Radiation-induced bilateral optic neuropathy in cancer of the nasopharynx: Case failure analysis and a review of the literature

• Published in: Strahlentherapie und Onkologie 1999-01, Vol.175 (1), p.21-27
• Main Authors: WIJERS, O. B, LEVENDAG, P. C, LUYTEN, G. P. M, BAKKER, B. A, FRELING, N. J. M, KLESMAN-BRADLEY, J, WOUDSTRA, E
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Blindness - etiology; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - radiotherapy; Combined Modality Therapy; Diseases of the upper aerodigestive tract; Dose-Response Relationship, Radiation; Ent and stomatology; Failure analysis; Fluorescein Angiography; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Nasopharyngeal Neoplasms - diagnosis; Nasopharyngeal Neoplasms - drug therapy; Nasopharyngeal Neoplasms - radiotherapy; Optic Chiasm - radiation effects; Optic Nerve - radiation effects; Optic Neuropathy, Ischemic - diagnosis; Optic Neuropathy, Ischemic - etiology; Radiation therapy; Radiotherapy - adverse effects; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, High-Energy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Time Factors; Tomography, X-Ray Computed
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/BF02743457

A case history of unanticipated radiation-induced bilateral optic neuropathy, 18 months after induction chemotherapy and radiation therapy for a locally advanced nasopharyngeal carcinoma, is presented. Retrospective reanalysis of the radiation therapy technique, with emphasis on the doses received by the optic pathway structures, was performed. These re-calculations revealed unexpectedly high doses in the range 79 to 82 Gy (cumulative external and brachytherapy dose) at the level of the optic nerves, which explained the observed radiation injury. Routine implementation of computed tomography for 3D dose planning purposes is therefore advocated. Review of the current literature confirms the importance of 3D dose planning in avoiding this complication and high-lights the role of MRI in establishing the diagnosis of radiation-induced optic neuropathy.