Vision loss following high-dose proton-based radiotherapy for skull-base chordoma and chondrosarcoma

Highlights: • Radiotherapy dose escalation for skull-based chordoma and chondrosarcoma can put critical adjacent structures at risk, specifically the anterior optic pathway, potentially causing toxicities such as vision loss. • We analyzed patients treated with high-dose conformal proton-based radiation therapy for chordoma and chondrosarcoma and observed a 5-year incidence of vision loss of 2.1%. • Despite the high radiotherapy dose delivered to patients with skull-base chordoma and chondrosarcoma, the rate of vision loss with high-dose proton therapy is low and no events occurred in those who received a maximum dose under 60GyRBE. Dose escalation for skull-based chordoma and chondrosarcoma can put critical adjacent structures at risk, specifically the anterior optic pathway. We report the incidence of vision loss following high-dose conformal proton-based radiotherapy.