Advances in radiation oncology · 2026
Critical Review of Cataractogenesis and Lens Contouring in Radiation Oncology.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Grosinger Alexander, Roovers Anna, Bergerud Kyra M Boorsma, Kaufman Marissa, Vadas Jessica, Evans Richard, Hubert Gregory, Alcorn Sara R, Yuan Jianling, Lawrence Jessica, Shen Colette, McClelland Collin M, Lee Michael S, Terezakis Stephanie, Sloan Lindsey
Аннотация
PURPOSE: The objective is to comprehensively review radiation-induced cataractogenesis and recommend lens contouring guidelines to unify and improve dose reporting that informs future lens constraints.
METHODS AND MATERIALS: A thorough literature review was conducted to examine the anatomic, physiological, and pathologic aspects of the lens. Studies on radiation-induced cataracts, including thresholds for cataractogenesis, latency periods, and classification systems, were reviewed. Standardized lens contouring guidelines were developed for use in radiation therapy treatment planning and dose reporting.
RESULTS: The lens is a transparent, avascular structure responsible for refraction and accommodation. It is highly radiosensitive, and radiation-induced cataractogenesis most often presents as posterior subcapsular cataracts, although cortical and nuclear sclerotic changes can also occur. Key risk factors include total dose, fractionation, and dose rate. Cataracts are a well-described late effect after ocular-directed radiation therapy and other treatments that deliver clinically meaningful lens dose (eg, ocular radiation therapy/brachytherapy and total body irradiation), with incidence varying by lens dose, fractionation, patient age, and duration of follow-up. Standard assessment tools-slit-lamp examination and the Lens Opacities Classification System III-are limited by interobserver variability. Scheimpflug tomography offers a promising, objective, quantitative alternative. We present a step-by-step guide to improve consistency in lens delineation for radiation therapy planning, facilitate avoidance when feasible, and standardize lens dose reporting for future studies.
CONCLUSIONS: Radiation-induced cataracts are a significant late complication of ocular, brain, total body, and head and neck radiation therapy. Standardized lens contouring guidelines and multidisciplinary collaboration with ophthalmology can improve lens-sparing and enhance detection and management of cataracts. Further research is needed to refine dose thresholds, improve assessment methods, and develop strategies to mitigate cataractogenesis.
METHODS AND MATERIALS: A thorough literature review was conducted to examine the anatomic, physiological, and pathologic aspects of the lens. Studies on radiation-induced cataracts, including thresholds for cataractogenesis, latency periods, and classification systems, were reviewed. Standardized lens contouring guidelines were developed for use in radiation therapy treatment planning and dose reporting.
RESULTS: The lens is a transparent, avascular structure responsible for refraction and accommodation. It is highly radiosensitive, and radiation-induced cataractogenesis most often presents as posterior subcapsular cataracts, although cortical and nuclear sclerotic changes can also occur. Key risk factors include total dose, fractionation, and dose rate. Cataracts are a well-described late effect after ocular-directed radiation therapy and other treatments that deliver clinically meaningful lens dose (eg, ocular radiation therapy/brachytherapy and total body irradiation), with incidence varying by lens dose, fractionation, patient age, and duration of follow-up. Standard assessment tools-slit-lamp examination and the Lens Opacities Classification System III-are limited by interobserver variability. Scheimpflug tomography offers a promising, objective, quantitative alternative. We present a step-by-step guide to improve consistency in lens delineation for radiation therapy planning, facilitate avoidance when feasible, and standardize lens dose reporting for future studies.
CONCLUSIONS: Radiation-induced cataracts are a significant late complication of ocular, brain, total body, and head and neck radiation therapy. Standardized lens contouring guidelines and multidisciplinary collaboration with ophthalmology can improve lens-sparing and enhance detection and management of cataracts. Further research is needed to refine dose thresholds, improve assessment methods, and develop strategies to mitigate cataractogenesis.