RESUMO
BACKGROUND: IgG4-related ophthalmic disease is a rare, newly recognized entity with high failure rates on first-line therapy of systemic corticosteroids and no other proven management options. Case Presentation. Here, we present the clinical course of a patient with IgG4 ophthalmic disease who achieved a favorable response from radiotherapy. Our patient initially presented with a history of recurrent painful flares of orbital inflammation, a pathologic diagnosis follicular lymphoid hyperplasia from a right lacrimal gland biopsy, and MRI imaging noting expansion of the lateral rectus muscle of the right eye. Initial treatment with dacryoadenectomy and multiple courses of corticosteroids failed to keep his symptoms at bay. Further evaluation revealed florid IgG4 staining. In this context, he was evaluated for image-guided intensity-modulated radiotherapy (IG-IMRT) to the orbit to 20 Gy in 10 fractions. His ophthalmic symptoms resolved. CONCLUSIONS: This treatment experience suggests radiotherapy may be a favorable option for symptom relief in patients with IgG4-related ophthalmic disease not controlled by corticosteroids.
RESUMO
There is concern about dose along the matchline when upper head-and-neck fields are treated with IMRT and the lower (supraclavicular) field is treated with a conventional fixed beam. An anatomical phantom was scanned and planned with IMRT upper head-and-neck fields and a fixed-beam supraclavicular field. The plans were fused and dose was calculated to points along the matchline. These doses were compared with thermolaminescent dosimetry measurements in the phantom, as the phantom was treated according to the plans.