RESUMO
BACKGROUND: To determine the efficacy and side-effects of (90)Y ibritumomab tiuxetan (Zevalin) as front-line treatment in patients with early-stage extranodal indolent lymphoma of the ocular adnexa (orbit, conjunctiva, or eyelid). PATIENTS AND METHODS: From August 2004 to November 2007, 12 patients with stages I-E extranodal indolent lymphoma of the ocular adnexa were enrolled in a prospective trial of rituximab followed by (90)Y ibritumomab tiuxetan (Zevalin therapeutic regimen). For each patient, clinical examinations and imaging studies were used to document response to therapy using the The International Working Group response criteria. All patients had (111)In ibritumomab tixuetan imaging to confirm expected biodistribution before (90)Y-Zevalin therapy; in addition, three patients had an optional single photon emission computed tomography-computed tomography scan to estimate the absorbed radiation dose to the orbital and ocular tissues. RESULTS: The study included seven women and five men. The median age was 60 years (range 22-79). Nine patients had mucosa-associated lymphoid tissue lymphoma of conjunctiva or orbit; three patients had grades 1-2 follicular lymphoma of orbit. One patient who had been deemed stage I-E initially was found to have another lesion in her deltoid muscle on positron emission tomography 2 weeks after enrollment. She was kept on trial although her disease was reclassified as stage IV due to this single additional (biopsy-proven) site. Ten patients had a complete response and two partial response (PR) within 3 months of treatment. One patient had a recurrence in the upper eyelid 6 months after an initial PR; he then received 30 Gy of external-beam radiotherapy (EBRT). His disease later progressed again in the orbit and he is currently being considered for other treatments. A second patient who attained a PR has remained stable with no progression 12 months after treatment. With a median follow-up time of 20 months (range 6-44 months), there were no cases of distant (extraorbital) relapse. All 12 patients experienced grade I or II transient pancytopenia during the first 3 months after enrollment in the trial. There were no episodes of grade III or IV myelosuppression. The estimated absorbed radiation dose to the orbital soft tissues was <3 Gy, 10 times lower than that with EBRT. CONCLUSIONS: Rituximab followed by (90)Y ibritumomab tiuxetan is an effective and safe front-line treatment for early-stage extranodal indolent B-cell lymphoma of the ocular adnexa.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Neoplasias Oculares/tratamento farmacológico , Linfoma de Zona Marginal Tipo Células B/tratamento farmacológico , Radioimunoterapia , Radioisótopos de Ítrio/uso terapêutico , Adulto , Idoso , Anticorpos Monoclonais/efeitos adversos , Neoplasias Oculares/patologia , Feminino , Humanos , Linfoma de Zona Marginal Tipo Células B/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radioisótopos de Ítrio/efeitos adversosRESUMO
PURPOSE: It has been reported that the effect of radioactive iodine (RAI) treatment is complete in 4 to 6 months. This retrospective study evaluated the appropriate time for repeated treatment of hyperthyroid disease with RAI after initial treatment failure. METHODS: Outcomes of 128 patients treated with RAI for hyperthyroid disease were reviewed retrospectively at 3 and 6 months. RESULTS: Eighty patients (group A) were treated successfully with a single dose of RAI. Twenty patients (group B) required a second treatment dose. Twenty-eight patients were lost to follow-up. All patients in group A were clinically improved to various degrees at 3 months and continued to improve at 6 months. All eight patients in group B who showed no improvement at 3 months remained the same at 6 months. The difference between the two groups was statistically significant. CONCLUSION: Patients with hyperthyroid disease who are unimproved at 3 months can be retreated with RAI without further delay.
Assuntos
Hipertireoidismo/radioterapia , Radioisótopos do Iodo/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Feminino , Bócio/complicações , Bócio/radioterapia , Humanos , Hipertireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Falha de TratamentoRESUMO
Brown tumors have been reported to take up TI-201 when dual-tracer parathyroid scintigraphy using TI-201 and Tc-99m pertechnetate was performed. With the change to the more favorable Tc-99m sestamibi parathyroid scanning, similar phenomena of tracer uptake in brown tumors have been reported. The authors describe a 44-year-old man with a left maxillary swelling. Laboratory investigations revealed elevated parathyroid hormone levels. Computed tomography of the head showed a left maxillary expansile mass. Subsequently, a Tc-99m sestamibi scan was performed to rule out a parathyroid adenoma. Left inferior parathyroid retention of the tracer was seen, indicating a parathyroid adenoma. An incidental finding was the uptake of Tc-99m MIBI in the left maxillary brown tumor. This case suggests the utility and possible specificity of Tc-99m MIBI uptake in diagnosing brown tumors.
Assuntos
Granuloma de Células Gigantes/diagnóstico por imagem , Doenças Maxilares/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adulto , Granuloma de Células Gigantes/etiologia , Granuloma de Células Gigantes/metabolismo , Humanos , Masculino , Doenças Maxilares/etiologia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico por imagem , CintilografiaAssuntos
Colecistite/diagnóstico por imagem , Compostos Radiofarmacêuticos , Disofenina Tecnécio Tc 99m , Telangiectasia Hemorrágica Hereditária/diagnóstico por imagem , Doença Aguda , Ductos Biliares Intra-Hepáticos/anormalidades , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Reações Falso-Negativas , Feminino , Vesícula Biliar/irrigação sanguínea , Vesícula Biliar/patologia , Gangrena/diagnóstico por imagem , Humanos , Isquemia/diagnóstico por imagem , Pessoa de Meia-Idade , Cintilografia , Tomografia Computadorizada por Raios XRESUMO
The course of proliferative diabetic retinopathy involving the optic disc was followed, and the response to peripheral retinal photocoagulation monitored by argon laser in 11 patients during and after 13 pregnancies. Traditional obstetric practice assumes that pregnancy is a stimulus to irreversible progression of proliferative diabetic retinopathy, and that timely abortion and sterilisation are essential in order to achieve control of the neovascular process. Extensive photocoagulation will cause significant regression of neovascular complexes in 63% of cases, and it confers sufficient benefits to make ophthalmic indications for therapeutic abortion and sterilisation no longer tenable.
Assuntos
Retinopatia Diabética/cirurgia , Terapia a Laser , Lasers , Gravidez em Diabéticas/cirurgia , Adulto , Cegueira/etiologia , Retinopatia Diabética/complicações , Retinopatia Diabética/patologia , Feminino , Seguimentos , Humanos , Neovascularização Patológica , Disco Óptico/irrigação sanguínea , Gravidez , Gravidez em Diabéticas/complicações , Gravidez em Diabéticas/patologia , Hemorragia Retiniana/etiologia , Transtornos da Visão/etiologiaRESUMO
A randomised controlled trial is reported of 94 patients with a symmetrical proliferative diabetic retinopathy involving the optic disc, who were treated by a peripheral retinal ablation technique using the argon laser. A highly significant difference in mean cumulative deterioration of visual acuity and blindness was shown in all but the late stages of the disease process between treated and untreated eyes. The untreated eyes exhibited far worse results. The earlier photocoagulation is initiated in the course of the proliferative process in this disease to control or preferably eliminate optic disc neovascularisation, the better the visual prognosis.