MANAGEMENT OF EPISTAXIS IN RENDU-OSLER DISEASE - IS BRACHYTHERAPY EFFECTIVE

Purpose: This paper reviews the results of intranasal brachytherapy fo r epistaxis in 43 patients with Rendu-Osler disease treated between 19 71-1991 at Henri Mondor Hospital. Methods and Materials: 2-3 intranasa l catheters were afterloaded with Ir-192 sources. Computer dosimetry w as performed and then the dose was prescribed to an isodose thought to cover the nasal mucosa. The dose rate ranged from 0.16 Gy/h-0.63 Gy/h with a median of 0.34 Gy/h. Dose at one application ranged from 15-35 Gy with a median of 30 Gy. The severity of epistaxis was graded 1 to 5. Results: The time to recurrence of significant epistaxis ranged fro m 6-178 months with a median of 24 months. The dose prescribed did not correlate with control rate. The only brachytherapy complication was septal perforation in 4 patients; in one this was a result of repeated nasal coagulation. Conclusion: We suggest that intranasal brachythera py is a useful modality in the management of epistaxis in Rendu--Osler disease.