Late retinal complications of radiation therapy for nasal and paranasal malignancies

Relationship between irradiated-dose area and severity

Atsuya Takeda, Naoyuki Shigematsu, Saburosuke Suzuki, Masato Fujii, Tetsuya Kawata, Osamu Kawaguchi, Takashi Uno, Hideyuki Takano, Atsushi Kubo, Hisao Ito

Research output: Contribution to journalArticle

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Abstract

Purpose: Radiation-induced cataract, once a notorious ocular complication of radiation therapy, is no longer considered a severe complication, because visual acuity can be restored by surgical treatment without significant complications. Late retinal complications of retinopathy and glaucoma, for which there is no effective method of treatment, have become serious complications of radiotherapy of the head and neck. We retrospectively investigated the risk of late retinal complications of radiotherapy for nasal and paranasal malignancies according to the radiation dose and area of the retina irradiated. Methods and Materials: Between October 1982 and May 1996, 43 eyes of 25 patients were exposed to fractionated external-beam irradiation for treatment of advanced nasal and paranasal cancer. None of the patients had tumor invasion into the eyes. The patients were followed ophthalmologically for a minimum of 2 years (range 2.0-11, mean 4.5, median 3.3). The radiation dose and area of the retina irradiated were estimated from the dose distribution figures calculated using the portal films and CT scan. Results: Major late adverse effects of radiotherapy were observed in the retina in 9 of 43 eyes (in 8/25 patients). Radiation retinopathy was observed in 7 eyes, and the cumulative incidence was 25%. The median interval before the onset of symptoms attributable to retinopathy was 32 months (range 16-60). Neovascular glaucoma developed in 3 of the 43 eyes, with a cumulative incidence of 7%. The median period to the onset of symptoms attributable to glaucoma was 22 months (range 16-26). Obstruction of the central retinal artery was observed in 1 eye. The irradiation doses to the retinas that developed late complications ranged between 54-75 Gy (mean 61, median 61). No patients who received less than 50 Gy developed retinal complications. The retina in 21 eyes was exposed to a dose of 50 Gy or more. In 13 of the 21 eyes, 60% or more of the retina was irradiated, and 8 of the eyes (62%) in this group (≥ 50 Gy, ≥ 60%) developed severe retinal complications, whereas such complications only developed in 1 of the 8 eyes (13%) in the other group (≥ 50 Gy, ≥ 60%). The results suggest that the radiation dose and area irradiated are the most important factors in the development of severe complications. Conclusion: Radiation-induced retinopathy and glaucoma are more serious late complications than cataracts, which are easily treated with surgery. We investigated the risk of late retinal complications of radiotherapy, and our findings suggested that the radiation dose and area irradiated are the most important factors in the development of severe complications. We recommend that the radiation dose and area of the retina irradiated be minimized in patients at risk of eye complications, and the patients should be closely followed by periodic ophthalmologic testing after treatment.

Original languageEnglish
Pages (from-to)599-605
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume44
Issue number3
DOIs
Publication statusPublished - 1999 Jun 1

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Nose
radiation therapy
Radiotherapy
dosage
retina
Retina
Radiation
Neoplasms
glaucoma
radiation
Glaucoma
cataracts
Cataract
Nose Neoplasms
Neovascular Glaucoma
Retinal Artery
incidence
visual acuity
Incidence
Therapeutics

Keywords

  • Glaucoma
  • Late effect
  • Nasal and paranasal cancer
  • Radiotherapy
  • Retinopathy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Late retinal complications of radiation therapy for nasal and paranasal malignancies : Relationship between irradiated-dose area and severity. / Takeda, Atsuya; Shigematsu, Naoyuki; Suzuki, Saburosuke; Fujii, Masato; Kawata, Tetsuya; Kawaguchi, Osamu; Uno, Takashi; Takano, Hideyuki; Kubo, Atsushi; Ito, Hisao.

In: International Journal of Radiation Oncology Biology Physics, Vol. 44, No. 3, 01.06.1999, p. 599-605.

Research output: Contribution to journalArticle

Takeda, Atsuya ; Shigematsu, Naoyuki ; Suzuki, Saburosuke ; Fujii, Masato ; Kawata, Tetsuya ; Kawaguchi, Osamu ; Uno, Takashi ; Takano, Hideyuki ; Kubo, Atsushi ; Ito, Hisao. / Late retinal complications of radiation therapy for nasal and paranasal malignancies : Relationship between irradiated-dose area and severity. In: International Journal of Radiation Oncology Biology Physics. 1999 ; Vol. 44, No. 3. pp. 599-605.
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abstract = "Purpose: Radiation-induced cataract, once a notorious ocular complication of radiation therapy, is no longer considered a severe complication, because visual acuity can be restored by surgical treatment without significant complications. Late retinal complications of retinopathy and glaucoma, for which there is no effective method of treatment, have become serious complications of radiotherapy of the head and neck. We retrospectively investigated the risk of late retinal complications of radiotherapy for nasal and paranasal malignancies according to the radiation dose and area of the retina irradiated. Methods and Materials: Between October 1982 and May 1996, 43 eyes of 25 patients were exposed to fractionated external-beam irradiation for treatment of advanced nasal and paranasal cancer. None of the patients had tumor invasion into the eyes. The patients were followed ophthalmologically for a minimum of 2 years (range 2.0-11, mean 4.5, median 3.3). The radiation dose and area of the retina irradiated were estimated from the dose distribution figures calculated using the portal films and CT scan. Results: Major late adverse effects of radiotherapy were observed in the retina in 9 of 43 eyes (in 8/25 patients). Radiation retinopathy was observed in 7 eyes, and the cumulative incidence was 25{\%}. The median interval before the onset of symptoms attributable to retinopathy was 32 months (range 16-60). Neovascular glaucoma developed in 3 of the 43 eyes, with a cumulative incidence of 7{\%}. The median period to the onset of symptoms attributable to glaucoma was 22 months (range 16-26). Obstruction of the central retinal artery was observed in 1 eye. The irradiation doses to the retinas that developed late complications ranged between 54-75 Gy (mean 61, median 61). No patients who received less than 50 Gy developed retinal complications. The retina in 21 eyes was exposed to a dose of 50 Gy or more. In 13 of the 21 eyes, 60{\%} or more of the retina was irradiated, and 8 of the eyes (62{\%}) in this group (≥ 50 Gy, ≥ 60{\%}) developed severe retinal complications, whereas such complications only developed in 1 of the 8 eyes (13{\%}) in the other group (≥ 50 Gy, ≥ 60{\%}). The results suggest that the radiation dose and area irradiated are the most important factors in the development of severe complications. Conclusion: Radiation-induced retinopathy and glaucoma are more serious late complications than cataracts, which are easily treated with surgery. We investigated the risk of late retinal complications of radiotherapy, and our findings suggested that the radiation dose and area irradiated are the most important factors in the development of severe complications. We recommend that the radiation dose and area of the retina irradiated be minimized in patients at risk of eye complications, and the patients should be closely followed by periodic ophthalmologic testing after treatment.",
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AU - Shigematsu, Naoyuki

AU - Suzuki, Saburosuke

AU - Fujii, Masato

AU - Kawata, Tetsuya

AU - Kawaguchi, Osamu

AU - Uno, Takashi

AU - Takano, Hideyuki

AU - Kubo, Atsushi

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N2 - Purpose: Radiation-induced cataract, once a notorious ocular complication of radiation therapy, is no longer considered a severe complication, because visual acuity can be restored by surgical treatment without significant complications. Late retinal complications of retinopathy and glaucoma, for which there is no effective method of treatment, have become serious complications of radiotherapy of the head and neck. We retrospectively investigated the risk of late retinal complications of radiotherapy for nasal and paranasal malignancies according to the radiation dose and area of the retina irradiated. Methods and Materials: Between October 1982 and May 1996, 43 eyes of 25 patients were exposed to fractionated external-beam irradiation for treatment of advanced nasal and paranasal cancer. None of the patients had tumor invasion into the eyes. The patients were followed ophthalmologically for a minimum of 2 years (range 2.0-11, mean 4.5, median 3.3). The radiation dose and area of the retina irradiated were estimated from the dose distribution figures calculated using the portal films and CT scan. Results: Major late adverse effects of radiotherapy were observed in the retina in 9 of 43 eyes (in 8/25 patients). Radiation retinopathy was observed in 7 eyes, and the cumulative incidence was 25%. The median interval before the onset of symptoms attributable to retinopathy was 32 months (range 16-60). Neovascular glaucoma developed in 3 of the 43 eyes, with a cumulative incidence of 7%. The median period to the onset of symptoms attributable to glaucoma was 22 months (range 16-26). Obstruction of the central retinal artery was observed in 1 eye. The irradiation doses to the retinas that developed late complications ranged between 54-75 Gy (mean 61, median 61). No patients who received less than 50 Gy developed retinal complications. The retina in 21 eyes was exposed to a dose of 50 Gy or more. In 13 of the 21 eyes, 60% or more of the retina was irradiated, and 8 of the eyes (62%) in this group (≥ 50 Gy, ≥ 60%) developed severe retinal complications, whereas such complications only developed in 1 of the 8 eyes (13%) in the other group (≥ 50 Gy, ≥ 60%). The results suggest that the radiation dose and area irradiated are the most important factors in the development of severe complications. Conclusion: Radiation-induced retinopathy and glaucoma are more serious late complications than cataracts, which are easily treated with surgery. We investigated the risk of late retinal complications of radiotherapy, and our findings suggested that the radiation dose and area irradiated are the most important factors in the development of severe complications. We recommend that the radiation dose and area of the retina irradiated be minimized in patients at risk of eye complications, and the patients should be closely followed by periodic ophthalmologic testing after treatment.

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KW - Glaucoma

KW - Late effect

KW - Nasal and paranasal cancer

KW - Radiotherapy

KW - Retinopathy

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