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

Kyle Wang, Rachel Tobillo, Panayiotis Mavroidis, Ryan Pappafotis, Kevin A. Pearlstein, Dominic H. Moon, Zahra M. Mahbooba, Allison M. Deal, Jordan A. Holmes, Nathan C. Sheets, Mohit S. Kasibhatla, Heather D. Pacholke, Trevor J. Royce, Ashley A. Weiner, Colette J. Shen, Timothy M. Zagar, Lawrence B. Marks, Bhishamjit S. Chera

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Dry eye is not typically considered a toxicity of whole brain radiation therapy (WBRT). We analyzed dry eye syndrome as part of a prospective study of patient-reported outcomes after WBRT. Methods and Materials: Patients receiving WBRT to 25 to 40 Gy were enrolled on a study with dry mouth as the primary endpoint and dry eye syndrome as a secondary endpoint. Patients received 3-dimensional WBRT using opposed lateral fields. Per standard practice, lacrimal glands were not prospectively delineated. Patients completed the Subjective Evaluation of Symptom of Dryness (SESoD, scored 0-4, with higher scores representing worse dry eye symptoms) at baseline, immediately after WBRT (EndRT), and at 1 month (1M), 3 months, and 6 months. Patients with baseline SESoD ≥3 (moderate dry eye) were excluded. The endpoints analyzed were ≥1-point and ≥2-point increase in SESoD score at 1M. Lacrimal glands were retrospectively delineated with fused magnetic resonance imaging scans. Results: One hundred patients were enrolled, 70 were eligible for analysis, and 54 were evaluable at 1M. Median bilateral lacrimal V20Gy was 79%. At 1M, 17 patients (32%) had a ≥1-point increase in SESoD score, and 13 (24%) a ≥2-point increase. Lacrimal doses appeared to be associated with an increase in SESoD score of both ≥1 point (V10Gy: P = .042, odds ratio [OR] 1.09/%; V20Gy: P = .071, OR 1.03/%) and ≥2 points (V10Gy: P = .038, OR 1.15/%; V20Gy: P = .063, OR 1.04/%). The proportion with increase in dry eye symptoms at 1M for lacrimal V20Gy ≥79% versus <79% was 46% versus 15%, respectively, for ≥1 point SESoD increase (P = .02) and 36% versus 12%, respectively, for ≥2 point SESoD increase (P = .056). Conclusions: Dry eye appears to be a relatively common, dose/volume-dependent acute toxicity of WBRT. Minimization of lacrimal gland dose may reduce this toxicity, and patients should be counseled regarding the existence of this potential side effect and treatments for dry eye.

Original languageEnglish (US)
Pages (from-to)765-772
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume105
Issue number4
DOIs
StatePublished - Nov 15 2019
Externally publishedYes

Fingerprint

Dry Eye Syndromes
brain
Radiation
Radiotherapy
radiation therapy
Brain
Lacrimal Apparatus
radiation
glands
Tears
Odds Ratio
toxicity
dosage
Cetirizine
Symptom Assessment
mouth
Mouth
magnetic resonance
Magnetic Resonance Imaging
proportion

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Prospective Assessment of Patient-Reported Dry Eye Syndrome After Whole Brain Radiation. / Wang, Kyle; Tobillo, Rachel; Mavroidis, Panayiotis; Pappafotis, Ryan; Pearlstein, Kevin A.; Moon, Dominic H.; Mahbooba, Zahra M.; Deal, Allison M.; Holmes, Jordan A.; Sheets, Nathan C.; Kasibhatla, Mohit S.; Pacholke, Heather D.; Royce, Trevor J.; Weiner, Ashley A.; Shen, Colette J.; Zagar, Timothy M.; Marks, Lawrence B.; Chera, Bhishamjit S.

In: International Journal of Radiation Oncology Biology Physics, Vol. 105, No. 4, 15.11.2019, p. 765-772.

Research output: Contribution to journalArticle

Wang, K, Tobillo, R, Mavroidis, P, Pappafotis, R, Pearlstein, KA, Moon, DH, Mahbooba, ZM, Deal, AM, Holmes, JA, Sheets, NC, Kasibhatla, MS, Pacholke, HD, Royce, TJ, Weiner, AA, Shen, CJ, Zagar, TM, Marks, LB & Chera, BS 2019, 'Prospective Assessment of Patient-Reported Dry Eye Syndrome After Whole Brain Radiation', International Journal of Radiation Oncology Biology Physics, vol. 105, no. 4, pp. 765-772. https://doi.org/10.1016/j.ijrobp.2019.07.015
Wang, Kyle ; Tobillo, Rachel ; Mavroidis, Panayiotis ; Pappafotis, Ryan ; Pearlstein, Kevin A. ; Moon, Dominic H. ; Mahbooba, Zahra M. ; Deal, Allison M. ; Holmes, Jordan A. ; Sheets, Nathan C. ; Kasibhatla, Mohit S. ; Pacholke, Heather D. ; Royce, Trevor J. ; Weiner, Ashley A. ; Shen, Colette J. ; Zagar, Timothy M. ; Marks, Lawrence B. ; Chera, Bhishamjit S. / Prospective Assessment of Patient-Reported Dry Eye Syndrome After Whole Brain Radiation. In: International Journal of Radiation Oncology Biology Physics. 2019 ; Vol. 105, No. 4. pp. 765-772.
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abstract = "Purpose: Dry eye is not typically considered a toxicity of whole brain radiation therapy (WBRT). We analyzed dry eye syndrome as part of a prospective study of patient-reported outcomes after WBRT. Methods and Materials: Patients receiving WBRT to 25 to 40 Gy were enrolled on a study with dry mouth as the primary endpoint and dry eye syndrome as a secondary endpoint. Patients received 3-dimensional WBRT using opposed lateral fields. Per standard practice, lacrimal glands were not prospectively delineated. Patients completed the Subjective Evaluation of Symptom of Dryness (SESoD, scored 0-4, with higher scores representing worse dry eye symptoms) at baseline, immediately after WBRT (EndRT), and at 1 month (1M), 3 months, and 6 months. Patients with baseline SESoD ≥3 (moderate dry eye) were excluded. The endpoints analyzed were ≥1-point and ≥2-point increase in SESoD score at 1M. Lacrimal glands were retrospectively delineated with fused magnetic resonance imaging scans. Results: One hundred patients were enrolled, 70 were eligible for analysis, and 54 were evaluable at 1M. Median bilateral lacrimal V20Gy was 79{\%}. At 1M, 17 patients (32{\%}) had a ≥1-point increase in SESoD score, and 13 (24{\%}) a ≥2-point increase. Lacrimal doses appeared to be associated with an increase in SESoD score of both ≥1 point (V10Gy: P = .042, odds ratio [OR] 1.09/{\%}; V20Gy: P = .071, OR 1.03/{\%}) and ≥2 points (V10Gy: P = .038, OR 1.15/{\%}; V20Gy: P = .063, OR 1.04/{\%}). The proportion with increase in dry eye symptoms at 1M for lacrimal V20Gy ≥79{\%} versus <79{\%} was 46{\%} versus 15{\%}, respectively, for ≥1 point SESoD increase (P = .02) and 36{\%} versus 12{\%}, respectively, for ≥2 point SESoD increase (P = .056). Conclusions: Dry eye appears to be a relatively common, dose/volume-dependent acute toxicity of WBRT. Minimization of lacrimal gland dose may reduce this toxicity, and patients should be counseled regarding the existence of this potential side effect and treatments for dry eye.",
author = "Kyle Wang and Rachel Tobillo and Panayiotis Mavroidis and Ryan Pappafotis and Pearlstein, {Kevin A.} and Moon, {Dominic H.} and Mahbooba, {Zahra M.} and Deal, {Allison M.} and Holmes, {Jordan A.} and Sheets, {Nathan C.} and Kasibhatla, {Mohit S.} and Pacholke, {Heather D.} and Royce, {Trevor J.} and Weiner, {Ashley A.} and Shen, {Colette J.} and Zagar, {Timothy M.} and Marks, {Lawrence B.} and Chera, {Bhishamjit S.}",
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TY - JOUR

T1 - Prospective Assessment of Patient-Reported Dry Eye Syndrome After Whole Brain Radiation

AU - Wang, Kyle

AU - Tobillo, Rachel

AU - Mavroidis, Panayiotis

AU - Pappafotis, Ryan

AU - Pearlstein, Kevin A.

AU - Moon, Dominic H.

AU - Mahbooba, Zahra M.

AU - Deal, Allison M.

AU - Holmes, Jordan A.

AU - Sheets, Nathan C.

AU - Kasibhatla, Mohit S.

AU - Pacholke, Heather D.

AU - Royce, Trevor J.

AU - Weiner, Ashley A.

AU - Shen, Colette J.

AU - Zagar, Timothy M.

AU - Marks, Lawrence B.

AU - Chera, Bhishamjit S.

PY - 2019/11/15

Y1 - 2019/11/15

N2 - Purpose: Dry eye is not typically considered a toxicity of whole brain radiation therapy (WBRT). We analyzed dry eye syndrome as part of a prospective study of patient-reported outcomes after WBRT. Methods and Materials: Patients receiving WBRT to 25 to 40 Gy were enrolled on a study with dry mouth as the primary endpoint and dry eye syndrome as a secondary endpoint. Patients received 3-dimensional WBRT using opposed lateral fields. Per standard practice, lacrimal glands were not prospectively delineated. Patients completed the Subjective Evaluation of Symptom of Dryness (SESoD, scored 0-4, with higher scores representing worse dry eye symptoms) at baseline, immediately after WBRT (EndRT), and at 1 month (1M), 3 months, and 6 months. Patients with baseline SESoD ≥3 (moderate dry eye) were excluded. The endpoints analyzed were ≥1-point and ≥2-point increase in SESoD score at 1M. Lacrimal glands were retrospectively delineated with fused magnetic resonance imaging scans. Results: One hundred patients were enrolled, 70 were eligible for analysis, and 54 were evaluable at 1M. Median bilateral lacrimal V20Gy was 79%. At 1M, 17 patients (32%) had a ≥1-point increase in SESoD score, and 13 (24%) a ≥2-point increase. Lacrimal doses appeared to be associated with an increase in SESoD score of both ≥1 point (V10Gy: P = .042, odds ratio [OR] 1.09/%; V20Gy: P = .071, OR 1.03/%) and ≥2 points (V10Gy: P = .038, OR 1.15/%; V20Gy: P = .063, OR 1.04/%). The proportion with increase in dry eye symptoms at 1M for lacrimal V20Gy ≥79% versus <79% was 46% versus 15%, respectively, for ≥1 point SESoD increase (P = .02) and 36% versus 12%, respectively, for ≥2 point SESoD increase (P = .056). Conclusions: Dry eye appears to be a relatively common, dose/volume-dependent acute toxicity of WBRT. Minimization of lacrimal gland dose may reduce this toxicity, and patients should be counseled regarding the existence of this potential side effect and treatments for dry eye.

AB - Purpose: Dry eye is not typically considered a toxicity of whole brain radiation therapy (WBRT). We analyzed dry eye syndrome as part of a prospective study of patient-reported outcomes after WBRT. Methods and Materials: Patients receiving WBRT to 25 to 40 Gy were enrolled on a study with dry mouth as the primary endpoint and dry eye syndrome as a secondary endpoint. Patients received 3-dimensional WBRT using opposed lateral fields. Per standard practice, lacrimal glands were not prospectively delineated. Patients completed the Subjective Evaluation of Symptom of Dryness (SESoD, scored 0-4, with higher scores representing worse dry eye symptoms) at baseline, immediately after WBRT (EndRT), and at 1 month (1M), 3 months, and 6 months. Patients with baseline SESoD ≥3 (moderate dry eye) were excluded. The endpoints analyzed were ≥1-point and ≥2-point increase in SESoD score at 1M. Lacrimal glands were retrospectively delineated with fused magnetic resonance imaging scans. Results: One hundred patients were enrolled, 70 were eligible for analysis, and 54 were evaluable at 1M. Median bilateral lacrimal V20Gy was 79%. At 1M, 17 patients (32%) had a ≥1-point increase in SESoD score, and 13 (24%) a ≥2-point increase. Lacrimal doses appeared to be associated with an increase in SESoD score of both ≥1 point (V10Gy: P = .042, odds ratio [OR] 1.09/%; V20Gy: P = .071, OR 1.03/%) and ≥2 points (V10Gy: P = .038, OR 1.15/%; V20Gy: P = .063, OR 1.04/%). The proportion with increase in dry eye symptoms at 1M for lacrimal V20Gy ≥79% versus <79% was 46% versus 15%, respectively, for ≥1 point SESoD increase (P = .02) and 36% versus 12%, respectively, for ≥2 point SESoD increase (P = .056). Conclusions: Dry eye appears to be a relatively common, dose/volume-dependent acute toxicity of WBRT. Minimization of lacrimal gland dose may reduce this toxicity, and patients should be counseled regarding the existence of this potential side effect and treatments for dry eye.

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