Frontiers in endocrinology · 2025
No retinopathy after orbital irradiation in patients with thyroid eye disease - a follow up study.
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Makhoul Sara, Aranyosi Janos K, Csiki Emese, Urbancsek Hilda, Nagy Edit B, Erdei Annamaria, Fodor Mariann, Kovacs Arpad, Nagy Endre V, Ujhelyi Bernadett
Аннотация
INTRODUCTION: Thyroid eye disease (TED) is an autoimmune disease of the orbit. In moderate to severe active disease, orbital radiotherapy (ORT) is a treatment option. Diabetes is considered a relative contraindication because of potential induction of retinopathy. The purpose of this study was to decide if ORT remains a risk towards retinopathy in the era of linear accelerators with 3D computer aided design. Follow up examinations were performed to detect radiogenic retinopathy.
METHODS: Of the 151 patients who received ORT for TED between 2004-2020 at the University of Debrecen, 97 patients were available for follow up. In each case, 3D-based LINAC radiotherapy with a total dose of 20 Gy in 2 Gy daily fractions was administered. Eighteen patients had type 2 and one patient had type 1 diabetes. Median duration of diabetes was 16 (IQR:11.75-17.0) years; most recent HbA1c before irradiation was 6.55 (IQR:6.22-6.95) %. Ophthalmological follow up included slit-lamp and fundus examination, visual acuity, exophthalmometry and clinical activity score (CAS) calculation.
RESULTS: Median time between TED start and ORT was 2 (IQR:1-8) years. At the time of ORT, median TSH was 0.84 (IQR:0-1.41) mU/L, fT4 18 (IQR:12.15-25.40) pmol/L and fT3 6.5 (IQR:4.4-11.0) pmol/L, CAS was 5 (IQR:4-6). No diabetic retinopathy was present before ORT. The median follow-up period after completion of ORT was 60 (IQR:38-100) months. No patient developed retinopathy.
DISCUSSION: The risk of radiation-induced retinopathy after orbital irradiation, including well controlled diabetic patients, appears to be negligible. In the absence of pre-existing diabetic retinopathy and with good glycemic control ORT might be safe if linear accelerator with 3D planning is used. However, ophthalmic surveillance is still recommended.
METHODS: Of the 151 patients who received ORT for TED between 2004-2020 at the University of Debrecen, 97 patients were available for follow up. In each case, 3D-based LINAC radiotherapy with a total dose of 20 Gy in 2 Gy daily fractions was administered. Eighteen patients had type 2 and one patient had type 1 diabetes. Median duration of diabetes was 16 (IQR:11.75-17.0) years; most recent HbA1c before irradiation was 6.55 (IQR:6.22-6.95) %. Ophthalmological follow up included slit-lamp and fundus examination, visual acuity, exophthalmometry and clinical activity score (CAS) calculation.
RESULTS: Median time between TED start and ORT was 2 (IQR:1-8) years. At the time of ORT, median TSH was 0.84 (IQR:0-1.41) mU/L, fT4 18 (IQR:12.15-25.40) pmol/L and fT3 6.5 (IQR:4.4-11.0) pmol/L, CAS was 5 (IQR:4-6). No diabetic retinopathy was present before ORT. The median follow-up period after completion of ORT was 60 (IQR:38-100) months. No patient developed retinopathy.
DISCUSSION: The risk of radiation-induced retinopathy after orbital irradiation, including well controlled diabetic patients, appears to be negligible. In the absence of pre-existing diabetic retinopathy and with good glycemic control ORT might be safe if linear accelerator with 3D planning is used. However, ophthalmic surveillance is still recommended.