Contour Variability in Thyroid Eye Disease with Compressive Optic Neuropathy Treated with Radiation Therapy
Autor: | Michael Kazim, Andrew Sanchez, Juhi M. Purswani, Cheng-Chia Wu, Tony J. C. Wang, Tavish Nanda |
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Rok vydání: | 2020 |
Předmět: |
lcsh:Medical physics. Medical radiology. Nuclear medicine
Visual acuity genetic structures lcsh:R895-920 Eye disease medicine.medical_treatment Planning target volume lcsh:RC254-282 Radiation planning 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Medicine Scientific Article Radiology Nuclear Medicine and imaging Contouring business.industry Compressive optic neuropathy Thyroid lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease eye diseases Radiation therapy medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis medicine.symptom business Nuclear medicine |
Zdroj: | Advances in Radiation Oncology, Vol 5, Iss 5, Pp 804-808 (2020) Advances in Radiation Oncology |
ISSN: | 2452-1094 |
Popis: | Purpose: Few studies have evaluated the methodology by which radiation therapy (RT) for thyroid eye disease and compressive optic neuropathy is performed. The objective of this study was to retrospectively review our experience from a radiation planning standpoint and to determine whether current treatment methods provide adequate dose to target and collateral structures. Methods: A retrospective review of 52 patients (104 orbits) with bilateral thyroid eye disease and compressive optic neuropathy treated with RT (20 Gy in 10 fractions) at our institution. RT plans were analyzed for target volumes and doses. Visual fields, color plates, and visual acuity were assessed pretreatment and at last available follow-up post RT. A standardized, anatomic contour of the retro-orbital space was applied to these retrospective plans to determine dose to the entire space, rather than the self-selected target structure. Results: Compared with the anatomic retro-orbital space, the original contour overlapped by only 68%. Maximum and mean dose was 2134 cGy and 1910 cGy to the anatomic retro-orbital space. Consequently, 39.8% of the orbits had a mean dose 21 Gy 5%). There was no significant association of improvement in color plates (P = .07), visual fields (P = .77), and visual acuity (P = .62), based on these dose differences. When beam placement was retrospectively adjusted to include a space of 0.5 cm between the lens and the anterior beam edge, there was a 39.4% and 20.3% decrease in max and mean dose to the lens. Conclusions: Without a standardized protocol for contouring in thyroid eye disease, target delineation was found to be rather varied, even among the same practitioner. Differences in dose to the anatomic retro-orbital space did not affect outcomes in the follow-up period. Although precise contouring of the retro-orbital space may be of little clinical consequence overall, a >0.5 cm space from the lens may significantly reduce or delay cataractogenesis. |
Databáze: | OpenAIRE |
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