LONG-TERM RESULTS AND COMPARISON OF CLASSIFICATIONS AFTER RADIOTHERAPY FOR GRAVES ORBITOPATHY

Background: This study compares 4 classifications in patients with pro gressive refractory Graves orbitopathy (GO) and examines their prognos tic value in long-term follow-up. Patients and Methods: From 1984 to 1 994, 60 consecutive patients (49 female, 11 male) received 20 Gy (10 x 2 Gy) radiotherapy with 6 MV Linac photons. Ocular symptoms and funct ional impairment was evaluated according to 4 GO-classification system s: Werner-, modified ATA- and Stanford-Score and Ophthalmopathy-Index (OI) according to Grussendorf [26, 27]. In addition, all patients note d their subjective response on a linear scale (0 to 100%). Results: Im provement was achieved within 1 year after radiotherapy according to t he Werner-Score in 28 (47%) patients in greater than or equal to 1 sym ptom category, according to the modified ATA-score in 48 (80%), the St anford-score in 47 (78%) and the OI-Score in 55 (92%) patients (reduct ion of: 2 points). The Werner-Score correlated less to the other score s (coeffizient r < 0.5) than the other scores among themselves (r simi lar to 0.9). The ATA-Score improved in the different symptom categorie s between 47% (stage VI) and 87% (stage V). The OI-Score was reduced b y a mean of 6 points. The patients reached a mean subjective improveme nt of +70 +/- 25%. Acute or chronic side effects were not observed. In multivariate analysis the ''male gender'' (p = 0.08), a ''symptom dur ation prior to radiotherapy > 1 year'' (p = 0.14) and a ''high symptom category'' (p = 0.11) indicated a negative prognostic trend. Conclusi ons: External radiotherapy is effective for severe, progressive GO aft er pretreatment. A minimum follow-up of at least 12 months and standar dized classification and success criteria are required.