Bartalena Luigi, Marcocci Claudio, Tanda Maria Laura, Rocchi Roberto, Mazzi Barbara, Barbesino Giuseppe, Pinchera Aldo
Cattedra di Endocrinologia, University of Insubria, Varese, Italy.
Thyroid. 2002 Mar;12(3):245-50. doi: 10.1089/105072502753600223.
Orbital radiotherapy is a well-established method of treatment for severe Graves' ophthalmopathy, because of its anti-inflammatory and locally immunosuppressive effects. It has been used for 60 years. Conventional external x-ray and cobalt therapy have been abandoned, and most groups now use supervoltage linear accelerators (4-6 MeV). Cumulative doses may vary, but in most studies a cumulative dose of 20 Gy delivered over 2 weeks was utilized. Successful outcome depends on the selection of patients, because recent onset, active ophthalmopathy is much more favorably affected than longstanding, inactive disease. Inflammatory signs, recent onset eye muscle dysfunction, and optic neuropathy respond well to orbital radiotherapy, while proptosis and longstanding eye muscle restriction respond poorly. Overall, favorable responses have been reported, with few exceptions, in approximately 60% of cases. Combination of irradiation with high-dose systemic glucocorticoids provides better results than either treatment alone. Orbital radiotherapy is well tolerated and safe. Preexisting retinopathy (e.g., in patients with diabetes) is a contraindication to this treatment for the risk of further retinal damage. No case of radiation-induced tumors has so far been described after orbital radiotherapy for Graves' ophthalmopathy.
由于具有抗炎和局部免疫抑制作用，眼眶放射治疗是重度格雷夫斯眼病一种成熟的治疗方法。它已被使用60年。传统的外照射X线和钴治疗已被摒弃，目前大多数机构使用超高压直线加速器（4-6兆电子伏特）。累积剂量可能有所不同，但在大多数研究中采用的是在2周内给予20戈瑞的累积剂量。治疗效果取决于患者的选择，因为近期发病的活动性眼病比长期存在的非活动性疾病对治疗的反应要好得多。炎症体征、近期出现的眼肌功能障碍和视神经病变对眼眶放射治疗反应良好，而眼球突出和长期存在的眼肌受限反应较差。总体而言，除少数例外，约60%的病例报告有良好反应。放射治疗与大剂量全身糖皮质激素联合使用比单独使用任何一种治疗效果更好。眼眶放射治疗耐受性良好且安全。既往存在视网膜病变（如糖尿病患者）因有进一步视网膜损伤的风险而成为该治疗的禁忌证。迄今为止，尚未有格雷夫斯眼病眼眶放射治疗后发生放射性肿瘤的病例报道。
