Graves ophthalmopathy: MR evaluation of 10-Gy versus 24-Gy irradiation combined with systemic corticosteroids.

Nakahara, Haruka; Noguchi, Shiro; Murakami, Naoya; Morita, Marcia E.; Tamaru, Masao; Ohnishi, Takashi; Hoshi, Hideki; Jinnouchi, Seishi; Nagamachi, S; Futami, S

doi:10.1148/radiology.196.3.7644656

Cited by 47 publications

(18 citation statements)

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“…Intravenous GC pulse therapy is more effective than oral GC (response rates w80% vs w50%; (70), but an alternative regimen of 1 Gy per week over a 20-week period was equally effective and better tolerated (71). Higher doses are no more effective (72). A lower cumulative dose of 10 Gy was found to be as effective as the standard 20 Gy regimen (71).…”

Section: Box 4 Simple Measures That May Alleviate Symptoms In Gomentioning

confidence: 99%

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

Bartalena¹,

Baldeschi²,

Dickinson³

et al. 2008

European Journal of Endocrinology

625

476

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Section: Box 4 Simple Measures That May Alleviate Symptoms In Gomentioning

confidence: 99%

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

Bartalena¹,

Baldeschi²,

Dickinson³

et al. 2008

European Journal of Endocrinology

625

476

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“…The most common delivered dose is 20 grays (Gy) per eye (117); this cumulative dose is usually fractionated in 10 daily doses over a 2-week period to reduce the cataractogenic effect of irradiation (116). Nakahara et al (122) reported that a cumulative dose of 24 Gy provided better results than a dose of 10 Gy. Recently, Kahaly et al (123) reported that a therapeutic scheme of 1 Gy per week over a 20-week period was equally effective and possibly better tolerated than the classical 2-week scheme.…”

Section: April 2000mentioning

confidence: 99%

Management of Graves' Ophthalmopathy: Reality and Perspectives

Bartalena¹

2000

Endocrine Reviews

299

351

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Graves' ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In mild cases, local therapeutic measures (artificial tears and ointments, sunglasses, nocturnal taping of the eyes, prisms) can control symptoms and signs. In severe forms of the disease (3-5%), aggressive measures are required. If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment. If the disease is severe but inactive, orbital decompression is preferred. Novel treatments such as somatostatin analogs or intravenous immunoglobulins are under evaluation. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease. Correction of both hyper-and hypothyroidism is crucial for the ophthalmopathy. Antithyroid drugs and thyroidectomy do not influence the course of the ophthalmopathy, whereas radioiodine treatment may cause the progression of preexisting ophthalmopathy, especially in smokers. The exacerbation, however, is prevented by glucocorticoids. In addition, thyroid ablation may prove beneficial for the ophthalmopathy in view of the pathogenetic model relating eye disease to autoimmune reactions directed against antigens shared by the thyroid and the orbit.

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“…Ravin et al (11), however, reported poor results with only lOGy retrobulbar irradiation in the treatment of GO. Nakahara et al also reported that response in the 24 Gy group was better than that in the lOGy group, in which nine out of 15 patients experienced persistent or recurrent symptoms of GO (12). A higher cumulative dose of 30…”

Section: Radiotherapy Of Graves' Ophthalmopathymentioning

confidence: 93%

Radiotherapy in the Management of Graves' Ophthalmopathy

Sakata

Hareyama

Oouchi

et al. 1998

Japanese Journal of Clinical Oncology

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Background:To report the results of radiotherapy for patients with failure, adverse reactions or relative contraindications to the use of steroids or immunosuppressants, by using newly developed quantitative indexes. Methods: Fourteen female and six malepatients withGraves' ophthalmopathy weretreated with radiotherapy between 1989 and 1996. Priorto radiotherapy, eightpatients received treatment with prednisone, four received immunosuppressants and four received a combination of both. Four patients with contraindications to steroids were initially managed with radiotherapy. Most of the patients received a dose of 24-28 Gy in 2 Gy fractions. We used the newly developed motility limitation index to assess extraocular motility. Results: Treatment waswelltolerated. Therehavebeen no latecomplications. AII12patients with soft tissue signs such as edema, irritation, tearing and pain were improved. Proptosis did not improve or improved only slightly, 3 mm at best. However, proptosis in all but two has been stabilized and has not deteriorated in the follow-up period. Mostof the patients haveexperienced an improvement of eye-muscle motility. Extraocular muscles thatworkfor elevation wereimpaired more severely thanthe othermuscles and thistended to remain. Of the 16patients using steroids before or when radiotherapy was initiated, 15 were tapered off and only one patient required additional steroids, thus sparing the majority from steroid adverse reactions. Conclusion: Radiotherapy was effective in preventing exacerbations of active inflammatory ophthalmopathy in patients with Graves' disease with minimal morbidity and thus eliminated the adverse reactions associated with protracted corticosteroid use. The newly developed motility limitation index was useful in detecting delicate changes in motility of individual extraocular muscles.

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Graves ophthalmopathy: MR evaluation of 10-Gy versus 24-Gy irradiation combined with systemic corticosteroids.

Abstract: In treatment of GO, 24 Gy of radiation is a more effective dose than 10 Gy when combined with systemic corticosteroids.

Cited by 47 publications

References 0 publications

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

Management of Graves' Ophthalmopathy: Reality and Perspectives

Radiotherapy in the Management of Graves' Ophthalmopathy

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