Visual decline in pediatric survivors of brain tumors following radiotherapy

Figures & data

Table 1. Demographic and treatment characteristics of pediatric brain tumor patients at risk of visual decline (n = 458).

Variable	Number of patients (%)
Median age at treatment	9.6 (1.3–21.8) years
Gender
Male	243
Female	215
Race/ethnicity
White	360
Black	59
Other	39
Nationality
North American	278
European	180
Other	22
Tumor location
Suprasellar, non-optic pathway	273
Optic pathway	46
Supratentorial	93
Other	46
Diagnosis
Craniopharyngioma	234
Glioma	109
Medulloblastoma	29
Other	86
Prior operations
0	20
1	267
≥2	171
Chemotherapy
None	302
Preradiotherapy	118
Concurrent with radiotherapy	36
Postradiotherapy	53

Figure 1. Cumulative incidence of visual acuity decline in the eyes of children treated with radiotherapy for intracranial tumors and at high risk of acuity decline.

Table 2. Incidence of visual acuity decline among 13 patients (17 events) throughout the study period.

Event no.	Laterality	Pre-RT vision status	Post-RT vision status	Max RT dose to 0.1 cm3 (GyRBE)	Age at treatment	Duration from radiation to visual decline (years)	Location	Diagnosis	Chemotherapy
1	Left	Normal	Impaired	55.5	9.4	5.2	Suprasellar	Craniopharyngioma	None
2	Right	Normal	Impaired	55.5		6.3
3	Left	Impaired	Functionally Blind	55.1	8.4	1.0	Optic Pathway	Glioma	Pre-RT
4	Right	Functionally Blind	Functionally Blind [Worse]	54.9	8.6	2.6	Optic Pathway	Glioma	Pre-RT
5	Left	Normal	Impaired	55	17.6	3.6	Optic Pathway	Glioma	Pre- and Post-RT
6	Left	Impaired	Functionally Blind	55.9	7.9	0.5	Suprasellar	Craniopharyngioma	None
7	Left	Impaired	Impaired [Worse]	55.2	4.4	4.4	Optic Pathway	Glioma	Pre-RT
8	Right	Normal	Impaired	55.2		4.4
9	Left	Normal	Impaired	54.6	3	5.0	Suprasellar	Craniopharyngioma	None
10	Right	Normal	Impaired	54.6		5.0
11	Left	Normal	Impaired	54.9	2	1.5	Suprasellar	Craniopharyngioma	None
12	Left	Impaired	Impaired [Worse]	55.1	14	3.3	Suprasellar	Glioma	Pre-RT
13	Right	Impaired	Impaired [Worse]	55.1		3.3
14	Right	Normal	Impaired	54.6	8.2	2.0	Suprasellar	Craniopharyngioma	None
15	Left	Normal	Impaired	55.5	2.6	1.5	Suprasellar	Craniopharyngioma	None
16	Left	Impaired	Impaired [Worse]	54.8	10.3	0.8	Suprasellar	Craniopharyngioma	None
17	Left	Normal	Impaired	54.4	7.3	2.4	Suprasellar	Craniopharyngioma	None

RT: radiation therapy.

Figure 2. Logistic regression model of the risk of visual acuity decline by radiotherapy dose to 0.1 cm³ of the ipsilateral optic nerve or optic chiasm.

Table 3. Univariate analysis of risk factors for visual acuity decline in survivors of pediatric brain tumor (n = 875 eyes).

Variable	5-Year actuarial rate of visual acuity decline	10-Year actuarial rate of visual acuity decline	p Value
Race
White	2.6%	2.6%	.06
Other	2.7%	11.4%
Age at radiotherapy treatment
0–4 years	2.9%	7.6%	.37
4–13 years	2.4%	4.2%
>13 years	3.5%	3.5%
Geographic region
US/Canada	3.0%	4.1%	.46
Other International	2.1%	7.1%
Baseline vision
Normal	2.0%	5.0%	.86
Impaired	4.0%	4.0%
Functional	2.5%	2.5%
Primary tumor diagnosis
Craniopharyngioma	1.7%	6.4%	.48
All other	3.5%	3.5%
Tumor location
Suprasellar, non-optic pathway	2.3%	5.8%	.008
Optic pathway	10.0%	10.0%
All Other	0.0%	0.0%
Number of preradiotherapy surgical operations
0-1	3.1%	4.7%	.34
≥2	1.8%	4.1%
Chemotherapy
Any	5.2%	5.2%	.50
None	1.3%	4.6%
Preradiotehrapy chemotherapy
Yes	6.3%	6.3%	.20
No	1.2%	4.2%