Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Dec;86(1032):20130459.
doi: 10.1259/bjr.20130459. Epub 2013 Oct 28.

Clinical-dosimetric relationship between lacrimal gland dose and ocular toxicity after intensity-modulated radiotherapy for sinonasal tumours

S S Batth  1 , R Sreeraman, E Dienes, L A Beckett, M E Daly, J Cui, M Mathai, J A Purdy, A M Chen
Affiliations

Clinical-dosimetric relationship between lacrimal gland dose and ocular toxicity after intensity-modulated radiotherapy for sinonasal tumours

S S Batth et al. Br J Radiol. 2013 Dec.

Abstract

Objective: To characterise the relationship between lacrimal gland dose and ocular toxicity among patients treated by intensity-modulated radiotherapy (IMRT) for sinonasal tumours.

Methods: 40 patients with cancers involving the nasal cavity and paranasal sinuses were treated with IMRT to a median dose of 66.0 Gy. Toxicity was scored using the Radiation Therapy Oncology Group morbidity criteria based on conjunctivitis, corneal ulceration and keratitis. The paired lacrimal glands were contoured as organs at risk, and the mean dose, maximum dose, V10, V20 and V30 were determined. Statistical analysis was performed using logistic regression and the Akaike information criterion (AIC).

Results: The maximum and mean dose to the ipsilateral lacrimal gland were 19.2 Gy (range, 1.4-75.4 Gy) and 14.5 Gy (range, 11.1-67.8 Gy), respectively. The mean V10, V20 and V30 values were 50%, 25% and 17%, respectively. The incidence of acute and late Grade 3+ toxicities was 23% and 19%, respectively. Based on logistic regression and AIC, the maximum dose to the ipsilateral lacrimal gland was identified as a more significant predictor of acute toxicity (AIC, 53.89) and late toxicity (AIC, 32.94) than the mean dose (AIC, 56.13 and 33.83, respectively). The V20 was identified as the most significant predictor of late toxicity (AIC, 26.81).

Conclusion: A dose-response relationship between maximum dose to the lacrimal gland and ocular toxicity was established. Our data suggesting a threshold relationship may be useful in establishing dosimetric guidelines for IMRT planning that may decrease the risk of acute and late lacrimal toxicities in the future.

Advances in knowledge: A threshold relationship between radiation dose to the lacrimal gland and ocular toxicity was demonstrated, which may aid in treatment planning and reducing the morbidity of radiotherapy for sinonasal tumours.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Representative contours of the paired lacrimal glands on axial CT imaging at (a) the level closest to the widest part of the lens, (b) mid-gland and (c) the superior aspect.
Figure 2.
Figure 2.
Isodose lines representing 20, 30, and 40 Gy for a patient who developed Grade 3 acute and late ocular toxicities after the treatment of a sphenoid sinus tumor.
Figure 3.
Figure 3.
Dot plots illustrating the relationship between maximum dose to the lacrimal gland and corresponding (a) acute and (b) late toxicity grades. Max, maximum.
Figure 4.
Figure 4.
Dot plot illustrating the relationship between acute toxicity and subsequent late toxicity.
See this image and copyright information in PMC

References

    1. Zoukhri D. Effect of inflammation on lacrimal gland function. Exp Eye Res 2006;82:885–98 10.1016/j.exer.2005.10.018 - DOI - PMC - PubMed
    1. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007;5:75–92 - PubMed
    1. Nakissa N, Rubin P, Strohl R, Keys H. Ocular and orbital complications following radiation therapy of paranasal sinus malignancies and review of literature. Cancer 1983;51:980–6 - PubMed
    1. Morita K, Kawabe Y. Late effects on the eye of conformation radiotherapy for carcinoma of the paranasal sinuses and nasal cavity. Radiology. 1979;130:227–32 10.1148/130.1.227 - DOI - PubMed
    1. Bessell EM, Henk JM, Whitelocke RA, Wright JE. Ocular morbidity after radiotherapy of orbital and conjunctival lymphoma. Eye (Lond) 1987;1(Pt 1):90–6 10.1038/eye.1987.14 - DOI - PubMed

MeSH terms