Marcocci Claudio, Bartalena Luigi, Rocchi Roberto, Marinò Michele, Menconi Francesca, Morabito Eugenia, Mazzi Barbara, Mazzeo Salvatore, Sartini Maria Sole, Nardi Marco, Cartei Francesco, Cionini Luca, Pinchera Aldo
Department of Endocrinology, University of Pisa, 56124 Pisa, Italy.
J Clin Endocrinol Metab. 2003 Aug;88(8):3561-6. doi: 10.1210/jc.2003-030260.
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.
我们调查了204例格雷夫斯眼病（GO）患者眼眶放射治疗（OR）的长期副作用，这些患者于1972年至1996年接受放射治疗（44例使用钴单元（CU），160例使用直线加速器（LA），大多数联合使用糖皮质激素），随访时间为5至25年（中位数为11年）。21例患者（10%）在眼眶放射治疗后3至21年出现白内障，接受CU治疗的患者白内障患病率较高（但无统计学意义）（18% 对比接受LA治疗患者的8%）。与普通人群相比，年龄小于60岁的接受CU治疗的患者白内障患病率较高（但无统计学意义），而接受LA治疗的患者则不然。在7例患有糖尿病和高血压的患者中有1例（14%）、31例仅患有高血压的患者中有1例（3%）以及11例仅患有糖尿病的患者中无1例出现轻度无症状视网膜病变。157例接受眼眶及邻近区域计算机断层扫描的患者未观察到肿瘤。总之，眼眶放射治疗是一种安全的治疗方法，若使用高电压设备，不会增加白内障的发生频率。高血压，尤其是合并糖尿病时，可能是相对禁忌证，因为它可能导致视网膜病变。尽管未检测到继发性肿瘤，但由于辐射诱发肿瘤的潜伏期较长，眼眶放射治疗应仅限于35岁以上的患者。
