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
Review
. 2023 Mar 27;15(7):1999.
doi: 10.3390/cancers15071999.

Radiation-Induced Retinopathy and Optic Neuropathy after Radiation Therapy for Brain, Head, and Neck Tumors: A Systematic Review

Buket Kinaci-Tas  1 , Tanja Alderliesten  1 , Frank D Verbraak  2 , Coen R N Rasch  1
Affiliations
Review

Radiation-Induced Retinopathy and Optic Neuropathy after Radiation Therapy for Brain, Head, and Neck Tumors: A Systematic Review

Buket Kinaci-Tas et al. Cancers (Basel). .

Abstract

Background: Patients with brain, head, and neck tumors experience a decline in their quality of life due to radiation retinopathy and optic neuropathy. Little is known about the dose-response relationship and patient characteristics. We aimed to systematically review the prevalence of radiation retinopathy and optic neuropathy.

Method: The primary outcome was the pooled prevalence of radiation retinopathy and optic neuropathy. The secondary outcome included the effect of the total radiation dose prescribed for the tumor according to the patient's characteristics. Furthermore, we aimed to evaluate the radiation dose parameters for organs at risk of radiation retinopathy and optic neuropathy.

Results: The pooled prevalence was 3.8%. No retinopathy was reported for the tumor's prescribed dose of <50 Gy. Optic neuropathy was more prevalent for a prescribed dose of >50 Gy than <50 Gy. We observed a higher prevalence rate for retinopathy (6.0%) than optic neuropathy (2.0%). Insufficient data on the dose for organs at risk were reported.

Conclusion: The prevalence of radiation retinopathy was higher compared to optic neuropathy. This review emphasizes the need for future studies considering retinopathy and optic neuropathy as primary objective parameters.

Keywords: brain tumors; head and neck tumors; radiation optic neuropathy; radiation retinopathy; radiation therapy.

PubMed Disclaimer

Conflict of interest statement

Tanja Alderliesten is involved in projects supported by Elekta AB, Stockholm, Sweden. Buket Kinaci-Tas, Frank Verbraak, and Coen R.N. Rasch declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram demonstrating the selection process of the included studies.
Figure 2
Figure 2
Bubble plot showing the prevalence of radiation-induced retinopathy plotted against the tumor’s prescribed dose (Gy). The size of the points is drawn proportional to the total number of patients in the studies (167). Based on the mixed-effects meta-regression model, the predicted average prevalence as a function of the tumor’s prescribed dose is also shown in the plot, with a corresponding 95% confidence interval.
Figure 3
Figure 3
Bubble plot showing the prevalence of radiation-induced optic neuropathy plotted against the tumor’s prescribed dose (Gy). The size of the points is drawn proportional to the total number of patients in the studies. Based on the mixed-effects meta-regression model, the predicted average prevalence of radiation-induced optic neuropathy as a function of the tumor’s prescribed dose is also shown in the plot with a corresponding 95% confidence interval.
Figure 4
Figure 4
Forest plot of studies that reported radiation-induced retinopathy events [1,7,21,23,24,25,26,27,29,30,31,32,33,34,35,36,37,38,39,40,42,44,45,46,47,48,49].
Figure 5
Figure 5
Forest plot of the studies that reported radiation-induced optic neuropathy events [1,15,19,20,21,22,26,28,31,32,33,35,36,38,39,40,42,43,44,45,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92].
Figure 6
Figure 6
Forest plot of subgroup studies that reported radiation-induced optic neuropathy events, <50 Gy (p= 0) and >50 Gy (p = 1) [1,19,22,26,28,35,39,40,41,42,43,44,45,49,51,52,54,55,59,60,61,62,65,71,73,75,77,79,81,85,87,89].
See this image and copyright information in PMC

References

    1. Jiang G.L., Tucker S.L., Guttenberger R., Peters L.J., Morrison W.H., Garden A.S., Ha C.S., Ang K.K. Radiation-induced injury to the visual pathway. Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol. 1994;30:17–25. doi: 10.1016/0167-8140(94)90005-1. - DOI - PubMed
    1. Mayo C., Martel M.K., Marks L.B., Flickinger J., Nam J., Kirkpatrick J. Radiation dose-volume effects of optic nerves and chiasm. Int. J. Radiat. Oncol. Biol. Phys. 2010;76((Suppl. S3)):S28–S35. doi: 10.1016/j.ijrobp.2009.07.1753. - DOI - PubMed
    1. Jansen E.P., Dewit L.G., van Herk M., Bartelink H. Target volumes in radiotherapy for high-grade malignant glioma of the brain. Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol. 2000;56:151–156. doi: 10.1016/S0167-8140(00)00216-4. - DOI - PubMed
    1. Jansen E.P., Keus R.B., Hilgers F.J., Haas R.L., Tan I.B., Bartelink H. Does the combination of radiotherapy and debulking surgery favor survival in paranasal sinus carcinoma? Int. J. Radiat. Oncol. Biol. Phys. 2000;48:27–35. doi: 10.1016/S0360-3016(00)00594-0. - DOI - PubMed
    1. Reichstein D. Current treatments and preventive strategies for radiation retinopathy. Curr. Opin. Ophthalmol. 2015;26:157–166. doi: 10.1097/ICU.0000000000000141. - DOI - PubMed

LinkOut - more resources