Clinical outcomes of radiotherapy as initial local therapy for Graves’ ophthalmopathy and predictors of the need for post-radiotherapy decompressive surgery

Radiation Oncology

Ian Crocker²  William A Hall²  Brent Hayek³  Ted Wojno³  Lang Liebman¹  Roshan S Prabhu² 

[1] Radiation Oncology Associates, Richmond, Georgia, USA;Winship Cancer Institute, Emory University, Atlanta, Georgia, USA;Division of Oculoplastics, Orbital and Cosmetic Surgery, Emory University, Atlanta, Georgia, USA

关键词: Graves’ orbitopathy;    Graves’ ophthalmopathy;    Orbital radiation;    Graves’ disease;    Radiation therapy;   

Others  :  1160821
DOI  :  10.1186/1748-717X-7-95

 received in 2012-04-27, accepted in 2012-06-09,  发布年份 2012

【 摘 要 】

Background

The optimal initial local treatment for patients with Graves’ ophthalmopathy (GO) is not fully characterized. The purpose of this retrospective study is to describe the clinical outcomes of RT as initial local therapy for GO and define predictors of the need for post-RT salvage bony decompressive surgery.

Methods

91 patients with active GO and without prior surgery were treated with RT as initial local therapy between 01/1999 and 12/2010, with a median follow-up period of 18.3 months (range 3.7 - 142 months). RT dose was 24 Gy in 12 fractions. 44 patients (48.4%) had prior use of steroids, with 31 (34.1%) being on steroids at the initiation of RT. The most common presenting symptoms were diplopia (79%), proptosis (71%) and soft tissue signs (62%).

Results

84 patients (92.3%) experienced stabilization or improvement of GO symptoms. 58 patients (64%) experienced improvement in their symptoms. 19 patients (20.9%) underwent salvage post-RT bony decompressive surgery. Smoking status and total symptom score at 4 months were independent predictors of post-RT bony decompression with odds ratios of 3.23 (95% CI 1.03 – 10.2) and 1.59 (95% CI 1.06 – 2.4), respectively. Persistent objective vision loss at 4 months post-RT was the most important symptom type in predicting salvage decompression. Chronic dry eye occurred in 9 patients (9.9%) and cataracts developed in 4 patients (4.4%).

Conclusions

RT is effective and well tolerated as initial local therapy for active GO, with only 21% of patients requiring decompressive surgery post RT. Most patients experience stabilization or improvement of GO symptoms, but moderate to significant response occurs in the minority of patients. Smoking status and total symptom severity at 4 months, primarily persistent objective vision loss, are the primary determinants of the need for post-RT salvage bony decompression. Patients who smoke or present with predominantly vision loss symptoms should be advised as to their lower likelihood of symptomatic response to RT and their increased likelihood of requiring post-RT decompressive surgery.

【 授权许可】

   
2012 Prabhu et al.; licensee BioMed Central Ltd.

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