[Brachytherapy of epistaxis in Rendu-Osler disease. Indications, technic, results]

Rendu-Osler disease is a clinical form characterized by skin, mucous and bowel teleangiectasias causing repeated bleeding, especially in the nasal region. Repeated epistaxis is controlled, however transiently, with electrocoagulation, laser therapy, embolization, mucous transplants and external radiotherapy or, more frequently, brachytherapy. The authors report on a Curietherapy technique based on the use of 192Iridium wires. The wires, which cannot be placed in parallel lines, must be positioned in three places after a fan-wise pattern: the first one on the floor, the second one along the anterior wall and the third one in between. The three wires are inserted into plastic tubes during fluoroscopy. The length of the wires is differentiated for greater dose distribution homogeneity. The dose given to the reference isodose--which is probably in contact with the mucosa--is 30 Gy. We performed 9 maneuvers in 6 patients and three of them were also treated in the contralateral nostril. Complete remission was seen in 4 patients. In 2 patients the response has lasted 18 and 32 months and 2 others have a shorter follow-up. In 5 patients we obtained a good response (mean: 58 months). Our results are in agreement with those in brachytherapy literature. Few trials are reported of external irradiation but in our personal experience, its results are poor. Brachytherapy effect is limited in time but yields major clinical benefits to the patient. Brachytherapy cannot replace other treatment methods and must therefore be considered as a palliative treatment which can improve patient's quality of life in time.