A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery

Scott L. Stafford, Bruce E. Pollock, Jacqueline A. Leavitt, Robert L. Foote, Paul D. Brown, Michael J. Link, Deborah A. Gorman, Paula J. Schomberg

Research output: Contribution to journalArticle

219 Citations (Scopus)

Abstract

Purpose: To evaluate the risk of clinically significant radiation optic neuropathy (RON) for patients having stereotactic radiosurgery of benign tumors adjacent to the optic apparatus. Methods and Materials: We reviewed the dose plans and clinical outcomes of 218 gamma knife procedures (215 patients) for tumors of the sellar and parasellar region (meningiomas, n = 122; pituitary adenomas, n = 89; craniopharyngiomas, n = 7 patients). Previous surgery or radiation therapy was performed in 156 (66%) and 24 (11%) patients, respectively. Median follow-up was 40 months (range 4-115). Results: The median maximum radiation dose to the optic nerve was 10 Gy (range 0.4-16.0). Four patients (1.9%) developed RON at a median of 48 months after radiosurgery. All had prior surgery, and 3 of 4 had external beam radiotherapy (EBRT) in their management either before (n = 2) or adjuvantly (n = 1). The risk of developing a clinically significant RON was 1.1% for patients receiving 12 Gy or less. Patients receiving prior or concurrent EBRT had a greater risk of developing RON after radiosurgery (p = 0.004). Conclusion: RON occurred in less than 2% of our patients, despite the majority (73%) receiving more than 8 Gy to a short segment of the optic apparatus. Knowledge of the dose tolerance of these structures permits physicians to be more aggressive in treating patients with sellar or parasellar tumors, especially those with hormone-producing pituitary adenomas that appear to require higher doses to achieve biochemical remission.

Original languageEnglish (US)
Pages (from-to)1177-1181
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume55
Issue number5
DOIs
StatePublished - Apr 1 2003

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chiasms
Optic Chiasm
Radiosurgery
Radiation Tolerance
nerves
radiation tolerance
Optic Nerve
optics
Optic Nerve Diseases
Radiation
radiation
radiation therapy
dosage
Radiotherapy
tumors
Pituitary Neoplasms
surgery
pituitary hormones
Craniopharyngioma
Neoplasms

Keywords

  • Optic nerve
  • Radiation injury
  • Radiosurgery

ASJC Scopus subject areas

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

Cite this

Stafford, S. L., Pollock, B. E., Leavitt, J. A., Foote, R. L., Brown, P. D., Link, M. J., ... Schomberg, P. J. (2003). A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. International Journal of Radiation Oncology Biology Physics, 55(5), 1177-1181. https://doi.org/10.1016/S0360-3016(02)04380-8

A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. / Stafford, Scott L.; Pollock, Bruce E.; Leavitt, Jacqueline A.; Foote, Robert L.; Brown, Paul D.; Link, Michael J.; Gorman, Deborah A.; Schomberg, Paula J.

In: International Journal of Radiation Oncology Biology Physics, Vol. 55, No. 5, 01.04.2003, p. 1177-1181.

Research output: Contribution to journalArticle

Stafford, SL, Pollock, BE, Leavitt, JA, Foote, RL, Brown, PD, Link, MJ, Gorman, DA & Schomberg, PJ 2003, 'A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery', International Journal of Radiation Oncology Biology Physics, vol. 55, no. 5, pp. 1177-1181. https://doi.org/10.1016/S0360-3016(02)04380-8
Stafford, Scott L. ; Pollock, Bruce E. ; Leavitt, Jacqueline A. ; Foote, Robert L. ; Brown, Paul D. ; Link, Michael J. ; Gorman, Deborah A. ; Schomberg, Paula J. / A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. In: International Journal of Radiation Oncology Biology Physics. 2003 ; Vol. 55, No. 5. pp. 1177-1181.
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abstract = "Purpose: To evaluate the risk of clinically significant radiation optic neuropathy (RON) for patients having stereotactic radiosurgery of benign tumors adjacent to the optic apparatus. Methods and Materials: We reviewed the dose plans and clinical outcomes of 218 gamma knife procedures (215 patients) for tumors of the sellar and parasellar region (meningiomas, n = 122; pituitary adenomas, n = 89; craniopharyngiomas, n = 7 patients). Previous surgery or radiation therapy was performed in 156 (66{\%}) and 24 (11{\%}) patients, respectively. Median follow-up was 40 months (range 4-115). Results: The median maximum radiation dose to the optic nerve was 10 Gy (range 0.4-16.0). Four patients (1.9{\%}) developed RON at a median of 48 months after radiosurgery. All had prior surgery, and 3 of 4 had external beam radiotherapy (EBRT) in their management either before (n = 2) or adjuvantly (n = 1). The risk of developing a clinically significant RON was 1.1{\%} for patients receiving 12 Gy or less. Patients receiving prior or concurrent EBRT had a greater risk of developing RON after radiosurgery (p = 0.004). Conclusion: RON occurred in less than 2{\%} of our patients, despite the majority (73{\%}) receiving more than 8 Gy to a short segment of the optic apparatus. Knowledge of the dose tolerance of these structures permits physicians to be more aggressive in treating patients with sellar or parasellar tumors, especially those with hormone-producing pituitary adenomas that appear to require higher doses to achieve biochemical remission.",
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