Protracted Hypofractionated Radiotherapy for Graves' Ophthalmopathy: A Pilot Study of Clinical and Radiologic Response

Cardoso, Cejana Casimiro de Deus; Giordani, Adelmo José; Wolosker, Ângela Maria Borri; Souhami, Luís; Manso, Paulo Góis; Dias, Rodrigo Souza; Segreto, Helena Regina Cômodo; Segreto, Roberto Araújo

doi:10.1016/j.ijrobp.2010.09.015

Cited by 27 publications

(14 citation statements)

References 18 publications

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“…A previous study reported that orbital irradiation resulted in a median exophthalmos reduction of 3 mm (11), whereas the present study reported average reductions of 3.36±1.73 mm (left eye) and 3.05±2.04 mm (right eye). Regarding the effect on eye protrusion, there is no significant difference between the results of the present and those of a previously published study on orbital irradiation combined with retrobulbar injection of triamcinolone actinide (12).…”

Section: Discussioncontrasting

confidence: 85%

“…For orbital irradiation, symptoms typically start to improve 1–2 weeks after treatment and exophthalmos reduction is rarely reported before one month after treatment (11,13,14). The response to brachytherapy was more rapid, with eye inflation, photophobia and light lacrimation obviously improved on the day of treatment, and eyeball swelling clearly reduced by 10 days.…”

Section: Discussionmentioning

confidence: 99%

“…Comparison of different dose and fractionation schemes (20 Gy/20 weeks; 10 Gy/2 weeks; 20 Gy/2 weeks) suggested that all such schemes were therapeutically equivalent. Moreover, Cardoso et al (11) gave 10 Gy over 10 weeks and also achieved a good curative effect. It is expected that 32 P brachytherapy requires a similar dose, while this requires further verification.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Graves' ophthalmopathy with an in-house Phosphorus-32 source: Initial clinical observations

Hao

Wang

et al. 2017

Experimental and Therapeutic Medicine

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The objective of the present study was to observe the therapeutic effect of radiation delivered via a 32P source on Graves' ophthalmopathy. A32P solution was injected into a 10-ml vacuum flask held inside a lead container. A window was cut in the lead, generating a treatment beam. Radiation was given to four areas: The upper and lower orbit (covering ~1/3 of the eyelid) and the inner and outer canthus. Each site received 10 daily doses of 20 cGy. Proptosis was measured by an exophthalmometer and the palpebral aperture was determined with a ruler. Measurements were taken before and after the treatment. After 5 days of treatment, the patient displayed a significant improvement, and by 10 days, the average reduction of proptosis in Graves' ophthalmopathy was 3.36±1.73 mm for the left and 3.05±2.04 mm for the right eyes. The treatment was effective in all patients, who uniformly reported rapid pain relief. Conjunctival congestion and eyelid edema also improved significantly. However, only 50% of patients showed improved diplopia after treatment, which was poor compared with other symptoms. No obvious side effects were found in the subsequent follow-up. In conclusion, 32P brachytherapy for Graves' ophthalmopathy was simple and effective, with few side effects, and should be considered as a promising therapy.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Treatment of Graves' ophthalmopathy with an in-house Phosphorus-32 source: Initial clinical observations

Hao

Wang

et al. 2017

Experimental and Therapeutic Medicine

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“… 2 , 7 , 8 , 11 20 Gy in 10 fractions was most widely used in the literature reviewed, although other fractionation schemes (1 Gy per week for 10 or 20 weeks) have shown clinically significant therapeutic responses. 14 , 15 Almost all studies agree on the tolerability and safety of OR, showing no increase in secondary malignancies and difference in survival. 2 , 4 , 5 Marcocci et al 4 showed cataract formation in 12% of patients with a median of 11 years after treatment and a median age of 59 years.…”

Section: Case Presentationmentioning

confidence: 97%

Orbital radiotherapy for thyroid eye disease: case report with a review of the literature

Luu

2016

BJR|case reports

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Thyroid eye disease (TED) is a condition mainly associated with Graves' disease. We report a patient with moderate-tosevere TED who underwent a combination of intravenous and oral steroids and orbital radiotherapy that improved her visual acuity and colour vision drastically, and decreased upper lid oedema. We review the clinical features of this unusual condition, our patient's history and treatment, and the knowledge base from the current literature.

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“…25 Alternative dose schedules such as 1 Gy per week over a 10-week period for a total dose of 10 Gy have also reported excellent outcomes. 26 Given that the natural history of TED is time dependent, the impact of treatment duration on assessment scores at 24 weeks posttreatment is unaccounted for in these studies. A retrospective series comparing outcomes with 10 and 16 Gy total doses reported a 35% rate of reirradiation in the low-dose group compared with 0% in the highdose group.…”

Section: Classification Of Disease-a Challengementioning

confidence: 99%

Radiation Therapy for Orbitopathy of Thyroid Eye Disease

Farach¹,

Carpenter²

2016

International Ophthalmology Clinics

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Thyroid eye disease (TED) or Graves ophthalmopathy is a debilitating autoimmune disorder of the orbit. This disease is closely associated with autoimmune hyperthyroidism, although it may develop in the euthyroid and hypothyroid states. TED affects approximately 16 women and 3 men in every 100,000 per year. 1 Orbital radiotherapy (OR) is a well-established therapy that has been safely utilized in the treatment of TED for over a century, yet high-level randomized evidence supporting its efficacy and clear treatment guidelines are sparse. This article summarizes the existing literature regarding the use of OR in TED and associated outcomes and toxicities. We also discuss emerging treatment techniques and potential future therapeutic strategies. ' BackgroundThe pathogenesis of TED is attributable to an autoimmune interaction between antithyrotropin receptor antibodies and thyrotropin receptors expressed in the orbit. In the diseased state, the thyrotropin receptor is degraded by antigen-presenting cells resulting in the activation of T-helper cells. Plasma cells are then activated through cytokine interactions to secrete autoantibodies directed against the thyrotropin receptor in the orbit. 1 The result is a progressive orbital inflammatory and fibrotic process. This presents clinically with varying degrees of eyelid retraction, lagophthalmos, proptosis, impaired extraocular motility, diplopia, exposure keratopathy, and periorbital edema. Symptoms may be self-limited or progressive and debilitating, persisting for years despite aggressive therapy. In severe cases, sight-threatening corneal ulceration or compressive optic neuropathy may develop.

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Protracted Hypofractionated Radiotherapy for Graves' Ophthalmopathy: A Pilot Study of Clinical and Radiologic Response

Cited by 27 publications

References 18 publications

Treatment of Graves' ophthalmopathy with an in-house Phosphorus-32 source: Initial clinical observations

Treatment of Graves' ophthalmopathy with an in-house Phosphorus-32 source: Initial clinical observations

Orbital radiotherapy for thyroid eye disease: case report with a review of the literature

Radiation Therapy for Orbitopathy of Thyroid Eye Disease

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