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Department of Endocrinology (C.M., R.R., M.M., F.M., E.M., B.M., A.P.) and Oncology (S.M., L.C.) and Neuroscience (M.S.S., M.N.), University of Pisa, 56124 Pisa, Italy; University of Insubria (L.B.), Varese, Italy; and Radiation Oncology Unit, Hospital of Ferrara (F.C.), Ferrara, Italy
Address all correspondence and requests for reprints to: Claudio Marcocci, M.D., Department of Endocrinology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy. E-mail: c.marcocci{at}endoc.med.unipi.it.
We investigated the long-term side-effects of orbital radiotherapy (OR) in 204 patients with Graves’ ophthalmopathy (GO), irradiated from 1972–1996 [44 by cobalt unit (CU) and 160 by linear accelerator (LA), mostly combined with glucocorticoids], with a 5- to 25-yr follow-up (median, 11 yr). Cataract was observed in 21 patients (10%) 3–21 yr after OR, with a higher (not significant) prevalence in CU-treated patients (18% vs. 8% in LA-treated patients). The prevalence of cataract was higher, although not significantly, in CU-treated patients aged less than 60 yr, but not in LA-treated patients, compared with the general population. Mild, asymptomatic retinopathy was observed in 1 of 7 patients (14%) with diabetes and hypertension, in 1 of 31 patients (3%) with hypertension alone, and in 0 of 11 patients with diabetes alone. No tumors were observed in 157 patients submitted to computed tomography scan of orbital and adjacent regions. In conclusion, OR is a safe treatment, not associated with an increased frequency of cataract, provided a high voltage apparatus is used. Hypertension, especially if associated with diabetes, may represent a relative contraindication, as it may cause retinopathy. Although no secondary tumors were detected, due to the long latency of radiation-induced tumors, OR should be restricted to patients older than 35 yr.
This work was supported in part by grants from the University of Pisa (Fondi di Ateneo per la Ricerca) and the Ministero dell’Istruzione, Università e Ricerca Scientifica e Tecnologica, Rome, Italy (Project Graves’ Ophthalmopathy: Analysis of Pathogenic Factors, New Diagnostic and Therapeutic Approaches, Long Term Efficacy and Safety of Traditional Treatments).
Abbreviations: CT, Computed tomography; CU, cobalt unit; GO, Graves’ ophthalmopathy; LA, linear accelerator; OR, orbital radiotherapy.
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