Sakata K, Hareyama M, Oouchi A, Shidou M, Nagakura H, Morita K, Osanai H, Ohtsuka K, Hinoda Y
Department of Radiology, Sapporo Medical University, School of Medicine, Japan.
Jpn J Clin Oncol. 1998 Jun;28(6):364-7. doi: 10.1093/jjco/28.6.364.
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.
Fourteen female and six male patients with Graves' ophthalmopathy were treated with radiotherapy between 1989 and 1996. Prior to radiotherapy, eight patients 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.
Treatment was well tolerated. There have been no late complications. All 12 patients 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. Most of the patients have experienced an improvement of eye-muscle motility. Extraocular muscles that work for elevation were impaired more severely than the other muscles and this tended to remain. Of the 16 patients 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.
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.
通过使用新开发的定量指标，报告对使用类固醇或免疫抑制剂失败、出现不良反应或存在相对禁忌证的患者进行放射治疗的结果。
1989年至1996年间，对14名女性和6名男性格雷夫斯眼病患者进行了放射治疗。放疗前，8名患者接受了泼尼松治疗，4名患者接受了免疫抑制剂治疗，4名患者接受了两者联合治疗。4名有类固醇禁忌证的患者最初接受了放射治疗。大多数患者接受了24 - 28 Gy的剂量，每次2 Gy分割。我们使用新开发的运动受限指数来评估眼外肌运动。
治疗耐受性良好。未出现晚期并发症。所有12名有软组织症状如水肿、刺激、流泪和疼痛的患者病情均有改善。眼球突出未改善或仅略有改善，最多3 mm。然而，除两名患者外，所有患者的眼球突出均已稳定，在随访期间未恶化。大多数患者的眼肌运动有所改善。负责上抬的眼外肌比其他肌肉受损更严重，且这种情况往往持续存在。在放疗开始前或放疗时使用类固醇的16名患者中，15名患者逐渐减少了类固醇用量，只有1名患者需要额外使用类固醇，从而使大多数患者避免了类固醇不良反应。
放射治疗可有效预防格雷夫斯病活动性炎性眼病的加重，发病率极低，从而消除了长期使用皮质类固醇相关的不良反应。新开发的运动受限指数有助于检测单个眼外肌运动的细微变化。
