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Case Reports
. 2011 May;4(2):392-9.
doi: 10.1159/000330238. Epub 2011 Aug 18.

Macroglossia due to Systemic Amyloidosis: Is There a Role for Radiotherapy?

Isabelle Thibault  1 , Isabelle Vallières
Affiliations
Case Reports

Macroglossia due to Systemic Amyloidosis: Is There a Role for Radiotherapy?

Isabelle Thibault et al. Case Rep Oncol. 2011 May.

Abstract

Background: Macroglossia due to amyloid depositions can cause cosmetic problems and functional disability, and can lead to life-threatening airway obstruction. Management of macroglossia in systemic amyloidosis is controversial, and the role of surgery is unclear.

Case description: We present a case of a 66-year-old woman affected by macroglossia due to light chain amyloidosis who presented with eating and breathing difficulties. Because of prior successful results of radiotherapy for localized amyloid disease, our patient was treated with external beam radiation therapy (20 Gy in 10 fractions). The treatment was well tolerated by the patient. However, her systemic amyloidosis progressed, with a subclinical increase in tongue width.

Conclusions: This is the first reported use of radiotherapy for amyloidosis of the tongue. There was no evidence of benefit using a total dose of 20 Gy. This therapeutic modality is not recommended for the routine management of macroglossia.

Keywords: Amyloidosis; Macroglossia; Radiation; Tongue.

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Figures

<underline><b>Fig. 1</b></underline>
Fig. 1
Oral examination reveals enlargement of the tongue, scalloping at the edge of the tongue and deep indentations adjacent to the premolars and molars. Due to the constant lingual pressure exerted by the teeth, the patient experienced oral discomfort.
<underline><b>Fig. 2</b></underline>
Fig. 2
Axial, sagittal and coronal sections demonstrate isodose distribution and target coverage for lingual amyloidosis. Clinical target volume (orange), planning target volume (green), parotid glands (yellow) and bone marrow (red) are delineated on CT images for radiation therapy treatment planning. A 5-field coaxial beam arrangement was used for treatment, consisting of 1 anterior-posterior and 4 oblique fields. The planning target volume received a dose of 20 Gy in 10 fractions.
See this image and copyright information in PMC

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