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Table 4 Optic toxicity after IMRT for sinonasal malignancies

From: Intensity modulated radiotherapy for sinonasal malignancies with a focus on optic pathway preservation

Ref.

#

Median follow up (mo)

Stage

Prescription dose

Local control

Dose to the optic pathway

Vision impairment

Blindness

Madani [22]CTCAE v2

84

40

T4: 29%

70 Gy/35 frx

77.4%

ON/OC constraint: V60 <5%.

Acute: 1.4%

None

Actual Dose to 2% vol¶:

Late:1.4% Grade 3 visual impairment related to IMRT in non-previously treated pts; 2.7% grade 3 impairment due to tumor invasion in both non-previously irradiated & re-irradiated pts

ON:

Ipsilateral 58.4 Gy; Contralateral 51.3 Gy

OC: 47.4 Gy

Combs [23]

46

16

T4: 65%

PTV 60 Gy/30 frx, bst CTV 66 Gy/33 frxǂ

81% at 2 yrs

ON/OC constraint: 54 Gy.

None

None

RON: 37.9 Gyǂ

LON: 37.4 Gyǂ

OC: 25.3 Gyǂ

Daly [24]

36

51

T4: 69%

GTV 70 Gy/33 frx, CTV 58 Gy/33 frxǂ

63.9%

ON/OC constraints: D1% 54 Gy (ON), 45 Gy (OC).

N/a

None

Actual Dmax:

OC: 52.3 Gy¶;

ON:

Ipsilateral 59.1 Gy¶

Contralateral 45.2 Gy¶

Hoppe [25]*

37

28

T4: 55%

PTV1 70 Gy

72.9%

ON/OC constraint: < 54 Gy.

No RTOG grade 3–4 toxicity

None

PTV2 60 Gy

Actual Dmax:

PTV3 54 Gy

ON

All in 33 frx

ipsilateral 53 Gyǂ

contralateral 41 Gyǂ

OC 50 Gyǂ

Wiegner [26]CTCAE v3

52

26.6

T4: 76%

High risk PTV 66 Gy/33 frx, 74.4 Gy, 1.2 Gy bid in 5 pts; SRS/SRT bst in 4 pts: 8 Gy x 1 frx or 5 Gy x 2 frx

75%

ON/OC constraint: 45 Gy, 63 Gy if treated with bid schedule.

1 grade 3 optic neuropathy related to herpes zoster infection, 1 grade 3 corneal ulcer

None

Postoperative: 77%

     

Definitive: 60%

   
  1. #: number of patients, *PTV1: residual disease, PTV2: surgical bed/areas at high risk for microscopic involvement, PTV3: elective nodal regions; n/a not available; ǂ median dose; ¶ average dose; ON optic nerve; OC optic chiasm; pts patients.