Article, 2023

Retinopathy, Optic Neuropathy, and Cataract in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review

International Journal of Radiation Oncology • Biology • Physics, ISSN 1879-355X, 0360-3016, Volume 119, 2, Pages 431-445, 10.1016/j.ijrobp.2023.06.007

Contributors

Shen, Colette J 0000-0002-3855-7360 (Corresponding author) [1] Kry, Stephen Frasier 0000-0001-6899-197X [2] Buchsbaum, Jeffrey Craig 0000-0002-8695-3448 [3] Milano, Michael T 0000-0001-8676-2855 [4] Inskip, Peter D [3] Ulin, Kenneth [5] Francis, Jasmine H 0000-0002-7637-3108 [6] Wilson, Matthew W [7] Whelan, Kimberly F [8] Mayo, Charles S 0000-0003-2030-9892 [9] Olch, Arthur J [10] Constine, Louis Sandy 0000-0003-0742-1740 [4] Terezakis, Stephanie Alicia 0000-0003-4933-6712 [11] Vogelius, Ivan Richter 0000-0002-8877-1218 [12] [13]

Affiliations

  1. [1] University of North Carolina at Chapel Hill
    2. [NORA names: United States; America, North; OECD];
  2. [2] The University of Texas MD Anderson Cancer Center
    3. [NORA names: United States; America, North; OECD];
  3. [3] National Cancer Institute
    4. [NORA names: United States; America, North; OECD];
  4. [4] University of Rochester Medical Center
    5. [NORA names: United States; America, North; OECD];
  5. [5] Imaging and Radiation Oncology Rhode Island QA Center, Lincoln, Rhode Island.
    6. [NORA names: United States; America, North; OECD];

Abstract

PURPOSE: Few reports describe the risks of late ocular toxicities after radiation therapy (RT) for childhood cancers despite their effect on quality of life. The Pediatric Normal Tissue Effects in the Clinic (PENTEC) ocular task force aims to quantify the radiation dose dependence of select late ocular adverse effects. Here, we report results concerning retinopathy, optic neuropathy, and cataract in childhood cancer survivors who received cranial RT. METHODS AND MATERIALS: A systematic literature search was performed using the PubMed, MEDLINE, and Cochrane Library databases for peer-reviewed studies published from 1980 to 2021 related to childhood cancer, RT, and ocular endpoints including dry eye, keratitis/corneal injury, conjunctival injury, cataract, retinopathy, and optic neuropathy. This initial search yielded abstracts for 2947 references, 269 of which were selected as potentially having useful outcomes and RT data. Data permitting, treatment and outcome data were used to generate normal tissue complication probability models. RESULTS: We identified sufficient RT data to generate normal tissue complication probability models for 3 endpoints: retinopathy, optic neuropathy, and cataract formation. Based on limited data, the model for development of retinopathy suggests 5% and 50% risk of toxicity at 42 and 62 Gy, respectively. The model for development of optic neuropathy suggests 5% and 50% risk of toxicity at 57 and 64 Gy, respectively. More extensive data were available to evaluate the risk of cataract, separated into self-reported versus ophthalmologist-diagnosed cataract. The models suggest 5% and 50% risk of self-reported cataract at 12 and >40 Gy, respectively, and 50% risk of ophthalmologist-diagnosed cataract at 9 Gy (>5% long-term risk at 0 Gy in patients treated with chemotherapy only). CONCLUSIONS: Radiation dose effects in the eye are inadequately studied in the pediatric population. Based on limited published data, this PENTEC comprehensive review establishes relationships between RT dose and subsequent risks of retinopathy, optic neuropathy, and cataract formation.

Keywords

Abstract, Cochrane, Cochrane Library databases, Gy, Library databases, MEDLINE, PENTEC, Pediatric Normal Tissue Effects, PubMed, RT data, RT dose, Task Force, cancer, cancer survivors, cataract, cataract formation, childhood, childhood cancer, childhood cancer survivors, clinic, comprehensive review, conjunctival, conjunctival injury, cranial RT, data, data permit, database, dependence, development, development of optic neuropathy, development of retinopathy, dose, dose effect, dose-dependently, dry eye, effect, endpoint, extensive data, eyes, force, formation, injury, life, literature search, model, neuropathy, normal tissue effects, ocular toxicity, optic neuropathy, outcome data, outcomes, pediatric population, peer-reviewed studies, permits, population, published data, quality, quality of life, radiation, radiation dose effect, radiation dose-dependent, radiation therapy, reference, relationship, reports, retinopathy, review, risk, risk of cataract, risk of retinopathy, risk of toxicity, search, self-report, self-reported cataract, study, survivors, systematic literature search, therapy, tissue effects, toxicity, treatment

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