to advocate local resection and radiotherapy for almost all patients with primary epithelial malignancies of the lacrimal gland-this treatment having lower morbidity, causing less disfigurement, and, importantly, preserving useful vision in most patients.
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Song X, Wang S, Wang J, Wang W, Wang S, Yang G, Li J, Zhu Y, Chen F, Zhu W. Clinical management and outcomes of lacrimal sac squamous cell carcinoma. Head Neck 2019; 41:974-981. [PMID: 30629760 DOI: 10.1002/hed.25529] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/02/2018] [Accepted: 09/28/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To investigate the management and outcomes of patients with lacrimal sac squamous cell carcinoma (SCC). METHODS This retrospective study examined 69 lacrimal sac SCC cases treated at our hospital between 1992 and 2017. The potential risk factors for prognosis, a new staging method, treatment outcomes, and complications were investigated. RESULTS The 5-year overall survival (OS) and progression-free survival (PFS) were 87.6 ± 4.8% and 76.3 ± 6.4%, respectively. Positive lymph node was associated with worse OS and PFS. We divided lacrimal sac SCC into four clinical stages, with significant differences in OS (P = .026) and PFS (P = .042) among each stage. Definitive radiotherapy was equivalent to surgery plus radiotherapy in 26.1% (18/69) of cases, and the incidence of complications was not higher. CONCLUSIONS Lymph node status was a key factor in determining outcomes. Our staging method could effectively classify tumor stage and predict prognosis, which can contribute to optimizing treatment regimes. Radiotherapy played an important role in treatment.
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Affiliation(s)
- Xinmao Song
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of FuDan University, Fenyang Road 83, Shanghai 200031, China
| | - Shengzi Wang
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of FuDan University, Fenyang Road 83, Shanghai 200031, China
| | - Jie Wang
- Department of E.N.T., Eye, Ear, Nose & Throat Hospital of FuDan University, Shanghai, China
| | - Weifang Wang
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of FuDan University, Fenyang Road 83, Shanghai 200031, China
| | - Shuyi Wang
- Department of Clinical Pathology, Eye, Ear, Nose & Throat Hospital of FuDan University, Shanghai, China
| | - Gang Yang
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of FuDan University, Fenyang Road 83, Shanghai 200031, China
| | - Ji Li
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of FuDan University, Fenyang Road 83, Shanghai 200031, China
| | - Yi Zhu
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of FuDan University, Fenyang Road 83, Shanghai 200031, China
| | - Fu Chen
- Department of Radiation Oncology, Eye, Ear, Nose & Throat Hospital of FuDan University, Fenyang Road 83, Shanghai 200031, China
| | - Wenjia Zhu
- Department of E.N.T., Eye, Ear, Nose & Throat Hospital of FuDan University, Shanghai, China
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Radiation dose constraints for organs at risk in neuro-oncology; the European Particle Therapy Network consensus. Radiother Oncol 2018; 128:26-36. [PMID: 29779919 DOI: 10.1016/j.radonc.2018.05.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/16/2018] [Accepted: 05/01/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE For unbiased comparison of different radiation modalities and techniques, consensus on delineation of radiation sensitive organs at risk (OARs) and on their dose constraints is warranted. Following the publication of a digital, online atlas for OAR delineation in neuro-oncology by the same group, we assessed the brain OAR-dose constraints in a follow-up study. METHODS We performed a comprehensive search to identify the current papers on OAR dose constraints for normofractionated photon and particle therapy in PubMed, Ovid Medline, Cochrane Library, Embase and Web of Science. Moreover, the included articles' reference lists were cross-checked for potential studies that met the inclusion criteria. Consensus was reached among 20 radiation oncology experts in the field of neuro-oncology. RESULTS For the OARs published in the neuro-oncology literature, we summarized the available literature and recommended dose constraints associated with certain levels of normal tissue complication probability (NTCP) according to the recent ICRU recommendations. For those OARs with lacking or insufficient NTCP data, a proposal for effective and efficient data collection is given. CONCLUSION The use of the European Particle Therapy Network-consensus OAR dose constraints summarized in this article is recommended for the model-based approach comparing photon and proton beam irradiation as well as for prospective clinical trials including novel radiation techniques and/or modalities.
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