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
. 2017 May 30;41(5):287-290.
doi: 10.1080/01658107.2017.1322989. eCollection 2017 Oct.

Bilateral Radiation Optic Neuropathy Following Concurrent Chemotherapy and Radiation in Glioblastoma

Jigisha P Thakkar  1 , John T Slevin  1   2 , Charles D Smith  1 , Padmaja Sudhakar  1 , William St Clair  3 , John L Villano  1   4
Affiliations

Bilateral Radiation Optic Neuropathy Following Concurrent Chemotherapy and Radiation in Glioblastoma

Jigisha P Thakkar et al. Neuroophthalmology. .

Abstract

Radiation optic neuropathy (RON) is an iatrogenic complication that causes severe, irreversible vision loss within months to years following radiation to lesions close to the visual pathway. The authors describe a case of RON in glioblastoma after radio-sensitisation with temozolomide with sequential involvement of both optic nerves. This case provides a timeline for clinical and imaging findings with RON and specifically resolution of nerve enhancement. The authors also highlight the potential of an increase in incidence of RON in glioblastoma with advances in survival seen with greater use of second-line chemotherapy and even re-radiation.

Keywords: Glioblastoma; radiation optic neuropathy; temozolomide.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Gadolinium-enhanced coronal (A) and axial (B) pre-surgical T1-weighted images demonstrating an irregular nodular and cystic mass in the right temporal lobe with associated shift to the left. Optic nerves (red arrowheads in A) are not displaced by the mass effect and do not enhance.
Figure 2.
Figure 2.
Enhanced coronal post-surgical T1-weighted images showing optic nerve abnormalities following radiation and temozolomide treatment. The optic nerves are indicated by red arrows; white asterisks denote abnormal enhancement. (A) At 36 weeks after beginning of therapy, there is enhancement of the left optic nerve after exiting the optic canal. The optic tracts and intracanalicular and orbital regions of the nerve were unaffected (not shown). (B) Approximately 9 weeks after the scan shown in A, both optic nerves now enhance. Subtle enhancement of the left optic chiasm was present, but not in other regions of the nerve (not shown). (C) After a further 9 weeks, persistent but decreased enhancement is seen in the right optic nerve. (D) Isodose curves for delivered radiation to the tumour. Orange asterisks indicate optic nerve locations. Dose estimates on labeled curves: 1–30 Gy; 2–48 Gy; 3–54 Gy; 4–57 Gy.
See this image and copyright information in PMC

References

    1. Lessell S. Friendly fire: neurogenic visual loss from radiation therapy. J Neuro-ophthalmol 2004;24:243–250. - PubMed
    1. Roden D, Bosley TM, Fowble B, Clark J, Savino PJ, Sergott RC, Schatz NJ.. Delayed radiation injury to the retrobulbar optic nerves and chiasm. Clinical syndrome and treatment with hyperbaric oxygen and corticosteroids. Ophthalmology 1990;97:346–351. - PubMed
    1. Kline LB, Kim JY, Ceballos R.. Radiation optic neuropathy. Ophthalmology 1985;92:1118–1126. - PubMed
    1. Demizu Y, Murakami M, Miyawaki D, Niwa Y, Akagi T, Sasaki R, Terashima K, Suga D, Kamae I, Hishikawa Y.. Analysis of Vision loss caused by radiation-induced optic neuropathy after particle therapy for head-and-neck and skull-base tumors adjacent to optic nerves. Int J Radiat Oncol Biol Phys 2009;75:1487–1492. - PubMed
    1. Hayreh SS. Anterior ischaemic optic neuropathy. I. Terminology and pathogenesis. Br J Ophthalmol 1974;58:955–963. - PMC - PubMed

LinkOut - more resources