Radiotherapy in the Management of Graves' Ophthalmopathy

Abstract

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.

Radiotherapy in the treatment of Graves ophthalmopathy—to do it or not?

“…Late complications following radiotherapy of retrobulbar area include: retinopathy, cataract and radiation-induced tumours [9, 13–15, 17, 23, 24, 26, 29, 42, 43, 45, 46, 51, 59, 61, 65, 66, 68, 73]. In the presented material, three cases of cataract (three out of 106 = 2.8%) were reported that however might have been related to the physiological ageing process and not to radiotherapy.…”

“…The following factors are considered to worsen the prognosis of ophthalmopathy: patient age above 50–60 years, male sex, smoking, symptom duration, concomitant diabetes, hyperthyreosis [2, 5, 8, 9, 13, 14, 25, 26, 30, 32, 45, 49, 51, 52, 58, 59, 70]. The effect of these factors was analysed in the group of patients treated with the most effective method, i.e.…”