Gillis Christopher C, Chang Eun Hae, Al-Kharazi Khalid, Pickles Tom
Division of Neurosurgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
Department of Otolaryngology, University of Nebraska Medical Center, Omaha, NE, United States; Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
Rep Pract Oncol Radiother. 2016 May-Jun;21(3):156-61. doi: 10.1016/j.rpor.2016.01.001. Epub 2016 Feb 8.
To describe the first case of a secondary meningioma in a patient after radiation treatment for thyroid eye disease (TED). Secondarily to identify any additional cases of secondary malignancy resulting from radiotherapy for thyroid eye disease from our institutional experience.
Thyroid eye disease (TED) is a self-limiting auto-immune disorder causing expansion of orbital soft tissue from deposition of glycosaminoglycans and collagen, leading to significant cosmetic and functional morbidity. Established management options for TED include: glucocorticosteroids, orbital radiotherapy, and surgical orbital decompression. Two large series on radiotherapy for TED have been reported without any cases of secondary malignancy.
The case of a patient with visual failure, found to have a sphenoid wing meningioma after previous TED radiotherapy is described. We then reviewed 575 patients with at least 3-year follow-up receiving radiotherapy for TED at British Columbia Cancer Agency to identify other possible secondary malignancies.
The patient had postoperative improvement in her vision without any identified complications. Three additional cases of hematologic malignancy were identified. The calculated risk in our population of developing a radiation-induced meningioma after TED with at least 3 years of follow-up of is 0.17% (1/575); with hematopoetic malignancies the risk for secondary malignancy is 0.7% (4/575).
Our calculated risk for secondary malignancy (0.17%, 0.7%) is similar to the reported theoretical risk published in the literature (0.3-1.2%). There is real risk for the development of a secondary malignancy after radiotherapy treatment of TED and treatment options should include consideration for this potential.
描述首例在接受甲状腺眼病（TED）放射治疗后发生继发性脑膜瘤的患者。其次，根据我们机构的经验，确定甲状腺眼病放射治疗导致的其他继发性恶性肿瘤病例。
甲状腺眼病（TED）是一种自限性自身免疫性疾病，由于糖胺聚糖和胶原蛋白的沉积导致眼眶软组织扩张，从而导致明显的美容和功能障碍。TED既定的治疗选择包括：糖皮质激素、眼眶放射治疗和手术眼眶减压。已有两项关于TED放射治疗的大型系列报道，均未出现继发性恶性肿瘤病例。
描述了一例视力衰竭患者的病例，该患者在先前接受TED放射治疗后被发现患有蝶骨嵴脑膜瘤。然后，我们回顾了不列颠哥伦比亚癌症机构575例接受TED放射治疗且至少随访3年的患者，以确定其他可能的继发性恶性肿瘤。
该患者术后视力改善，未发现任何并发症。另外发现了3例血液系统恶性肿瘤病例。在我们的人群中，接受TED放射治疗且至少随访3年后发生放射性脑膜瘤的计算风险为0.17%（1/575）；发生血液系统恶性肿瘤时，继发性恶性肿瘤的风险为0.7%（4/575）。
我们计算出的继发性恶性肿瘤风险（0.17%，0.7%）与文献中报道的理论风险（0.3 - 1.2%）相似。TED放射治疗后确实存在发生继发性恶性肿瘤的风险，治疗选择应考虑到这种可能性。
