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Title: Role of radiotherapy in the treatment of exophthalmos

Abstract:

Introduction: Exophthalmos is a syndrome of ophthalmological symptoms associated in 90% with hyperthyroidism. Diminishing of the volume of swollen intraorbital tissues is often necessity in the treatment of exophthalmos regardless of thyroid function compensation. Sterydotherapy, radiotherapy, combination of both methods and surgical decompression of orbits are used to achieve this aim. Aim: Estimation of efficacy of exophthalmos radiotherapy, verification of indications and estimation of the factors influencing the treatment results are the purpose of the work. Material: Between 2000 and 2003 years in 121 patients with Graves ophthalmopathy retrobulbar regions were irradiated to total dose of 20 Gy in 10 fractions using 6 MeV photon beam in the Department of Radiotherapy in Pediatric University Hospital in Cracow, Prokocim. In 116 patients radiotherapy was preceeded by corticosteroid treatment (Solu Medrol) which was administered i.v., 2 g weekly for 4 consecutive weeks. So 5 patients were treated with radiotherapy alone. Methods: For each patient ophthalmologic examination was performed before the started treatment. Also before radiotherapy for each patient an individual perspex mask was prepared to ensure appropriate treatment reproducibility. Computered tomographic (CT) of the orbits were performed for planning goals for each patient. Two opposite, isocentric lateral beams of retrobulbar regions which created common line from the part of lens were the technique of irradiation. Retrobulbar structures were protected by individual shields made of Woods alloy. The field size was on average 4 cm x 5 cm. Treatment planning was made in the planning treatment system 3 D – TMS Helaks. CT of the retrobulbar regions and ophthalmologic examination using NOSPECS scale were performed in 106 out of 121 irradiated patients 12 months after finishing the treatment. (Of the remaining 15 patients: 3 died before the check up and 12 refused the examination). Efficacy of radiotherapy alone in 5 patients, corticosteroid treatment alone (situation before radiotherapy) in 101 patients, the combined treatment (corticosteroid treatment with radiotherapy) in 93 patients (isolated from 101 patients) were evaluated on the basis of the mentioned examinations and subjective estimation taking into consideration parameters such as: age, sex, coexistence diabetes mellitus, smoking, TSH and FT4 levels. Results: Radiotherapy alone did not decrease exophthalmos in the subjective estimation. In was most effective in relation to eye burning sensation and lacrimation. Improvement of peribulbar soft tissues, cornea and visual acuity was observed on the basis of follow-up ophthalmologic examination. Improvement of the right eye optic nerve was found on the basis of CT check-up examination of the orbits. In the subjective estimation corticosteroid treatment given intravenously alone improvemed exophthalmos, colour vision, visual acuity and diplopia in over 50% patients. Improvement of peribulbar soft tissues was found on the basis of the follow-up ophthalmologic examination. Diminishing of the quantity of the left eye retrobulbar fatty tissue was observed on the basis of CT check-up examination of the orbits. Over 70% subjective improvement in the form of diminishing of exophthalmos, eye burning sensation and lacrimation, aching and/or pushing out of the orbits succeeded after the combined treatment (corticosteroid treatment followed by radiotherapy). Improvement of peribulbar soft tissues and extraocular muscles was found on the basis of the check-up ophthalmologic examination. Improvement of the left eye concerning diminishing of the quantity of retrobulbar fatty tissue and optic nerve was obtainted on the basis of CT check-up examination of the orbit. Neither age of patients, time of ophthalmologic symptom lasting, smoking during radiotherapy, nor levels of TSH and FT4 influenced effectiveness of the cominated treatment. ; The patients without diabetes mellitus responded to the treatment in the range of ophthalmologic symptoms such as: exophthalmos, diplopia and eye burning sensation/ lacrimation. Also female sex essentially influenced better effect of the combinated treatment concerning diminishing of eye burning sensation/ lacrimation. During radiotherapy in 11/106 patients (10,4%) occured intensification of lacrimation, mild skin erythema, irritation of conjuctivas, eyelid oedema, intensification of diplopia with worsening of visual acuity. The complications (early side effect) were transient. Conclusions: 1.Efficacy of radiotherapy alone as a method of exophthalmos treatment seems to be lower than radiotherapy combined with sterydotherapy. 2. Diabetes mellitus is adverse prognostic factor in exophthalmos. 3. Almost 92% patients with exophthalmos treated in the Oncology Clinic in 2000-2003 fullfilled criteria for the intense treatment.

Level of degree:

2 - studia doktoranckie

Degree discipline:

okulistyka ; endokrynologia

Degree grantor:

Wydział Lekarski

Promoter:

Janusz Pawlęga

Date issued:

2007

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text/html

Identifier:

oai:dl.cm-uj.krakow.pl:978

Call number:

ZB-107310

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tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego - Collegium Medicum

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Last modified:

Feb 12, 2020

In our library since:

Nov 21, 2012

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http://dl.cm-uj.krakow.pl:8080/publication/978

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ZB-107310 Feb 12, 2020
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