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• W2104544107 abstract "To evaluate functional integrity of the optic nerve and chiasm after radiotherapy and thus assess the radiation tolerance dose of the visual pathway. Thirty patients who received significant radiation doses (greater than 36 Gy) to the optic nerve and chiasm from 1977 to 2001 for treatment of various malignancies (13 pituitary adenoma, 4 astrocytoma, 3 medulloblastoma, 2 ependymoma, 2 cranipharyngioma, 2 rhabdomyosarcoma, 1 optic glioma, 1 mixed astrocytoma, 1 hemagioendothelioma, 1 non-Hodgkin’s lymphoma) were included in this study. Dose to the optic nerve and chiasm ranged from 36 Gy to 60 Gy (five:>35 G, <40 Gy; three:>40 Gy, <45 Gy; five:>45 Gy, <50 Gy; fourteen:>50 Gy, <55 Gy; three:>55 Gy, <60 Gy). All patients were treated in 1.8 Gy or 2.0 Gy daily fractions. Age at RT ranged from 5 to 79 years(mean age of 30.5 years old). The function of the optic nerve and chiasm was evaluated for each patient with visual evoked response (VER) testing. The mean time from RT to VER was 4.9 years (ranged from less than one year to 17 years). VERs record electrical responses from visual stimulation. Pattern, amplitude, and latency (time from stimulation to response) were recorded and analyzed to discriminate radiation effects from other causes of abnormalities. Twelve of 30 patients (40.0%) demonstrated abnormal VER results. Of patients with abnormal VER findings, three (25.0%), four (33.3%), and five (41.7%) were found to have decreased amplitude only, increased latency only, and both, respectively. Abnormal VER findings were attributed to tumor compression or infiltration in 10 of these 12 patients (83.3%). One patient’s abnormal VER could not be explained. One patient who received 45 Gy to the optic nerve and chiasm when he was 5 years old for ependymoma (15 years prior to VER) was found to have mildly increased latency bilaterally. Clinically, he was asymptomatic (visual acuity with correction: OD 20/15, OS 20/20). This was interpreted to be due to radiation. Overall, only 1 of 30 patients (3.3%) was found to have abnormal VER findings due to radiotherapy. Following radiotherapy to the anterior visual pathway, most patients do not demonstrate functional changes of the optic nerve and chiasm that can be attributed to radiation. Radiation doses up to 60 Gy given in conventional fractionation appears to be well tolerated by the optic nerve and chiasm in most patients. Further studies involving more patients and systematic evaluations (e.g. pre and post-RT VER) are needed to more accurately determine the radiation tolerance dose of the optic nerve and chiasm as well as pathogenesis of radiation optic neuropathy" @default.
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• W2104544107 date "2004-09-01" @default.
• W2104544107 modified "2023-09-28" @default.
• W2104544107 title "Optic nerve and chiasmatic tolerance to radiotherapy" @default.
• W2104544107 doi "https://doi.org/10.1016/j.ijrobp.2004.07.288" @default.
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