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. 2021 Mar;7(1):36-43.
doi: 10.1159/000511011. Epub 2020 Nov 16.

Clinical Spectrum and Outcomes of Ocular and Periocular Complications following External-Beam Radiotherapy for Inoperable Malignant Maxillary Sinus Tumors

Darren Shu Jeng Ting  1   2 , Romeela Rana-Rahman  2 , Jia Yu Ng  2 , David J P Wilkinson  3 , Desiree Ah-Kine  2 , Trushar Patel  2
Affiliations

Clinical Spectrum and Outcomes of Ocular and Periocular Complications following External-Beam Radiotherapy for Inoperable Malignant Maxillary Sinus Tumors

Darren Shu Jeng Ting et al. Ocul Oncol Pathol. 2021 Mar.

Abstract

Purpose: To highlight the clinical spectrum, management, and outcomes of ocular/periocular complications following high-dose external-beam radiotherapy (EBRT) for inoperable malignant maxillary sinus-involving tumors (MMST).

Methods: A retrospective, interventional case series. All patients who were diagnosed with inoperable MMST (with orbital involvement) and treated with high-dose fractionated EBRT (65 Gy in 30 fractions) at James Cook University Hospital, UK, were included.

Results: Seven patients with advanced MMST (T4aN0M0-T4bN2cM0) were included and were followed up for 23.8 ± 10.2 months. Severe lid margin disease, dry eye, and neurotrophic keratopathy were universally observed. Other complications included cicatricial conjunctivitis (71%), corneal perforation (57%), limbal stem cell deficiency (LSCD; 43%), glaucoma (29%), and superimposed candida keratitis (14%). Amniotic membrane transplant (AMT; 71%), tarsorrhaphy (43%), tectonic keratoplasty (29%), and evisceration (14%) were warranted. Intact corneal epithelium was observed in all patients and good corrected-distance visual acuity (≥20/60) was observed in 3 (43%) patients at final follow-up.

Conclusion: High-dose EBRT for inoperable MMST can lead to a wide array of severe ocular/periocular complications. AMT serves as a potentially useful treatment modality to restore the ocular surface integrity after severe radiation keratopathy. We advocate active monitoring for any evolving ophthalmic complications during and after EBRT to enable timely intervention.

Keywords: Amniotic membrane; Limbal stem cell deficiency; Maxillary tumor; Neurotrophic keratopathy; Paranasal sinus tumor; Radiation keratopathy; Radiotherapy.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Transverse view of a treatment plan for Patient 2 delivering 65 Gy in 30 fractions to the planning target volume (PTV) using intensity-modulated radiotherapy (IMRT). Gross tumor volume (GTV), green; clinical target volume (CTV), yellow; PTV, red. In this case, the GTV extends superiorly and can be seen involving the ethmoid sinuses and nasal cavity medial to the globe. Isodose lines are demonstrated as a color wash according to the key on the left of the image. The globes and left lens are also outlined.
Fig. 2
Fig. 2
An overview obtained by slit-lamp photography of the ocular and periocular complications following high-dose external beam radiotherapy for inoperable malignant maxillary sinus-involving tumors. a Patient 1: an area of corneal macro-perforation (red arrow) and complete madarosis. b Patient 2: a multilayered amniotic membrane transplant for descemetocoele. Note the complete madarosis and inferior conjunctival scarring and keratinization. c Patient 3: widespread stippled fluorescein staining of the cornea, consistent with the diagnosis of limbal stem cell deficiency (LSCD). d Patient 4: grade 3 neurotrophic keratopathy with central corneal macro-perforation. e Patient 5: there is a small area of epithelial defect with diffuse stippled fluorescein staining of the inferior cornea, consistent with LSCD. f Patient 6: significant interpalpebral corneal staining.
Fig. 3
Fig. 3
Images obtained by slit-lamp photography of the right eye of Patient 7. a, b Two weeks after radiotherapy, there was complete madarosis of the upper and lower eyelids, and severe conjunctival inflammation with complete corneal and perilimbal conjunctival epithelial defect. c, d Five weeks after radiotherapy, there was 60% epithelialization of the corneal and conjunctival epithelial defect superiorly after the insertion of a bandage contact lens device with amniotic membrane (PROKERA PLUS implant). e, f Three months after radiotherapy, there was a temporary tarsorrhaphy with complete epithelialization of the corneal and conjunctival defect.
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