Dry eye after whole brain radiation: Analysis from a prospective study.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 198-198
Author(s):  
Rachel Tobillo ◽  
Kevin A. Pearlstein ◽  
Zahra Mahbooba ◽  
Dominic Himchan Moon ◽  
Colette J. Shen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Median Survival ◽  
Dry Eye ◽  
Subjective Evaluation ◽  
Sign Test ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Imaging Results ◽  
Brain Radiation

198 Background: Lacrimal glands (LGs) receive incidental dose of unknown significance in patients undergoing whole brain radiation therapy (WBRT). Median survival following diagnosis of brain metastases is poor, so quality of life is of utmost importance for these patients. We enrolled patients on a prospective observational cohort study with an endpoint of dry eye syndrome, which is not thought to be a toxicity of WBRT. Methods: Patients receiving WBRT for any diagnosis to a total dose of 25 to 40 Gy in 10 to 20 fractions were eligible. Patients received 3D-conformal WBRT using opposed lateral fields covering the skull and C1 or C2 vertebrae. LGs were not prospectively contoured before treatment but were subsequently contoured for dosimetric analysis. Patients completed the single-question Subjective Evaluation of Symptom of Dryness (5-point Likert scale) at baseline, immediately after WBRT (EndRT), 1 month (1M), 3 months (3M), and 6 months (6M). The primary endpoint was change in proportion of patients at 1M experiencing moderate or worse dry eye (defined as symptoms that cause discomfort and interfere with activities). Orbital dose was analyzed as a surrogate for LG dose as LGs were difficult to contour on computed tomography (CT) imaging. Results: 73 enrolled patients were eligible for analysis. There were 69 evaluable patients at EndRT, 55 at 1M, 33 at 3M, and 28 at 6M. Most patients received 30 Gy in 10 fractions. Median bilateral orbit mean dose was 17 Gy. Median bilateral lacrimal mean dose was 25 Gy. Median survival was 8 months. At baseline, 4% of patients had moderate or worse dry eye versus 9% at EndRT, 11% at 1M (1-tailed sign test, p = 0.031), 9% at 3M, and 7% at 6M. No significant relationship was noted between presence of dry eye and CT-contoured lacrimal gland or orbit doses. Conclusions: WBRT appears to cause a small increase in dry eye symptoms. A correlation between dry eye and LG dose was not observed, perhaps due to the overall low rate of toxicity, uncertainty in CT-based contouring of the LGs, set-up variations between planned and delivered doses, and the possibility of non-radiation causes of dry eye. Nonetheless, physicians should be aware of the possible occurrence of dry eye after WBRT, given its potential effects on quality of life.

Symptoms and quality of life in patients with brain metastases receiving whole-brain radiation therapy

2016 ◽  
Vol 24 (11) ◽  
pp. 4747-4759 ◽  
Author(s):  
Erin Wong ◽  
Liying Zhang ◽  
Leigha Rowbottom ◽  
Nicholas Chiu ◽  
Leonard Chiu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Brain Metastases ◽  
Whole Brain Radiation Therapy ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation

scholarly journals NTCP modeling and dose–volume correlations for acute xerostomia and dry eye after whole brain radiation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Panayiotis Mavroidis ◽  
Kevin A. Pearlstein ◽  
Dominic H. Moon ◽  
Victoria Xu ◽  
Trevor J. Royce ◽  
...  
Keyword(s):  
Dry Eye ◽  
Subjective Evaluation ◽  
Secondary Analysis ◽  
Normal Tissue Complication Probability ◽  
Whole Brain ◽  
Conformal Radiation Therapy ◽  
Whole Brain Radiation ◽  
Point Increase ◽  
3D Conformal Radiation Therapy ◽  
Brain Radiation

Abstract Background Whole brain radiation (WBRT) may lead to acute xerostomia and dry eye from incidental parotid and lacrimal exposure, respectively. We performed a prospective observational study to assess the incidence/severity of this toxicity. We herein perform a secondary analysis relating parotid and lacrimal dosimetric parameters to normal tissue complication probability (NTCP) rates and associated models. Methods Patients received WBRT to 25–40 Gy in 10–20 fractions using 3D-conformal radiation therapy without prospective delineation of the parotids or lacrimals. Patients completed questionnaires at baseline and 1 month post-WBRT. Xerostomia was assessed using the University of Michigan xerostomia score (scored 0–100, toxicity defined as ≥ 20 pt increase) and xerostomia bother score (scored from 0 to 3, toxicity defined as ≥ 2 pt increase). Dry eye was assessed using the Subjective Evaluation of Symptom of Dryness (SESoD, scored from 0 to 4, toxicity defined as ≥ 2 pt increase). The clinical data were fitted by the Lyman–Kutcher–Burman (LKB) and Relative Seriality (RS) NTCP models. Results Of 55 evaluable patients, 19 (35%) had ≥ 20 point increase in xerostomia score, 11 (20%) had ≥ 2 point increase in xerostomia bother score, and 13 (24%) had ≥ 2 point increase in SESoD score. For xerostomia, parotid V10Gy–V20Gy correlated best with toxicity, with AUC 0.68 for xerostomia score and 0.69–0.71 for bother score. The values for the D50, m and n parameters of the LKB model were 22.3 Gy, 0.84 and 1.0 for xerostomia score and 28.4 Gy, 0.55 and 1.0 for bother score, respectively. The corresponding values for the D50, γ and s parameters of the RS model were 23.5 Gy, 0.28 and 0.0001 for xerostomia score and 32.0 Gy, 0.45 and 0.0001 for bother score, respectively. For dry eye, lacrimal V10Gy–V15Gy were found to correlate best with toxicity, with AUC values from 0.67 to 0.68. The parameter values of the LKB model were 53.5 Gy, 0.74 and 1.0, whereas of the RS model were 54.0 Gy, 0.37 and 0.0001, respectively. Conclusions Xerostomia was most associated with parotid V10Gy–V20Gy, and dry eye with lacrimal V10Gy–V15Gy. NTCP models were successfully created for both toxicities and may help clinicians refine dosimetric goals and assess levels of risk in patients receiving palliative WBRT.

scholarly journals Prospective Assessment of Patient-Reported Dry Eye Syndrome after Whole Brain Radiation

2019 ◽  
Vol 105 (1) ◽  
pp. S13
Author(s):  
K. Wang ◽  
R. Tobillo ◽  
P. Mavroidis ◽  
R. Pappafotis ◽  
K.A. Pearlstein ◽  
...  
Keyword(s):  
Dry Eye ◽  
Dry Eye Syndrome ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Patient Reported ◽  
Prospective Assessment ◽  
Brain Radiation

Brain Metastases

2017 ◽  
Author(s):  
Jasmin Jo ◽  
David Schiff
Keyword(s):  
Brain Metastases ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Brain Irradiation ◽  
The Past ◽  
Whole Brain Radiation ◽  
Current State ◽  
Brain Radiation ◽  
Definitive Management

In the past, detection of brain metastases signaled the conclusion of aggressive systemic treatment and shifted the focus of care toward palliation. The median survival for patients with single brain metastasis without brain-directed treatment is about a month. Whole brain radiation therapy was the traditional palliative treatment utilized, offering an additional 2 to 5 months. More recently, in addition to whole brain irradiation, the roles of surgery, stereotactic radiosurgery, chemotherapy, and targeted therapies in the definitive management of brain metastases have been investigated in numerous studies. In selected patients, the use of aggressive local therapies can be associated with long survival and good quality of life. This chapter discusses the current state of the art therapeutic options for brain metastases.

scholarly journals A Randomized Controlled Open-Label Pilot Study of Simvastatin Addition to Whole-Brain Radiation Therapy in Patients With Brain Metastases

2016 ◽  
Vol 24 (6) ◽  
pp. 521-528 ◽  
Author(s):  
Manal El-Hamamsy ◽  
Hesham Elwakil ◽  
Amr S. Saad ◽  
May A. Shawki
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Pilot Study ◽  
Control Group ◽  
Open Label ◽  
Randomized Controlled ◽  
Whole Brain Radiation ◽  
Radiological Response ◽  
Brain Radiation

Statins have been reported to have a potential radiosensitizing effect that has not been evaluated in clinical trials. The aim of this study was to evaluate the efficacy and safety of simvastatin in addition to whole-brain radiation therapy (WBRT) in patients with brain metastases (BM). A prospective randomized, controlled, open-label pilot study was conducted on 50 Egyptian patients with BM who were randomly assigned to receive 30-Gy WBRT (control group: 25 patients) or 30 Gy WBRT + simvastatin 80 mg/day for the WBRT period (simvastatin group: 25 patients). The primary outcome was radiological response at 4 weeks after WBRT. Secondary outcomes were 1-year progression-free survival (PFS), 1-year overall survival (OS), and health-related quality of life (HRQL) that was assessed using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and its brain module (BN-20), at baseline, after WBRT, and 4 weeks after WBRT. The addition of simvastatin was tolerated. Twenty-one patients were not evaluated for radiological response because of death (n = 16), noncompliance to follow-up (n = 4), and clinical deterioration (n = 1). Response rates were 60% and 78.6% (p = 0.427), 1-year PFS rates were 5.2% and 17.7% (p = 0.392), and 1-year OS rates were 12% and 8% (p = 0.880) for the control group and simvastatin group, respectively. Nonsignificant differences were found between the two arms regarding HRQL scales. The addition of simvastatin 80 mg/day did not improve the clinical outcomes of patients with BM receiving WBRT.

scholarly journals Prospective Assessment of Patient-Reported Dry Eye Syndrome After Whole Brain Radiation

2019 ◽  
Vol 105 (4) ◽  
pp. 765-772 ◽  
Author(s):  
Kyle Wang ◽  
Rachel Tobillo ◽  
Panayiotis Mavroidis ◽  
Ryan Pappafotis ◽  
Kevin A. Pearlstein ◽  
...  
Keyword(s):  
Dry Eye ◽  
Dry Eye Syndrome ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Patient Reported ◽  
Prospective Assessment ◽  
Brain Radiation

The Louisiana State University Experience in the Management of Single Small Cerebellar Metastasis

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1515-1522 ◽  
Author(s):  
Vijayakumar Javalkar ◽  
Raul Cardenas ◽  
Federico Ampil ◽  
Osama Ahmed ◽  
Runhua Shi ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Gamma Knife ◽  
Median Survival ◽  
Gamma Knife Radiosurgery ◽  
Whole Brain Radiation Therapy ◽  
Treatment Modalities ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation ◽  
Cerebellar Metastasis

Abstract BACKGROUND: Cerebellar metastasis is often believed to be a more immediately life-threatening complication than brain metastasis in other locations. It is considered a negative prognostic factor in patients with systemic cancers. Despite its clinical importance and technological advances, the survival outcomes of patients with single small cerebellar metastases are rarely studied. OBJECTIVE: To retrospectively evaluate our experience in the management of patients with single small cerebellar metastasis and compare the treatment modalities. MATERIAL AND METHODS: A total of 35 patients with single small cerebellar metastasis were included in this retrospective analysis. Of the 35 patients, 24 had surgery followed by whole-brain radiation therapy and 11 had Gamma Knife radiosurgery alone. RESULTS: The median survival for the whole cohort was 5.6 months after the intervention. No significant differences were noted in median survival between the surgery plus whole-brain radiation therapy and the Gamma Knife radiosurgery alone groups (6.3 months: 95% confidence interval [CI], 4.0-8.6; vs 5.0 months: 95% CI, 1.9-8.1; P = .9). There was no difference in the median time to local progression, distance progression, and overall progression between the 2 groups. Patients with hydrocephalus had a significantly lower survival rate (median, 3.3 months; 95% CI, 0.0-6.6) compared with those without hydrocephalus (median, 6.9 months; 95% CI, 4.4-9.8; P = .02). In the Cox regression model, the significant predictor of survival was hydrocephalus (P = .01; hazard ratio, 3.5; 95% CI, 1.3-9.1) after propensity score adjustment. CONCLUSION: Treatment with Gamma Knife radiosurgery alone and surgery plus whole-brain radiation therapy were both efficacious in patients with single small cerebellar metastasis. Overall survival was nearly identical in both treatment groups.

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