Bhandare Niranjan, Monroe Alan T, Morris Christopher G, Bhatti M Tariq, Mendenhall William M
Department of Radiation Oncology, Health Science Center, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Int J Radiat Oncol Biol Phys. 2005 Jul 15;62(4):1070-7. doi: 10.1016/j.ijrobp.2004.12.009.
To analyze the parameters that influence the risk of radiation-induced optic neuropathy (RION) after radiotherapy for head-and-neck tumors.
Between 1964 and 2000, 273 patients with tumors of the nasopharynx, paranasal sinuses, nasal cavity, and hard palate adenoid cystic carcinomas were treated with curative intent and had radiation fields that included the optic nerves and/or chiasm. Patients were followed for at least 1 year after radiotherapy.
Radiation-induced optic neuropathy developed in 32 eyes of 24 patients (9%). The 5-year rates of freedom from RION according to the total dose and once- vs. twice-daily fractionation were as follows: < or =63 Gy once daily, 95%; < or =63 Gy twice daily, 98%; >63 Gy once daily, 78%; and >63 Gy twice daily, 91%. Multivariate analysis revealed that the total dose affected the risk of RION (p = 0.0047), with patient age (p = 0.0909), once-daily vs. twice-daily fractionation (p = 0.0684), and overall treatment time (p = 0.0972) were marginally significant. The use of adjuvant chemotherapy did not significantly influence the likelihood of developing RION.
The likelihood of developing RION is primarily influenced by the total dose. Hyperfractionation may reduce the risk of experiencing this complication.
分析影响头颈部肿瘤放疗后放射性视神经病变（RION）风险的参数。
1964年至2000年间，273例患有鼻咽癌、鼻窦癌、鼻腔癌和硬腭腺样囊性癌的患者接受了根治性治疗，其放射野包括视神经和/或视交叉。放疗后对患者进行至少1年的随访。
24例患者的32只眼睛（9%）发生了放射性视神经病变。根据总剂量以及每日一次与每日两次分割放疗，5年无RION发生率如下：每日一次≤63 Gy，95%；每日两次≤63 Gy，98%；每日一次>63 Gy，78%；每日两次>63 Gy，91%。多因素分析显示，总剂量影响RION风险（p = 0.0047），患者年龄（p = 0.0909）、每日一次与每日两次分割放疗（p = 0.0684）以及总治疗时间（p = 0.0972）的影响接近显著。辅助化疗的使用对发生RION的可能性没有显著影响。
发生RION的可能性主要受总剂量影响。超分割放疗可能降低发生这种并发症的风险。
