Protracted hypofractionated radiotherapy for graves' ophthalmopathy: a pilot study of clinical and radiologic response

Protracted hypofractionated radiotherapy for graves' ophthalmopathy: a pilot study of clinical and radiologic response

Author Cardoso, Cejana Casimiro de Deus Autor UNIFESP Google Scholar
Giordani, Adelmo José Autor UNIFESP Google Scholar
Borri Wolosker, Angela Maria Autor UNIFESP Google Scholar
Souhami, Luis Google Scholar
Manso, Paulo Gois Autor UNIFESP Google Scholar
Dias, Rodrigo Souza Autor UNIFESP Google Scholar
Comodo Segreto, Helena Regina Autor UNIFESP Google Scholar
Segreto, Roberto Araujo Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
McGill Univ
Abstract Purpose: To evaluate the clinical and radiologic response of patients with Graves' ophthalmopathy given low-dose orbital radiotherapy (RT) with a protracted fractionation.Methods and Materials: Eighteen patients (36 orbits) received orbital RT with a total dose of 10 Gy, fractionated in 1 Gy once a week over 10 weeks. of these, 9 patients received steroid therapy as well. Patients were evaluated clinically and radiologically at 6 months after treatment. Clinical response assessment was carried out using three criteria: by physical examination, by a modified clinical activity score, and by a verbal questionnaire considering the 10 most common signs and symptoms of the disease. Radiologic response was assessed by magnetic resonance imaging.Results: Improvement in ocular pain, palpebral edema, visual acuity, and ocular motility was observed in all patients. Significant decrease in symptoms such as tearing (p < 0.001) diplopia (p = 0.008), conjunctival hyperemia (p = 0.002), and ocular grittiness (p = 0.031) also occurred. Magnetic resonance imaging showed decrease in ocular muscle thickness and in the intensity of the T2 sequence signal in the majority of patients. Treatments were well tolerated, and to date no complications from treatment have been observed. There was no statistical difference in clinical and radiologic response between patients receiving RT alone and those receiving RT plus steroid therapy.Conclusion: RT delivered in at a low dose and in a protracted scheme should be considered as a useful therapeutic option for patients with Graves' ophthalmopathy. (C) 2012 Elsevier Inc.
Keywords Graves' ophthalmopathy
Altered fractionation
Magnetic resonance imaging
Language English
Date 2012-03-01
Published in International Journal of Radiation Oncology Biology Physics. New York: Elsevier B.V., v. 82, n. 3, p. 1285-1291, 2012.
ISSN 0360-3016 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 1285-1291
Access rights Closed access
Type Article
Web of Science ID WOS:000300423500070

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