Department of Radiation Oncology, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Radiat Oncol. 2020 Sep 21;15(1):220. doi: 10.1186/s13014-020-01663-8.
We aimed to explore the efficacy of orbital radiotherapy (RT) in patients with moderate-to-severe active Graves' orbitopathy (GO), including long-lasting disease, and to determine the predictive factors associated with treatment response.
This was a retrospective study of 62 moderate-to-severe active GO patients treated with RT. Demographic data and ophthalmic findings prior to RT and at 3 and 6 months afterward were analyzed. Computed tomography was performed before and after RT to compare orbital volume change. We used logistic regression to determine the predictive factors for treatment response. Subjects were divided into early- and late-active phase groups based on GO duration of 24 months and treatment outcomes were compared with each other to observe the effects of RT timing on treatment response.
Forty (64.5%) and forty-six (74.1%) patients experienced improvements in GO at 3 and 6 months after radiotherapy, respectively. Ocular parameters such as clinical activity score (CAS), proptosis, extraocular muscle (EOM) limitation, and compressive optic neuropathy (CON) were improved by RT. Volumes of EOM significantly decreased after RT. The enlargement of EOMs and EOM limitation were predictive factors for a good response to RT. At 6 months after RT, 22 (68.8%) patients of late-active phase group exhibited improvement in GO, which is comparable to the number of 24 (80.0%) patients of early-active phase group. In the late-active phase group, CAS, diplopia, and visual acuity were improved significantly, but there was no change in EOM limitation.
In moderate-to-severe active GO patients, orbital RT may help improve high CAS, proptosis, EOM limitation, and CON. The orbital RT in long-lasting active GO patients may be considered as treatments for the relief of symptoms including high CAS and poor visual acuity.
本研究旨在探讨中重度活动期 Graves 眼病（GO）患者，包括持续性疾病患者，接受眼眶放射治疗（RT）的疗效，并确定与治疗反应相关的预测因素。
本研究回顾性分析了 62 例中重度活动期 GO 患者接受 RT 的资料。分析了 RT 前及治疗后 3 个月和 6 个月的人口统计学资料和眼部表现。在 RT 前后进行计算机断层扫描（CT）以比较眼眶容积变化。我们使用逻辑回归确定治疗反应的预测因素。根据 GO 病程将患者分为早、晚期活动期组，并对两组患者的治疗结果进行比较，观察 RT 时机对治疗反应的影响。
40（64.5%）和 46（74.1%）例患者在 RT 后 3 个月和 6 个月时 GO 得到改善。放射治疗可改善 GO 的眼部参数，如临床活动评分（CAS）、眼球突出度、眼外肌（EOM）受限和压迫性视神经病变（CON）。RT 后 EOM 体积显著减小。EOM 增大和 EOM 受限是 RT 反应良好的预测因素。在 RT 后 6 个月，晚期活动期组 22（68.8%）例患者 GO 得到改善，与早期活动期组 24（80.0%）例患者的改善例数相当。在晚期活动期组，CAS、复视和视力明显改善，但 EOM 受限无变化。
在中重度活动期 GO 患者中，眼眶 RT 可能有助于改善高 CAS、眼球突出度、EOM 受限和 CON。对于持续性活动期 GO 患者，眼眶 RT 可作为缓解包括高 CAS 和视力不佳在内的症状的治疗方法。
