title: Dose-response of critical structures in the posterior eye segment to hypofractioned stereotactic photon radiotherapy of choroidal melanoma.
abstract: OBJECTIVE
  To identify modifying factors and dose-/volume-response relationships for the retina and optic nerve related to highly conformal hypofractionated radiotherapy.
  
  
  METHODS
  Seventy-three patients undergoing hypofractionated stereotactic photon radiotherapy of choroidal melanoma were included in this retrospective study. The volumes of the optic nerve receiving doses of more than 7.5 or 12 Gy, respectively, were defined. Optic nerve circumference included in the 30%, 40%, 50%, or 80% isodose (ON%) and retina included in 30% or 40% were determined as quantal effects. Univariate and multivariate analyses were performed for clinical variables as well as probit analysis to define EDx (doses where a positive response is expected in x% of the cases).
  
  
  RESULTS
  Median follow-up was 90.0 (interquartile range 69.0-98.0) months. Fifty-two (71%) and 49 (67%) patients developed radiation retinopathy and optic neuropathy (any grade). Age, length of follow-up and diabetes were significant parameters regarding retinopathy. Optic neuropathy was significantly influenced by age, length of follow-up, and ON30. The probability of optic neuropathy (any grade and grade ≥ 2) significantly increases with the dose (p ranges from 0.0126 to 0.0211).
  
  
  CONCLUSIONS
  Treatment planning should aim at minimizing encompassing isodoses particularly in the low dose region, without compromising PTV coverage.
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Austria.
authors.forename: Roman
authors.initials: R
authors.lastname: Dunavoelgyi
authors.forename: Dietmar
authors.initials: D
authors.lastname: Georg
authors.forename: Martin
authors.initials: M
authors.lastname: Zehetmayer
authors.forename: Ursula
authors.initials: U
authors.lastname: Schmidt-Erfurth
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dörr
authors.forename: Karin
authors.initials: K
authors.lastname: Dieckmann
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria; D002830:Choroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009900:Optic Nerve / Q000473:pathology / Q000528:radiation effects*; D009901:Optic Nerve Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D011832:Radiation Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Dose–response; Eye; Optic nerve; Stereotactic hypofractionation