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Int J Radiat Oncol Biol Phys 1999 Mar 1;43(4):805-15
Place of radiotherapy in the treatment of Graves’
orbitopathy.Beckendorf V, Maalouf T, George JL, Bey P, Leclere J, Luporsi E
Department of Radiotherapy, Centre Alexis Vautrin, Vandoeuvre les Nancy, France.
PURPOSE: The aim of this study is to evaluate the response of Graves’ orbitopathy to
irradiation, and to specify the prognostic factors allowing one to better define the indications of
orbital radiotherapy. METHODS AND MATERIALS: From 1977 to 1996, 199 patients
received bilateral orbital irradiation delivering 20 Gy in 10 fractions and 2 weeks for a
progressive Graves’ orbitopathy. 195 patients were seen between 1 and 6 months after
radiotherapy. The different symptoms were studied and their response to radiation was
analyzed. Factors such as age, sex, evolution of thyroid disease, history of symptoms, and
previous or combined treatments were analyzed. RESULTS: The results revealed that 50
patients (26%) had a good or excellent response, 98 (50%) had a partial response, 37 (19%)
were stable, 10 (5%) had a progression of disease. The signs that best responded to
radiotherapy were the infiltration of soft tissues and the corneal involvement. Responses of
proptosis or oculomotor disorders were more complete when these signs were not advanced at
the time of treatment. Irradiation seemed to have the same efficacy when applied as first-line
treatment or after failure of corticosteroids. Neither modality of treatment of hyperthyroidism
nor thyroid status at the time of orbital irradiation modified the results. The best results were
recorded for early or moderately advanced presentation (p = 0.05). Patients treated within a
delay of 7 months after the beginning of the ophthalmopathy had better responses than patients
treated later (p = 0.10). CONCLUSION: Radiation therapy was successful in Graves’
orbitopathy by stopping the progression of disease in almost all cases, by improving the comfort
of patients, by obtaining objective responses, and by avoiding surgical treatments particularly
when signs were moderate. -
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