ACUTE TOXIC EFFECTS OF OCULAR SURFACE AND ADNEXA INDUCED BY EXTERNAL BEAM RADIOTHERAPY IN HEAD AND NECK CANCER PATIENTS

Abstract

Head and neck cancers (HNC) are one of the commonest cancers in India. The primary treatment modality of these patients is either radiotherapy (RT) alone or combined surgical and radio/chemotherapy approach. RT of HNC leads to various acute and chronic ophthalmic complications. After approval from institutional ethics committee we conducted a prospective cohort study for a period of 3 months at a tertiary care center to find the incidence of various acute ophthalmic complications of radiotherapy in these patients specifically dry eye disease (DED) and also to correlate these findings with the total radiation dose (TRD). We recruited 40 patients "of HNC" undergoing. external beam radiotherapy by cobalt-60 machine. Patients were selected based on inclusion and exclusion criteria. Radiation records of all patients were noted. Patients were evaluated prior to start of RT and then at 1 week, 4 weeks and 12 weeks post RT. All underwent a thorough clinical history and complete ophthalmological examination including Ocular surface disease index (OSDI) questionnaire, visual acuity, anterior segment, angle and posterior segment examination, a complete dry eye work up including Schirmer test, tear meniscus height, tear break up time, corneal fluorescein staining & grading at each visit. Data was analysed using percentage and microsoft excel. Of the 40 patients; 24 (60%) were male and 16 (40%) were female (ratio1.5:1) and the median age of patients was 56 years with an age range of 35 to 63 years. Various acute complications found in our study were redness, madarosis, tylosis, limbal ischemia and dry eye disease (18 patients; 45%). We also found a strong positive correlation of DED with TRD. (r= 0.87)