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

Michael T. Milano, Jimm Grimm, Scott G. Soltys, Ellen Yorke, Vitali Moiseenko, Wolfgang A. Tome, Arjun Sahgal, Jinyu Xue, Lijun Ma, Timothy D. Solberg, John P. Kirkpatrick, Louis S. Constine, John C. Flickinger, Lawrence B. Marks, Issam El Naqa

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
JournalInternational Journal of Radiation Oncology Biology Physics
DOIs
StateAccepted/In press - Jan 1 2018

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Optic Chiasm
Radiosurgery
Optic Nerve
chiasms
nerves
optics
Radiation
dosage
radiation
Radiotherapy
radiation therapy
Optic Nerve Neoplasms
tumors
Optic Nerve Glioma
Craniopharyngioma
Neoplasms
Cavernous Sinus
toxicity
Skull Base
Pituitary Neoplasms

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways. / Milano, Michael T.; Grimm, Jimm; Soltys, Scott G.; Yorke, Ellen; Moiseenko, Vitali; Tome, Wolfgang A.; Sahgal, Arjun; Xue, Jinyu; Ma, Lijun; Solberg, Timothy D.; Kirkpatrick, John P.; Constine, Louis S.; Flickinger, John C.; Marks, Lawrence B.; El Naqa, Issam.

In: International Journal of Radiation Oncology Biology Physics, 01.01.2018.

Research output: Contribution to journalArticle

Milano, MT, Grimm, J, Soltys, SG, Yorke, E, Moiseenko, V, Tome, WA, Sahgal, A, Xue, J, Ma, L, Solberg, TD, Kirkpatrick, JP, Constine, LS, Flickinger, JC, Marks, LB & El Naqa, I 2018, 'Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways', International Journal of Radiation Oncology Biology Physics. https://doi.org/10.1016/j.ijrobp.2018.01.053
Milano, Michael T. ; Grimm, Jimm ; Soltys, Scott G. ; Yorke, Ellen ; Moiseenko, Vitali ; Tome, Wolfgang A. ; Sahgal, Arjun ; Xue, Jinyu ; Ma, Lijun ; Solberg, Timothy D. ; Kirkpatrick, John P. ; Constine, Louis S. ; Flickinger, John C. ; Marks, Lawrence B. ; El Naqa, Issam. / Single- and Multi-Fraction Stereotactic Radiosurgery Dose Tolerances of the Optic Pathways. In: International Journal of Radiation Oncology Biology Physics. 2018.
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AU - Milano, Michael T.

AU - Grimm, Jimm

AU - Soltys, Scott G.

AU - Yorke, Ellen

AU - Moiseenko, Vitali

AU - Tome, 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

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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.

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