Main Session
Sep
28
PQA 04 - Breast Cancer, Patient Reported Outcomes/QoL/Survivorship, Functional Radiation Medicine, Hematologic Malignancies, Palliative Care, and International/Global Oncology
Presenter(s)
Adannia Ufondu, MD - Cleveland Clinic, Cleveland, OH
A. Ufondu1, C. A. Reddy1, J. H. Suh1, N. M. Woody1, J. A. Miller1, S. R. Campbell1, C. Hwang2, and S. A. Koyfman1; 1Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, 2Department of Ophthalmology, Cleveland Clinic Foundation, Cleveland, OH
Purpose/Objective(s):
Advanced planning techniques using intensity-modulated radiation therapy (IMRT) has been increasingly utilized in recent years to provide more conformal dose distributions and reduce doses to organs at risk (OAR) including the lenses, lacrimal glands and retina. We reviewed our initial experience of IMRT in patients with Graves Eye Disease (GED) with a focus on functional and dosimetric outcomes.Materials/Methods:
Patients with GED treated with IMRT from 2023–2025 were included in this IRB-approved study. All patients were treated using 20 Gy in 10 fractions to the bilateral orbits. RT was delivered either concurrently (+/- 1 week of infusion) with IV solumedrol and/or Teprotumumab or as salvage after disease progression following systemic therapy. RT target volumes included the extraocular muscles and peri/retroorbital fat. OARs that were maximally spared included lenses, lacrimal glands, globe, and retina. Optic nerves were generally in the target volume and received prescription dose, but hot spots were avoided. Functional outcomes recorded included Clinical Activity Score (CAS) , proptosis, extraocular muscle function (EOM)/diplopia and visual acuity. Toxicities were graded according to CTCAE v5.Results:
Of the 21 pts in this study, 81% were female with a median age of 59 years (range: 38.9-85.3). Two pts (9%) smoked during RT while 6 (26.5%) were former smokers. Fifteen patients (71%) had a pre-RT CAS =3 and 4 required preRT surgical decompression. RT was delivered concurrently with IV solumedrol in 13 pts (61%) and teprotumumab in 2 pts, while RT was used as salvage in 8 pts (38%) and in 3 pts (14%) previously treated with IV solumedrol and teprotumumab, respectively. Mean doses to OARs included: R lens (4.7 Gy) L lens (4.7 Gy), R lacrimal gland (13.4 Gy), L lacrimal gland (13.3 Gy), R retina (15.7 Gy), L retina (15.8 Gy), R globe (11.2 Gy), L globe (11.1 Gy). Post RT, 13 pts (61%) achieved a CAS score of 0, with a mean CAS reduction of 3 points. Proptosis improved in 8 patients (38%) and EOM function improved in 10 patients (47.6%). In a total of 42 eyes, 19 (45.2%) had improved visual acuity, 12 (28%) remained unchanged, and 5 (11.8%) worsened due to disease progression despite RT. Grade 3 toxicity occurred in only one patient (4%) who had PVD which was managed successfully with surgery. Grade 2 xeropthalmia occurred in 7 pts (33%) while Grade 2 keratitis occurred in 1 pt (4%). All patients required artificial tears after RT.Conclusion:
IMRT provides excellent functional outcomes with minimal morbidity in the treatment of Graves eye disease while reducing doses to critical normal tissues.