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Echographic monitoring of response of extraocular muscles to irradiation in graves' ophthalmopathy
Radiation Oncology, Biology. Physics
256
Volume 27. Supplement 1
1017 ECHOGRAPHIC MONITORING OF RESPONSE OF EXTRAOCULAR MUSCLESTO IRRADIATION IN GRAVES’ OPHTHALMOPATHY Beth A. Erickson, The Medical
M. D.,
College
Gerald
J.
of Wisconsin,
Harris,
M. D.,
8700 W. Wisconsin
Michael
F. Lewandowski,
Avenue,
Milwaukee,
WI.
RDMS, Bruce M. Massaro,
M. D.
53226
ophthalmopathy is Confirmation of the efficacy of extraocular muscle irradiation in Graves’ Purpose/Objective: and the lack of controlled studies using objective needed due to the unpredictable natural history of the disease Orbital echography before and at select intervals following orbital criteria to classify and assess response over time. parameter of tissue response lo orbital irradiation over time. irradiation is proposed as an objective underwent 2000 cGy From 1983 to 1992, 51 patients with progressive Graves’ ophthalmopathy Materials-Methods: Standardized orbital echography was performed prior lo irradiation in 33 of the 51 patients to retrobulbar irradiation. of the extraocular muscles and to quantitate their individual and summed assess the morphologic characteristics diameters. Sixteen patients had at least one follow-up echographic evaluation at random intervals of 0 to 22 months Nine patients received steroids before or during irradiation, which were tapered following completion of irradiation. in proximity to completion of radiation. Follow-up ranged from 2 to 67 mo. with the majority followed at least 6 mo. 15 showed an interval decrease in individual and summed muscle size. Of the 16 patients with serial studies. Results: but continued improvement in the 1 month follow-up study, with less dramatic Interval improvemenr was observed 12 months. Exacerbation of disease was, with stability typically achieved within seen during the 3 - 9 mo studies, echographically documented al 13 months in one patient and at 8.5 months in the single non-responder. however, Conclusion:
Objective
parameters
orbital irradiation on the course as such a new parameter.
of response are needed to document both the immediate and long term outcome of Serial echography is proposed of Graves’ ophthalmopathy and confirm its efficacy.
1018 IRIDIUM BRACHYTHERAPY FOR EYELIDS CARCINOMAS. LONG TERMRESULTS IN 251 PATIENTS. Nicolas
DALY-SCHVEITZER, Martine
Department
of Radiotherapy,
DELANNES, CHEN-IXING, Jacques
Centre
Claudius
Regaud,
Toulouse,
BONNET. France.
Brachytherapy with Iridium wires is an experienced treatment for skin carcinomas. This study will evaluate the long term results of this treatment technique in a functional area, the eyelid, with concern about local control and side effects. From l/78 to 12/87, 251/365 patients were treated with an Iridium implant and followed at least 5 years after treatement. and methods : 204/751 (81 %) tumors occured in previously untreated patients. 164 were treated with brachytherapy alone, 40 with surgery and brachytherapy for involved section margins. 47/251 (19 %) were treated for local recurrence after different treatments. Most of the lesions were basal cell carcinomas, with nodular presentation, occuring on the inferior eyelid (52 %) or inner canthus (34 %). Minimal and maximal lesion’s size was 3 and 40 mm (mean value 12 mm). 4 % were associated with clinical or radiological epiphora involvement. The interstitial implant was realized with disposable angiocatheters, inserted under local anesthesia. 2 to 3 Iridium wires, 20 mm long, were usually placed in a single plane, with 6 mm space between the wires. Dose rate ranged from 0.48 to 1.54 Gy/H (mean value 0.8 Gy/H). The dosimetry was made according to the PARIS System. The delivered dose was mainly 60 Gy (55 to 70). Since
Purpose:
1983, lead contact Resultsoftreatment:: rate was 93 % for
be used (20 cases) to prevent iatrogenic cataract. The mean follow-up was 90 months (60 to 166 months). Local control the whole series, 94 % for previously untreated patients. 87 % for Patients treated for local recurrence. Treatment for recurrence was a second brachytheraiy (10/18), surgery-(3/18), both (1118) or other treatment (2/18), 2/18 patients needing enucleation, 2 patients receiving no treatment. 15/18 had definite local control after salvage treatment (mean follow up 77 months). Cosmesis : 59 % patients presented with slight (38 %) or marked (22 %) telangiectasias, 66 % with slight (45 %) or marked (21 %) achromia. Global cosmesis was evaluated as good (52 %), acceptable (41 %) or poor
lens
1 mm thick
could
(8 %).
: Functional side effects consisted in photophobia 12 %). conjonctivitis (3 %), eyelid retraction (6 %J. decreased eyelid aperture (6 %), ectropion (3 %) and epiphora stenosis (22 %). Unilateral cataract was observed in 15/248 (6 %I patients and supposed to be related to the brachytherapy treatment. 3 % patients showed decreased vision without recognized cataract. Conclusion : Iridium brachytherapy for eyelid carcinomas provides long term satisfactory results, with high local contra1 rate and few severe long term side effects, most of the patients being cured with minimal cosmesis or functional sequelae.
v
256
Volume 27. Supplement 1
1017 ECHOGRAPHIC MONITORING OF RESPONSE OF EXTRAOCULAR MUSCLESTO IRRADIATION IN GRAVES’ OPHTHALMOPATHY Beth A. Erickson, The Medical
M. D.,
College
Gerald
J.
of Wisconsin,
Harris,
M. D.,
8700 W. Wisconsin
Michael
F. Lewandowski,
Avenue,
Milwaukee,
WI.
RDMS, Bruce M. Massaro,
M. D.
53226
ophthalmopathy is Confirmation of the efficacy of extraocular muscle irradiation in Graves’ Purpose/Objective: and the lack of controlled studies using objective needed due to the unpredictable natural history of the disease Orbital echography before and at select intervals following orbital criteria to classify and assess response over time. parameter of tissue response lo orbital irradiation over time. irradiation is proposed as an objective underwent 2000 cGy From 1983 to 1992, 51 patients with progressive Graves’ ophthalmopathy Materials-Methods: Standardized orbital echography was performed prior lo irradiation in 33 of the 51 patients to retrobulbar irradiation. of the extraocular muscles and to quantitate their individual and summed assess the morphologic characteristics diameters. Sixteen patients had at least one follow-up echographic evaluation at random intervals of 0 to 22 months Nine patients received steroids before or during irradiation, which were tapered following completion of irradiation. in proximity to completion of radiation. Follow-up ranged from 2 to 67 mo. with the majority followed at least 6 mo. 15 showed an interval decrease in individual and summed muscle size. Of the 16 patients with serial studies. Results: but continued improvement in the 1 month follow-up study, with less dramatic Interval improvemenr was observed 12 months. Exacerbation of disease was, with stability typically achieved within seen during the 3 - 9 mo studies, echographically documented al 13 months in one patient and at 8.5 months in the single non-responder. however, Conclusion:
Objective
parameters
orbital irradiation on the course as such a new parameter.
of response are needed to document both the immediate and long term outcome of Serial echography is proposed of Graves’ ophthalmopathy and confirm its efficacy.
1018 IRIDIUM BRACHYTHERAPY FOR EYELIDS CARCINOMAS. LONG TERMRESULTS IN 251 PATIENTS. Nicolas
DALY-SCHVEITZER, Martine
Department
of Radiotherapy,
DELANNES, CHEN-IXING, Jacques
Centre
Claudius
Regaud,
Toulouse,
BONNET. France.
Brachytherapy with Iridium wires is an experienced treatment for skin carcinomas. This study will evaluate the long term results of this treatment technique in a functional area, the eyelid, with concern about local control and side effects. From l/78 to 12/87, 251/365 patients were treated with an Iridium implant and followed at least 5 years after treatement. and methods : 204/751 (81 %) tumors occured in previously untreated patients. 164 were treated with brachytherapy alone, 40 with surgery and brachytherapy for involved section margins. 47/251 (19 %) were treated for local recurrence after different treatments. Most of the lesions were basal cell carcinomas, with nodular presentation, occuring on the inferior eyelid (52 %) or inner canthus (34 %). Minimal and maximal lesion’s size was 3 and 40 mm (mean value 12 mm). 4 % were associated with clinical or radiological epiphora involvement. The interstitial implant was realized with disposable angiocatheters, inserted under local anesthesia. 2 to 3 Iridium wires, 20 mm long, were usually placed in a single plane, with 6 mm space between the wires. Dose rate ranged from 0.48 to 1.54 Gy/H (mean value 0.8 Gy/H). The dosimetry was made according to the PARIS System. The delivered dose was mainly 60 Gy (55 to 70). Since
Purpose:
1983, lead contact Resultsoftreatment:: rate was 93 % for
be used (20 cases) to prevent iatrogenic cataract. The mean follow-up was 90 months (60 to 166 months). Local control the whole series, 94 % for previously untreated patients. 87 % for Patients treated for local recurrence. Treatment for recurrence was a second brachytheraiy (10/18), surgery-(3/18), both (1118) or other treatment (2/18), 2/18 patients needing enucleation, 2 patients receiving no treatment. 15/18 had definite local control after salvage treatment (mean follow up 77 months). Cosmesis : 59 % patients presented with slight (38 %) or marked (22 %) telangiectasias, 66 % with slight (45 %) or marked (21 %) achromia. Global cosmesis was evaluated as good (52 %), acceptable (41 %) or poor
lens
1 mm thick
could
(8 %).
: Functional side effects consisted in photophobia 12 %). conjonctivitis (3 %), eyelid retraction (6 %J. decreased eyelid aperture (6 %), ectropion (3 %) and epiphora stenosis (22 %). Unilateral cataract was observed in 15/248 (6 %I patients and supposed to be related to the brachytherapy treatment. 3 % patients showed decreased vision without recognized cataract. Conclusion : Iridium brachytherapy for eyelid carcinomas provides long term satisfactory results, with high local contra1 rate and few severe long term side effects, most of the patients being cured with minimal cosmesis or functional sequelae.
v