A DOSIMETRIC STUDY OF INTENSITY MODULATED AND THREE DIMENSIONAL CONFORMAL RETRO-ORBITAL RADIOTHERAPY PLANS OF GRAVES OPHTHALMOPTHY DIAGNOSED PATIENTS

Yıl 2018, , 75 - 81, 01.08.2018

Duygu Bolat Sibel Kahraman Çetintaş Sema Gözcü Tunç Meral Kurt , Candan Demiröz Abakay Oğuz Aydın , Habibe Altaş

https://doi.org/10.32708/uutfd.418437

Öz

In
the treatment of Graves Ophthalmopthy (GO) with radiotherapy, we aimed to compare
the doses of target volume and critical organs by using mutual lateral three
dimensional conformal radiotherapy (3DCRT) and intensity
modulated radiotherapy (IMRT) techniques.

            In this study,
two separete treatment plans were develepod with 3DCRT radiotherapy and IMRT
with a fraction dose of 2 Gy and the total doses of 20 Gy in 15 patients with GO
diagnosis. The dose values of the planned target volume (PTV) and critical
organs were compared and homogeneity index (HI), conformity index (CI) values
were calculated and Monitor Unit (MU) values were eveluated.

            There was no difference between two techniques at D_95%
(p=0,583) of PTV; D_98% (p<0,001) took advantege of in IMRT
technique.

            As a result; it can be said that the 3DCRT technique used
for the lateral angle of the patient wants to avoid the doses that cause cataract.

Anahtar Kelimeler

Graves ophthalmopthy, Intensity Modulated Radiotherapy, Orbit Radiotherapy, Three Dimensional Conformal Radiotherapy

Graves Oftalmopati Tanılı Olguların Yoğunluk Ayarlı ve Üçboyutlu Konformal Retro-Orbital Radyoterapi Planlarının Dozimetrik Olarak İncelenmesi

Öz

Graves
oftalmopati (GO) tanılı olguların radyoterapi ile tedavisinde; karşılıklı
lateral üç boyutlu konformal radyoterapi (3BKRT) ve yoğunluk ayarlı radyoterapi
(YART) teknikleri kullanılarak hedef hacmin ve riskli organların aldığı
dozların karşılaştırılması amaçlanmıştır.

Çalışmada; GO tanılı 15 hastaya fraksiyon
dozu 2 Gy toplam doz 20 Gy olacak şekilde 3BKRT ve YART tekniği ile iki ayrı
tedavi planı oluşturuldu. Planlanan hedef hacmin (PTV) ve riskli
organların aldığı doz değerleri karşılaştırıldı ve homojenite indeksi (HI),
konformite indeksi (CI) değerleri hesaplanıp Monitor Unit (MU) değerlerine
bakıldı.

PTV’nin D_95% (p=0,583) değerinde iki teknik arasında fark görülmedi; D_98%
(p<0,001) değerinde YART tekniğinin üstünlüğü görüldü.

Sonuç
olarak; hastanın katarakt olmasına
neden olabilecek dozlardan kaçınmak istendiğinden, kullanılan
karşılıklı lateral açıdan dolayı
3BKRT tekniğinin daha düşük doz radyasyon aldığı söylenebilir.

Anahtar Kelimeler

Graves Oftalmopatisi, Orbita Radyoterapisi, Üç Boyutlu Konformal Radyoterapi, Yoğunluk Ayarlı Radyoterapi

Kaynakça

• 1)Schotthoefer EO, Wallace DK. Strabismus associated with thyroid eye disease. Current opinion in ophthalmology 2007;18.5:361-365.
• 2)Dallow RL, Netland PA. Management of thyroid ophthalmopathy (Graves’ disease). Principles and practice of ophthalmology: clinical practice. Philadelphia: WB Saunders 1994;1905-22.
• 3)Vilar-González S, Lamas-Oliveria C, Fagúndez-Vargas MA et al. Thyroid orbitopathy, an overview with special attention to the role of radiotherapy. Endocrinología y Nutrición (English Edition) 2015;62.4:188-199.
• 4)San Miguel I, Arenas M, Carmona R et al. Review of the treatment of Graves’ ophthalmopathy. The role of the new radiation techniques. Saudi Journal of Ophthalmology 2017.
• 5)Davies TF, Larsen PR. Thyrotoxicosis. In: Larsen PR, Kronenberg HM (eds). Williams Textbook of Endocrinology. 10th edition. Pennsylvania: Saunders, Elsevier Science; 2003. 374-421.
• 6)Perros P, Crombie AL, Matthews JNS, Kendall-Taylor P. Age and gender influence the severity of thyroid‐associated ophthalmopathy: a study of 101 patients attending a combined thyroid‐eye clinic. Clinical endocrinology 1993;38.4:367-372.
• 7)Hiromatsu Y, Eguchi H, Tani J, Kasaoka M, Teshima Y. Graves' ophthalmopathy: epidemiology and natural history. Internal Medicine 2014;53.5:353-360.
• 8)Manso PG, Furlanetto RP, Wolosker AMB et al. Prospective and controlled study of ophthalmopathy after radioiodine therapy for Graves' hyperthyroidism. Thyroid 1998; 8.1:49-52.
• 9)Prummel MF, Wiersinga WM. Smoking and risk of Graves' disease. Journal-Amerıcan Medıcal Assocıatıon 1993;269:479-479. 10) Bartalena L, Tanda ML. Graves' ophthalmopathy. New England Journal of Medicine 2009;360.10:994-1001.
• 10)Bartalena L, Tanda ML. Graves' ophthalmopathy. New England Journal of Medicine 2009;360.10:994-1001.
• 11)Bahn RS. Graves' ophthalmopathy. New England Journal of Medicine 2010;362.8:726-738.
• 12)Mcdougall IR, Donaldson SS. Radiotherapy for Graves ophthalmopathy: Current Treatment Recommendations. In: The Radiation Therapy of Benign Diseases. Karger Publishers 2001;57-64.
• 13)Bartalena L, Marcocci C, Gorman CA, Wiersinga WM, Pinchera A. Orbital radiotherapy for Graves’ ophthalmopathy: useful or useless? Safe or dangerous? Journal of endocrinological investigation 2003;26.1:5-16.
• 14)Kuhnt T, Müller AC, Janich M et al. Radiotherapy for Graves' ophthalmopathy. Klinische Monatsblatter fur Augenheilkunde 2004;221.11:915-921.
• 15)Bartalena L, Marcoccı C, Pinchera A. Treating severe Graves' ophthalmopathy. Bailliere's clinical endocrinology and metabolism 1997;11.3:521-536.
• 16)Prummel MF, Berghout A, Wiersinga WM et al. Randomised double-blind trial of prednisone versus radiotherapy in Graves' ophthalmopathy. The Lancet 1993;342.8877: 949-954.
• 17)Tsujino K, Hirota S, Hagiwara M et al. Clinical outcomes of orbital irradiation combined with or without systemic high-dose or pulsed corticosteroids for Graves’ ophthalmopathy. International Journal of Radiation Oncology Biology Physics 2000;48.3:857-864.
• 18)Bordón E, Henríquez-Hernández LA, Lara PC et al. Prediction of clinical toxicity in locally advanced head and neck cancer patients by radio-induced apoptosis in peripheral blood lymphocytes (PBLs). Radiation oncology 2010;5.1: 4.
• 19)Bartalena L, Pinchera A, Marcocci C. Management of Graves’ ophthalmopathy: reality and perspectives. Endocrine Reviews 2000;21.2:168-199.
• 20)Jaulerry C. The role of radiotherapy in Graves' ophthalmopathy. Journal francais d'ophtalmologie 2004;27.7:825-827.
• 21)Kao SCS, Kendler DL, Nugent RA, Adler JS, Rootman J. Radiotherapy in the management of thyroid orbitopathy: computed tomography and clinical outcomes. Archives of Ophthalmology 1993;111.6:819-823.
• 22)Perez CA, Brady LW, Halperin EC, Schmidt-Ulrich RK. Principles and practice of radiation oncology. Radiation treatment of benign disease 2004:2333–4.
• 23)Kahaly GJ, Rösler HP, Pitz S, Hommel G. Low-versus high-dose radiotherapy for Graves’ ophthalmopathy: a randomized, single blind trial. The Journal of Clinical Endocrinology & Metabolism 2000;85.1:102-108.
• 24)Gripp S, Doeker R, Glag M, Vogelsang P, Pape H. Conventional and virtual simulation in retrobulbar irradiation. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft...[et al] 2000;176.3:131-134.
• 25)Lacka K, Manuszewska E, Korczowska I, Lacki JK. The effect of methylprednisolone pulse treatment on cytokine network in Graves ophthalmopathy. Current eye research 2007;32.3:291-297.
• 26)Marquez SD, Lum BL, Mcdougall IR, Katkuri S et al. Long-term results of irradiation for patients with progressive Graves’ophthalmopathy. International Journal of Radiation Oncology Biology Physics 2001;51.3:766-774.
• 27)Wakelkamp IMMJ, Tan H, Saeed P et al. Orbital irradiation for Graves' ophthalmopathy: Is it safe? A long-term follow-up study. Ophthalmology 2004;111.8:1557-1562.
• 28)Gupta T, Agarwal J, Jain S et al. Three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: a randomized controlled trial. Radiotherapy and Oncology 2012;104.3:343-348.
• 29)Yoon M, Park SY, Shin D et al. A new homogeneity index based on statistical analysis of the dose–volume histogram. Journal of applied clinical medical physics 2007;8.2:9-17.
• 30)Feuvret L, Noël G, Mazeron J-J, Bey P. Conformity index: a review. International Journal of Radiation Oncology Biology Physics 2006;64.2:333-342.
• 31)Kouloulıas V, Kouvaris J, Zygogianni A et al. Efficacy and toxicity of radiotherapy for Graves’ ophthalmopathy: the University of Athens experience. Head Neck Oncol 2013;5.2:12.
• 32)Li Y-J, Luo Y, He W-M, Li P, Wang F. Clinical outcomes of graves’ ophthalmopathy treated with intensity modulated radiation therapy. Radiation Oncology 2017;12.1:171.
• 33)Zygulska AL, Kowalska B. Irradiation of malignant exophthalmos in the course of Graves Basedow disease. Reports of Practical Oncology & Radiotherapy 2008;13.4:187-195.
• 34)Zygulska A. Radiotherapy in the treatment of Graves ophthalmopathy—to do it or not?. Journal of ocular biology, diseases, and informatics 2010;3.1:1-11.
• 35)Lee VHF, Ng SCY, Choi CW et al. Comparative analysis of dosimetric parameters of three different radiation techniques for patients with Graves’ ophthalmopathy treated with retro-orbital irradiation. Radiation Oncology 2012;7.1:199.
• 36)San-Miguel I, Carmona R, Luque L et al. Volumetric Modulated Arc Therapy (VMAT) make a difference in retro-orbital irradiation treatment of patients with bilateral Graves’ ophthalmopathy. Comparative analysis of dosimetric parameters from different radiation techniques. Reports of Practical Oncology & Radiotherapy 2016;21.5:435-440.
• 37)Parsons JT, Bova FJ, Mendelhall WM et al. Response of the normal eye to high dose radiotherapy. Oncology (Williston Park, NY) 1996;10.6:837-47;discussion 847-8,851-2.
• 38)Takeda A, Shigematsu N, Suzuki S et al. Late retinal complications of radiation therapy for nasal and paranasal malignancies: relationship between irradiated-dose area and severity. International Journal of Radiation Oncology Biology Physics 1999;44.3:599-605.