PDF Ophthalmic Radiation Therapy (Developments in Ophthalmology)

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Authors and Affiliations
  1. Better Options Emerging In Ocular Oncology
  2. Paul Finger
  3. Why Choose Us?
  4. Radiation therapy: conjunctival and eyelid tumors. - Semantic Scholar

Kaplan-Meier survival estimates were used to study the development of radiation retinopathy as a function of time. Five hundred sixty Demographics and ocular findings in patients in whom radiation retinopathy developed vs those in whom it did not are listed in Table 1. Of the patients in whom radiation retinopathy developed, were women and were men. The median age was 58 years range, years.

Forty-nine patients 8. Choroidal melanoma was found in The epicenter of the tumor was superior in 27 patients 4. The median largest basal tumor diameter was 10 mm range, mm , and the median tumor thickness was 4 mm range, mm. The median distance of the posterior margin of the tumor to the optic disc was 4 mm range, mm and to the foveola was 3 mm range, mm. Subretinal fluid was present in patients The tumor was dome shaped in patients Extraocular extension was observed in 7 patients 1. Retinal invasion was present in 5 patients 0. The radioisotope I was used in patients A regular, round plaque was used in patients The plaque size ranged from 10 to 25 mm.

The most frequently used plaque size was 15 mm The radiation characteristics for patients in whom radiation retinopathy developed vs those who were free of retinopathy are shown in Table 2. Follow-up ranged from 20 to months median, 61 months ; patients had regular follow-up examinations. The median follow-up times of patients treated with radioisotope I was 57 months; Ru, 64 months; Ir, 72 months; and 60 Co, 81 months. All patients with radiation retinopathy had nonproliferative changes. Radiation maculopathy was found in patients Of the patients, Twelve patients 2.

Forty-seven eyes 8. Fifty-five patients 9. Of the 55 patients with melanoma-related mortality, 6 previously had undergone enucleation. Iodine was the most commonly used radioisotope. Radiation retinopathy is an important complication of plaque radiotherapy of posterior uveal melanoma, often leading to irreversible visual impairment. The diverse manifestations of radiation-induced retinal vascular changes can be divided into nonproliferative and proliferative retinopathy. Radiation maculopathy is a subgroup of nonproliferative retinopathy, diagnosed when any of these changes occur within 3 mm of the foveola.

Proliferative radiation retinopathy is diagnosed when there is retinal or disc neovascularization.

Better Options Emerging In Ocular Oncology

The early manifestations of radiation retinopathy include microaneurysms and telangiectasia as well as retinal edema and exudation from compromise of the retinal capillary bed. Larger vessels are involved later in the course of the disease, and vascular sheathing becomes apparent. When there are large or multiple areas of capillary nonperfusion, retinal and disc neovascularization can develop, sometimes leading to vitreous hemorrhage.

Results of histopathologic studies of the eyes with radiation retinopathy confirm the vascular nature of damage produced by radiation therapy. Although small retinal vessels are commonly involved, larger retinal and choroidal vessels can also be affected. The most important predictor of nonproliferative radiation retinopathy in our study was posterior tumor location. Our results indicate that the peripheral retina may be less susceptible to the damaging effects of irradiation in terms of developing retinopathy.

Similarly in diabetes mellitus, retinal vascular changes most often are found posteriorly near the vascular arcades, more so than in the retinal periphery. It has been reported that clinically and angiographically, radiation retinopathy is virtually identical to diabetic retinopathy.

There has been more emphasis in the literature on the subject of radiation maculopathy because of its profound visual effects.

Paul Finger

In our study, the best subset of independent variables related to the development of radiation maculopathy included tumor margin of less than 4 mm to foveola and radioisotope Ir compared with I on a multivariate level. The higher rate of radiation maculopathy after the use of radioisotope Ir can be explained on the basis of its high energy levels 0.

In our study, radiation maculopathy was found in Radiation maculopathy can manifest with macular edema if capillary abnormalities and leakage predominate and with macular ischemia if perifoveal capillary loss predominates. In a recent study, focal laser treatment was found to improve visual acuity modestly at 6 months in patients with radiation-induced macular edema, but sustained benefit was not achieved at 2 years.

Also By The Authors

Brown et al 6 reported that patients in whom radiation maculopathy developed after plaque radiotherapy received a mean radiation dose of 15, cGy to the fovea vs cGy for those who had no maculopathy. They suggested that plaque radiotherapy doses of less than cGy to the fovea were probably safe. In our study, a fovea radiation dose of greater than cGy was associated with a significantly higher risk for nonproliferative radiation retinopathy on a univariate level.

We agree that a cutoff dose of approximately cGy or less may be tolerated safely by the fovea following plaque radiotherapy. After plaque radiotherapy for posterior uveal melanoma, the most important factors for the development of proliferative radiation retinopathy were diabetes mellitus, radioisotope Ir compared with I, and tumor base of greater than 10 mm. The presence of diabetes mellitus exacerbates the effects of radiation retinopathy.

Therefore, the 2 components of the capillary wall are destroyed by the combined effect of diabetes and radiation, leaving little cellular support behind. The radioisotope Ir is associated with a higher risk for proliferative radiation retinopathy compared with I, due to its higher energy levels.

Larger tumor base is associated with a higher incidence of retinopathy because spillover radiation energy delivered to the surrounding retina is greater when the tumor base is larger. During the past decade, we have been using I as the radioisotope of choice because of its availability, ease of shielding, good tissue penetration, and ability to be custom-designed. The radioisotope 60 Co was used in the earlier part of the study, and many eyes with more posterior tumors may have been enucleated rather than treated with plaque radiotherapy during that period.

Similar cases recently have been treated with I plaque radiotherapy, altering the relative frequency of radiation retinopathy compared with 60 Co.

In this subset of patients, tumor proximity to the foveola was not a significant factor. There are certain limitations of our study that should be considered. First, it is a retrospective study, and more difficult cases may have been sent to us for management because of our special interest in ocular tumors. Second, follow-up may be considered short for a study dealing with posterior uveal melanoma.

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However, we realize from previous reports that radiation retinopathy generally occurs at 1 to 3 years after plaque treatment. Third, mild degrees of radiation retinopathy, especially in the peripheral retina, not resulting in visual loss may have been overlooked in our study. We suspect that many patients had some radiation-related change on or near the tumor. Stereotactic radiation therapy allows radiation beams to be given to a specific area.

Some people have many side effects. Other people have few or none at all. During radiation therapy, the healthcare team protects healthy cells in the treatment area as much as possible. But damage to healthy cells can happen and may cause side effects. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after radiation therapy. Sometimes late side effects develop months or years after radiation therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of radiation therapy will depend mainly on the size of the area being treated and the specific area being treated, the type of radiation therapy, the total dose of radiation and the treatment schedule. Other common side effects are: vision changes , poor vision or loss of vision in the treated eye loss of eyelash or eyebrow a dry, red or teary eye sensitivity to light skin problems fatigue change in eyelid position.

Tell your healthcare team if you have these side effects or others you think might be from radiation therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them. Find out more about radiation therapy and side effects of radiation therapy.

Retinoblastoma Treatment and Eye Cancer Survival Rate

To make the decisions that are right for you, ask your healthcare team questions about radiation therapy. A cloudy area on or within the lens of the eye that reduces vision. Symptoms of cataracts include blurred, cloudy or double vision, sensitivity to light and difficulty seeing at night. Call us toll-free at Or write us.

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We will reply by email or phone if you leave us your details. If we are not able to reach you by phone, we will leave a voicemail message. Learn more. Select the text below and copy the link. Radiation therapy for eye cancer Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may have radiation therapy to: destroy the cancer cells in the eye shrink a tumour in the eye before other treatments such as surgery destroy cancer cells left behind after surgery or chemotherapy to reduce the risk that the cancer will come back recur called adjuvant therapy relieve pain or control the symptoms of advanced eye called palliative therapy The following types of radiation therapy are most commonly used to treat eye cancer.

Brachytherapy Brachytherapy is a type of radiation therapy that uses a radioactive material called a radioactive isotope.

Radiation therapy: conjunctival and eyelid tumors. - Semantic Scholar

External beam radiation therapy During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it. Proton beam radiation therapy Proton beam radiation therapy is a type of charged particle radiation therapy. Stereotactic radiation therapy Stereotactic radiation therapy is another type of external beam radiation therapy that is used to treat melanoma of the eye. Questions to ask about radiation therapy Find out more about radiation therapy and side effects of radiation therapy.

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