Abstract
Background: There is limited data regarding the incidence, timing, and
risk factors for ocular complications after proton radiation (RT) for
childhood brain tumors. Methods: We performed a single-institution
retrospective review of children treated with protons for brain tumors.
Data abstracted included demographics, radiation details and ocular
complications. Results: Of 81 children treated with protons for brain
tumors, from 2010-18, 42 with ophthalmology data available, were
included. Median age was 8.3 years (y) (0.8 – 20.6y) and median follow-
was 2.1 years. Ocular complications were detected only in patients who
received craniospinal irradiation (CSI). The incidence of ocular
complications was 19% (8/42 patients) overall, and 62% (8/13) after
craniospinal irradiation (CSI). Bilateral cataracts were detected at a
median of 3.2 y post-CSI, with an incidence of 38% (5/13). Dry eyes
were detected in 23% (3/13) of patients during or soon after CSI (0.04
and 0.7y post-RT). The median radiation dose (Gray RBE) to the lenses
for patients with cataract was 29.3 Gy (19.41 – 38.07), and with dry
eyes was 27.93 Gy (11.98 – 28.71) (mean doses to bilateral ocular
structures). Multivariable analysis identified CSI as a significant risk
factor for cataract and ocular complications overall. Conclusions:
Children are at risk for cataract and dry eyes after proton CSI and need
ophthalmology follow-up. Larger prospective studies are needed to
validate our findings, identify risk factors, and formulate strategies
for risk-mitigation. Longer follow-up is needed to determine the
incidence of late ocular complications and consequent functional
outcomes after cranial proton radiation.