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Boudoux O, Bailleul H, Marty PA, Miguel A, Quintyn JC, Thariat J. Prospective assessment of peripapillary microvasculature using optical coherence tomography angiography in para-optic intracranial and sinonasal tumors treated with proton therapy. J Fr Ophtalmol 2024; 47:104239. [PMID: 38964279 DOI: 10.1016/j.jfo.2024.104239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/27/2024] [Accepted: 03/08/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Radiation-induced optic neuropathy (RION) is rare but may lead to blindness. The mechanisms by which this occurs include endothelial and neuronal damage, but RION has been assessed very little in the case of extraocular tumors treated with high-energy proton therapy, the use of which is expanding worldwide. We assessed peripapillary microvascular changes by optical coherence tomography angiography (OCT-A) in patients undergoing high-energy proton therapy for para-optic intracranial or head and neck tumors. MATERIALS AND METHODS In this prospective institutional review board approved study, patients receiving>40Gy_RBE maximal PBT dose to their optic nerve between 2018 and 2020 underwent quantitative OCT-A analyses. ImageJ software was used to assess changes in the peripapillary superficial vascular complex (SVC) using vascular area density (VAD), vessel length density (VLD) and fractal dimension (FDsk). Uni- and multivariate analyses were performed. RESULTS Of 47 patients (78 eyes) with 29±6 months of follow-up (range 18-42), 29 patients (61.7%) had previously undergone surgery and 18 (32.1%) had microvascular abnormalities prior to proton therapy. Total radiotherapy dose was the most relevant factor in decreased peripapillary microvasculature. Duration of follow-up was associated with lower VAD (P=0.005) and mean retinal nerve fiber layer (RNFLm) thickness also decreased. There was no significant correlation between OCT-A changes and mean visual defect. CONCLUSION Peripapillary microvasculature changes may occur from tumor compression or surgery and proton therapy for extraocular tumors. OCT-A may provide quantitative and mechanistic insights into RION before the occurrence of clinical symptoms.
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Affiliation(s)
- O Boudoux
- Ophthalmology Department, University Hospital of Caen, Caen, France.
| | - H Bailleul
- Ophthalmology Department, Hôpital Privé de la Baie, Avranches, France
| | - P-A Marty
- Centre ophtalmologique du pays des Olonnes, Olonne-sur-Mer, France
| | - A Miguel
- Ophthalmology Department, Hôpital Privé de la Baie, Avranches, France
| | - J-C Quintyn
- Ophthalmology Department, University Hospital of Caen, Caen, France
| | - J Thariat
- Radiation Oncology Department, Centre François-Baclesse, Caen, France
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Carey AR, Page BR, Miller N. Radiation-induced optic neuropathy: a review. Br J Ophthalmol 2022; 107:743-749. [DOI: 10.1136/bjo-2022-322854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
Radiation is a commonly used treatment modality for head and neck as well as CNS tumours, both benign and malignant. As newer oncology treatments such as immunotherapies allow for longer survival, complications from radiation therapy are becoming more common. Radiation-induced optic neuropathy is a feared complication due to rapid onset and potential for severe and bilateral vision loss. Careful monitoring of high-risk patients and early recognition are crucial for initiating treatment to prevent severe vision loss due to a narrow therapeutic window. This review discusses presentation, aetiology, recent advances in diagnosis using innovative MRI techniques and best practice treatment options based on the most recent evidence-based medicine.
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Case study of a bolus helmet used to maintain optic chiasm and nerve sparing while improving target coverage using IMPT. Med Dosim 2022; 47:242-246. [PMID: 35513997 DOI: 10.1016/j.meddos.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to examine if the use of a bolus helmet when treating the head with intensity modulated proton therapy (IMPT) will maintain organs at risk (OAR) sparing while improving the clinical target volume (CTV) coverage. A bolus helmet is a device that aims to improve on the traditionally used range shifter in proton therapy by improving dose distribution characteristics. Ten patients were retrospectively selected who had 2 separate treatment planning scans performed, a scan with the bolus helmet and a second scan without. Plans were created using both scans. Dose to organs at risk (OAR) including the left optic nerve, right optic nerve, optic chiasm, and normal brain minus CTV (brain-CTV), as well as CTV coverage were compared between the 2 plans. The use of the bolus helmet displayed lower mean OAR doses as well as higher CTV coverage, suggesting that use of the bolus helmet provides benefit when treating the head with IMPT.
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Dağdelen M, Akbaş ZŞ, Barlas C, Can G, Arıcı C, Uzel Ö. Evaluation of Retinal and Optic Disc Vascular Changes and Retinal Nerve Fiber Layer Thickness in Patients with Nasopharyngeal Carcinoma Following Image Guided Intensity-Modulated Radiation Therapy Using Optical Coherence Tomography Angiography. Photodiagnosis Photodyn Ther 2022; 38:102887. [DOI: 10.1016/j.pdpdt.2022.102887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
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Nouraeinejad A. The visual evoked potential can save sight in patients with radiation-induced optic neuropathy. Eur J Ophthalmol 2021; 32:11206721211049141. [PMID: 34664524 DOI: 10.1177/11206721211049141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radiation-induced optic neuropathy (RION) is a late complication of radiation therapy for brain and skull base tumors. RION leads to the devastating total vision loss in one or both eyes. Therefore, the early detection of RION is vital. Since visual symptoms and clinical signs of RION are not present at early stages of the radiation injury, it is essential to apply a diagnostic test to detect RION as early as possible in order to start therapeutic interventions. The author proposes to apply visual evoked potential (VEP) as a diagnostic test in the interval time after radiation therapy.
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Akagunduz OO, Yilmaz SG, Tavlayan E, Baris ME, Afrashi F, Esassolak M. Radiation-Induced Ocular Surface Disorders and Retinopathy: Ocular Structures and Radiation Dose-Volume Effect. Cancer Res Treat 2021; 54:417-423. [PMID: 34176248 PMCID: PMC9016314 DOI: 10.4143/crt.2021.575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/23/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to evaluate the radiation-induced adverse effects on ocular structures in head and neck cancer patients and investigate the radiation dose-volume effects on the cornea, lacrimal gland, retina, optic nerve and chiasm. Materials and Methods A total of 38 eyes of 19 patients were included in this prospective, cohort study. All patients underwent complete ophthalmological examination in addition to contrast sensitivity, visual field and visual evoked potentials (VEP) tests. Ophthalmological examinations and psychophysical tests were performed in 6th, 12th, 18th, 24th months and in the last visit. The relationship between the ophthalmologic findings, and the radiation doses below and above the cut-off values was evaluated. Results Contrast sensitivity decrease and visual field deterioration were observed in 42% of the patients in the last visit (median 26 months) whereas a prolonged latency and decreased amplitude of P100 wave in VEP was observed in 58% and 33% of the eyes, respectively at 24th month. Totally 16 patients (84.2%) developed dry eye disease and eight of them received radiotherapy below tolerance doses and had mild to moderate dry eye findings. Radiation-induced retinopathy was observed in three of the eyes in eight patients who received radiation above tolerance dose. Conclusion Head and neck cancers treated with radiotherapy, resulted in various ophthalmic complications. All patients who are treating with radiotherapy should be evaluated by an ophthalmologist in terms of anterior and posterior segment damage, even if the radiation dose is below the tolerance limit.
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Affiliation(s)
| | - Suzan Guven Yilmaz
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Emin Tavlayan
- Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mine Esen Baris
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Filiz Afrashi
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mustafa Esassolak
- Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
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Lecornu M, Lesueur P, Salleron J, Balosso J, Stefan D, Kao W, Plouhinec T, Vela A, Dutheil P, Bouter J, Marty PA, Thariat J, Quintyn JC. Prospective Assessment of Early Proton Therapy-Induced Optic Neuropathy in Patients With Intracranial, Orbital or Sinonasal Tumors: Impact of A Standardized Ophthalmological Follow Up. Front Oncol 2021; 11:673886. [PMID: 34211847 PMCID: PMC8239302 DOI: 10.3389/fonc.2021.673886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Proton therapy (PT) can be a good option to achieve tumor control while reducing the probability of radiation induced toxicities compared to X-ray-based radiotherapy. However, there are still uncertainties about the effects of PT on the organs in direct contact with the irradiated volume. The aim of this prospective series was to report 6-month follow-up of clinical and functional optic neuropathy rates of patients treated by proton therapy using a standardized comprehensive optic examination. METHODS AND MATERIALS Standardized ophthalmological examinations were performed to analyze subclinical anomalies in a systematic way before treatment and 6 months after the end of proton therapy with: Automatic visual field, Visual evoked potential (VEP) and optic coherence of tomography (OCT). RESULTS From October 2018 to July 2020 we analyzed 81 eyes. No significant differences were found in the analysis of the clinical examination of visual functions by the radiation oncologist. However, considering VEP, the impairment was statistically significant for both fibers explored at 30'angle (p:0.007) and 60'angle (p <0.001). In patients with toxicity, the distance of the target volume from the optical pathways was more important with a p-value for 30'VEP at 0.035 and for 60'VEP at 0.039. CONCLUSIONS These results confirm uncertainties concerning relative biological effectiveness of proton therapy, linear energy transfer appears to be more inhomogeneous especially in areas close to the target volumes. The follow-up of patients after proton therapy is not an easy process to set up but it is necessary to improve our knowledges about the biological effects of proton therapy in real life. Our study which will continue during the coming years, suggests that follow-up with in-depth examinations such as VEP as a biomarker could improve the detection of early abnormalities.
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Affiliation(s)
- Marie Lecornu
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - Paul Lesueur
- Radiation Oncology Department, Centre François Baclesse, Caen, France
- Radiation Oncology Department, Centre Guillaume le Conquérant, Caen, France
- ISTCT UMR6030-CNRS, CEA, Université de Caen-Normandie, Equipe CERVOxy, Caen, France
| | - Julia Salleron
- Cellule Data Biostatistique, Instistut de Cancerologie de Lorraine, Nancy, France
| | - Jacques Balosso
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - Dinu Stefan
- Radiation Oncology Department, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - William Kao
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | | | - Anthony Vela
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - Pauline Dutheil
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - Jordan Bouter
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | | | - Juliette Thariat
- Radiation Oncology Department, Centre François Baclesse, Caen, France
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Zhang T, Xu M, Mi J, Yang H, Liu Z, Huang L, Hu K, Wang R. Loosening Neuro-Optic Structures Dosimetric Constraints Provides High 5-Year Local Recurrence-Free Survival With Acceptable Toxicity in T4 Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy. Front Oncol 2021; 11:598320. [PMID: 33692949 PMCID: PMC7937960 DOI: 10.3389/fonc.2021.598320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/05/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Whether the original dosimetric constraints of neuro-optic structures (NOS) are appropriate for patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiotherapy (IMRT) remains controversial. The present study compared the survival rates and radiation-induced optic neuropathy (RION) occurrence between T4 NPC patients whose NOS were irradiated with a near maximum dose received by 2% of the volume (D2%) >55 Gy and ≤55 Gy. Moreover, the NOS dosimetric parameters and their correlation with RION occurrence were also evaluated. Methods In this retrospective study, 256 T4 NPC patients treated with IMRT between May 2009 and December 2013 were included. Patient characteristics, survival rates, dosimetric parameters, and RION incidence were compared between the D2% ≤55 Gy and D2% >55 Gy groups. Results The median follow-up durations were 87 and 83 months for patients in the D2% >55 Gy and D2% ≤55 Gy groups, respectively. The 5-year local recurrence-free survival rates were 92.0 and 84.0% in the D2% >55 Gy and D2% ≤55 Gy groups (P = 0.043), respectively. There was no significant difference in the 5-year overall survival (OS) between both groups (D2% >55 Gy, 81.6%; D2% ≤55 Gy, 79.4%; P = 0.586). No patients developed severe RION (Grades 3–5), and there was no significant difference (P = 0.958) in the incidence of RION between the two groups. The maximum dose of NOS significantly affected the RION incidence, with a cutoff point of 70.77 Gy. Conclusion Appropriately loosening NOS dosimetric constraints in order to ensure a more sufficient dose to the target volume can provide a better 5-year local recurrence-free survival and acceptable neuro-optic toxicity in T4 NPC patients undergoing IMRT.
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Affiliation(s)
- Tingting Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Meng Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinglin Mi
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hui Yang
- Department of Oncology, Liuzhou Worker Hospital, Liuzhou, China
| | - Zhengchun Liu
- Department of Radiotherapy, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Lulu Huang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Kai Hu
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rensheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Li Z, Zhan Z, Xiao J, Lan Y. Radiation-Induced Optical Coherence Tomography Angiography Retinal Alterations in Patients With Nasopharyngeal Carcinoma. Front Med (Lausanne) 2021; 7:630880. [PMID: 33614678 PMCID: PMC7886685 DOI: 10.3389/fmed.2020.630880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of the study was to investigate the early neurovascular alterations of the retina in radiation encephalopathy (RE) patients with normal-ranged visual acuity after radiotherapy for nasopharyngeal carcinoma. Methods: Fifty-five RE patients and 54 healthy age-matched subjects were enrolled in this retrospective cross-sectional case–control study. The best corrected visual acuity (LogMAR) of the included eye should not be more than 0. The vessel density and thickness of different locations in the retina were acquired automatically using optical coherence tomography angiography (OCTA). The data were then compared between the RE patients and the controls. The location included the whole retina, the superficial vascular plexus (SVP)/the ganglion cell complex (GCC), the deep vascular plexus (DVP), and the choroid in the macular area, as well as the inside disc and peripapillary area in the optic nerve head (ONH). The risk factors in OCTA retinal impairments were analyzed using a backward multiple linear regression. The relationships between mean deviation (MD) and pattern standard deviation (PSD) in the visual field (VF) and the OCTA parameters were also analyzed in RE patients. Results: The vessel density of the GCC was significantly reduced in RE patients compared with controls (p = 0.018), and the reductions were mainly shown in the parafoveal (p = 0.049) and perifoveal fields (p = 0.006). The thickness of the GCC was correspondingly reduced (whole image GCC mean thickness: p = 0.044; parafoveal thickness: p = 0.038; perifoveal thickness: p = 0.038). In addition, the sub-foveal choroidal thickness (p = 0.039) was also reduced in RE patients. The vessel density of the GCC (R2 = 0.643) and DVP (R2 = 0.777) had a significant positive correlation with high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (ApoA1) and had a significant negative correlation with age (GCC: HDL-C, β = 29.89, p = 0.005; ApoA1, β = 78.92, p = 0.002; age, β = −0.886, p = 0.001; DVP: HDL-C, β = 40.09, p = 0.003; ApoA1, β = 62.65, p = 0.013; age, β = −1.31, p = 0.001). The vessel density of the GCC also had a significant negative correlation with apolipoprotein B (ApoB) (β = −32.18, p = 0.006). In the VF, MD had a significant positive correlation with the vessel density inside disc (R2 = 0.241, β = 0.304, p = 0.045), whereas PSD showed a significant negative correlation with the vessel density inside disc and the average GCC thickness, respectively (R2 = 0.437; vessel density inside disc, β = −0.358, p = 0.004; average GCC thickness, β = −0.510, p < 0.001). Conclusion: With the aid of OCTA, we found that neurovascular alterations of the retina may exist in RE patients with normal-ranged visual acuity. Herein, we suggest the implementation of OCTA to assist ophthalmologists in the early detection and consistent monitoring of radiation-related eye diseases to avoid delayed diagnosis.
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Affiliation(s)
- Zijing Li
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zongyi Zhan
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianhui Xiao
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuqing Lan
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Azzam P, Mroueh M, Francis M, Daher AA, Zeidan YH. Radiation-induced neuropathies in head and neck cancer: prevention and treatment modalities. Ecancermedicalscience 2020; 14:1133. [PMID: 33281925 PMCID: PMC7685771 DOI: 10.3332/ecancer.2020.1133] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Indexed: 12/24/2022] Open
Abstract
Head and neck cancer (HNC) is the sixth most common human malignancy with a global incidence of 650,000 cases per year. Radiotherapy (RT) is commonly used as an effective therapy to treat tumours as a definitive or adjuvant treatment. Despite the substantial advances in RT contouring and dosage delivery, patients suffer from various radiation-induced complications, among which are toxicities to the nervous tissues in the head and neck area. Radiation-mediated neuropathies manifest as a result of increased oxidative stress-mediated apoptosis, neuroinflammation and altered cellular function in the nervous tissues. Eventually, molecular damage results in the formation of fibrotic tissues leading to susceptible loss of function of numerous neuronal substructures. Neuropathic sequelae following irradiation in the head and neck area include sensorineural hearing loss, alterations in taste and smell functions along with brachial plexopathy, and cranial nerves palsies. Numerous management options are available to relieve radiation-associated neurotoxicities notwithstanding treatment alternatives that remain restricted with limited benefits. In the scope of this review, we discuss the use of variable management and therapeutic modalities to palliate common radiation-induced neuropathies in head and neck cancers.
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Affiliation(s)
- Patrick Azzam
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Manal Mroueh
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Marina Francis
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Alaa Abou Daher
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Youssef H Zeidan
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
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Yang J, Li Q, Han D, Liao C, Wang P, Gao J, Xu Z, Liu Y. Radiation-induced impairment of optic nerve axonal transport in tree shrews and rats monitored by longitudinal manganese-enhanced MRI. Neurotoxicology 2020; 77:145-154. [PMID: 31987859 DOI: 10.1016/j.neuro.2020.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Radiation-induced optic neuropathy (RION) is a serious complication that occurs after radiation therapy of tumors in the vicinity of the optic nerve, yet its mechanism and imaging features are poorly understood. In this study, we employed manganese-enhanced MRI (MEMRI) to assess optic nerve axonal transport in tree shrews and rats after irradiation. MATERIALS AND METHODS A comparison of normal visual projections in tree shrews and rats was conducted by intravitreal MnCl2 injection followed by MRI. Adult male tree shrews and rats received a total dose of 20 Gy delivered in two fractions (10 Gy per fraction) within 5 days. Longitudinal MEMRI was conducted 5, 10, 20 and 30 weeks after radiation. At the end of observation, motor proteins involved in axonal transport were detected by western blotting, and the axon cytoskeleton was assessed by immunofluorescence. RESULTS The eyeballs, lens sizes, vitreous volumes, optic nerves and superior colliculi of tree shrews were significantly larger than those of rats on MEMRI (P < 0.05). The Mn2+-enhancement of the optic nerve showed no significant changes at 5 and 10 weeks (P > 0.05) but decreased gradually from 20 to 30 weeks postirradiation (P < 0.05). The enhancement of the superior colliculus gradually decreased from 5 weeks to 30 weeks, and the decrease was most significant at 30 weeks (P < 0.05). The levels of the motor proteins cytoplasmic dynein-1, kinesin-1 and kinesin-2 in the experimental group were significantly decreased (P < 0.05). The immunofluorescence results showed that the α-tubulin, β-tubulin and SMI 31 levels in the experimental groups and control groups were not significantly different (P > 0.05). CONCLUSION Tree shrews show great advantages in visual neuroscience research involving MEMRI. The main cause of the decline in axonal transport in RION is an insufficient level of motor protein rather than damage to the axonal cytoskeletal structure. Longitudinal MEMRI can be used to detect changes in axonal transport function and to observe the relatively intact axon structure from the early to late stages after radiation administration.
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Affiliation(s)
- Jun Yang
- Department of Radiology. The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital & Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, PR China.
| | - Qinqing Li
- Department of Radiology. The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital & Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, PR China
| | - Dan Han
- Department of Medical Imaging. The First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming, 650032, Yunnan, PR China
| | - Chengde Liao
- Department of Radiology. The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital & Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, PR China
| | - Pengfei Wang
- Department of Key Laboratory. The Second Affiliated Hospital of Kunming Medical University, No. 374 Dianmian Road, Kunming, 650101, Yunnan, PR China
| | - Jingyan Gao
- Department of Radiation Oncology. The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital & Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, PR China
| | - Zeyan Xu
- Department of Radiology. The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital & Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, PR China
| | - Yifan Liu
- Department of Radiology. The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital & Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, PR China
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Lee AW, Ng WT, Pan JJ, Chiang CL, Poh SS, Choi HC, Ahn YC, AlHussain H, Corry J, Grau C, Grégoire V, Harrington KJ, Hu CS, Kwong DL, Langendijk JA, Le QT, Lee NY, Lin JC, Lu TX, Mendenhall WM, O'Sullivan B, Ozyar E, Peters LJ, Rosenthal DI, Sanguineti G, Soong YL, Tao Y, Yom SS, Wee JT. International Guideline on Dose Prioritization and Acceptance Criteria in Radiation Therapy Planning for Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2019; 105:567-580. [PMID: 31276776 DOI: 10.1016/j.ijrobp.2019.06.2540] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 12/09/2022]
Abstract
PURPOSE The treatment of nasopharyngeal carcinoma requires high radiation doses. The balance of the risks of local recurrence owing to inadequate tumor coverage versus the potential damage to the adjacent organs at risk (OARs) is of critical importance. With advancements in technology, high target conformality is possible. Nonetheless, to achieve the best possible dose distribution, optimal setting of dose targets and dose prioritization for tumor volumes and various OARs is fundamental. Radiation doses should always be guided by the As Low As Reasonably Practicable principle. There are marked variations in practice. This study aimed to develop a guideline to serve as a global practical reference. METHODS AND MATERIALS A literature search on dose tolerances and normal-tissue complications after treatment for nasopharyngeal carcinoma was conducted. In addition, published guidelines and protocols on dose prioritization and constraints were reviewed. A text document and preliminary set of variants was circulated to a panel of international experts with publications or extensive experience in the field. An anonymized voting process was conducted to rank the proposed variants. A summary of the initial voting and different opinions expressed by members were then recirculated to the whole panel for review and reconsideration. Based on the comments of the panel, a refined second proposal was recirculated to the same panel. The current guideline was based on majority voting after repeated iteration for final agreement. RESULTS Variation in opinion among international experts was repeatedly iterated to develop a guideline describing appropriate dose prioritization and constraints. The percentage of final agreement on the recommended parameters and alternative views is shown. The rationale for the recommendations and the limitations of current evidence are discussed. CONCLUSIONS Through this comprehensive review of available evidence and interactive exchange of vast experience by international experts, a guideline was developed to provide a practical reference for setting dose prioritization and acceptance criteria for tumor volumes and OARs. The final decision on the treatment prescription should be based on the individual clinical situation and the patient's acceptance of optimal balance of risk.
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Affiliation(s)
- Anne W Lee
- Department of Clinical Oncology, University of Hong Kong Shenzhen Hospital and University of Hong Kong, China
| | - Wai Tong Ng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Jian Ji Pan
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Chi-Leung Chiang
- Department of Clinical Oncology, University of Hong Kong Shenzhen Hospital and University of Hong Kong, China
| | - Sharon S Poh
- Division of Radiation Oncology, National Cancer Centre Singapore, Oncology ACP, Duke-NUS Medical School, Singapore
| | - Horace C Choi
- Department of Clinical Oncology, University of Hong Kong, Hong Kong
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hussain AlHussain
- Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - June Corry
- Radiation Oncology, GenesisCare, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Vincent Grégoire
- Center for Molecular Imaging, Oncology and Radiotherapy, Université Catholique de Louvain, Brussels, Belgium and Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Kevin J Harrington
- The Royal Marsden/The Institute of Cancer Research National Institute for Health Research Biomedical Research Centre, London, UK
| | - Chao Su Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Dora L Kwong
- Department of Clinical Oncology, University of Hong Kong and Queen Mary Hospital, Hong Kong
| | - Johannes A Langendijk
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University, NRG Oncology and Head and Neck Cancer International Group, California
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York
| | - Jin Ching Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Tai Xiang Lu
- Department of Radiation Oncology, Cancer Center of Sun Yat-Sen University, Guangzhou, China
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Canada
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Lester J Peters
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Oncology ACP, Duke-NUS Medical School, Singapore
| | - Yungan Tao
- Department of Radiation Oncology, Institut Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Sue S Yom
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, California
| | - Joseph T Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Oncology ACP, Duke-NUS Medical School, Singapore.
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