目的:很少有报道描述儿童癌症放射治疗(RT)后晚期眼部毒性的风险,尽管它们对生活质量有影响。临床儿科正常组织效应(PENTEC)眼部工作组旨在量化选择晚期眼部不良反应的辐射剂量依赖性。这里,我们报告了视网膜病变的结果,视神经病变,和接受头颅RT的儿童癌症幸存者的白内障。
方法:使用PubMed进行了系统的文献检索,MEDLINE,和Cochrane图书馆数据库,用于1980年至2021年发表的与儿童癌症有关的同行评审研究,RT,和眼部终点,包括干眼,角膜炎/角膜损伤,结膜损伤,白内障,视网膜病变,和视神经病变.最初的搜索产生了2947篇参考文献的摘要,其中269项被选择为可能具有有用的结果和RT数据。数据允许,治疗和结果数据用于生成正常组织并发症概率模型.
结果:我们确定了足够的RT数据来生成3个终点的正常组织并发症概率模型:视网膜病变,视神经病变,和白内障的形成。根据有限的数据,视网膜病变的发展模型表明,在42和62Gy时,有5%和50%的毒性风险,分别。视神经病变的发展模型表明,在57和64Gy时,有5%和50%的毒性风险,分别。更广泛的数据可用于评估白内障的风险,分为自我报告和眼科医生诊断的白内障。模型表明,在12和>40Gy时,自我报告的白内障风险分别为5%和50%。分别,9Gy时,眼科医生诊断为白内障的风险为50%(仅接受化疗的患者在0Gy时的长期风险>5%)。
结论:在儿童人群中对眼睛辐射剂量效应的研究不充分。根据有限的公布数据,这项PENTEC全面审查建立了RT剂量与随后的视网膜病变风险之间的关系,视神经病变,和白内障的形成。
OBJECTIVE: 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: 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.