Place of radiotherapy in the treatment of Graves' orbitopathy

Purpose: The aim of this study is to evaluate the response of Graves' orbit opathy to irradiation, and to specify the prognostic factors allowing one t o better define the indications of orbital radiotherapy. Methods and Materials: From 1977 to 1996, 199 patients received bilateral o rbital irradiation delivering 20 Gy in 10 fractions and 2 weeks for a progr essive Graves' orbitopathy, 195 patients were seen between I and 6 months a fter radiotherapy. The different symptoms were studied and their response t o radiation was analyzed. Factors such as age, sex, evolution of thyroid di sease, history of symptoms, and previous or combined treatments were analyz ed, Results: The results revealed that 50 patients (26%) had a good or excellen t 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. Respons es 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 cor ticosteroids, Neither modality of treatment of hyperthyroidism nor thyroid status at the time of orbital irradiation modified the results. The best re sults were recorded for early or moderately advanced presentation (p = 0.05 ). Patients treated within a delay of 7 months after the beginning of the o phthalmopathy had better responses than patients treated later (p = 0.10), Conclusion: Radiation therapy was successful in Graves' orbitopathy by stop ping the progression of disease in almost all cases, by improving the comfo rt of patients, by obtaining objective responses, and by avoiding surgical treatments particularly when signs were moderate. (C) 1999 Elsevier Science Inc.