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Endokrine Orbitopathie: Vergleich der Langzeitergebnisse und Klassifikationen nach Radiotherapie

Long-Term results and comparison of classifications after radiotherapy for graves orbitopathy

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Zusammenfassung

Hintergrund

Diese Studie vergleicht vier verschiedene Klassifikationen bei Patienten mit fortgeschrittener, therapierefraktärer endokriner Orbitopathie und untersucht deren prognostische Wertigkeit.

Patienten und Methode

Von 1984 bis 1994 wurden 60 konsekutive Patienten (49 Frauen, elf Männer) wegen progredienter, therapierefraktärer endokriner Orbitopathie bestrahlt (Linac 6 MV, 10mal 2 Gy). Im Verlauf wurden die Symptome und funktionellen Einschränkungen nach vier Klassifikationen bewertet: Werner-Score, modifizierter ATA-Score, Standford-Score und Ophthalmopathieindex (OI) nach Grussendorf [26, 27]. Außerdem notierten alle Patienten das subjektive Ansprechen auf einer linearen Skala (0 bis 100%).

Ergebnisse

Im Verlauf eines Jahres nach Radiotherapie besserten sich der Werner-Score bei 28 (47%) Patienten um ≥1 Kategorie, nach modifizierten ATA-Score 48 (80%), nach Stanford-Score 47 (78%) und nach OI-Score 55 (92%) Patienten (Reduktion um >2 Punkte). Der Werner-Score korrelierte kaum mit den anderen Scores (Koeffizient r<0,5), während diese untereinander hoch korrelierten (r ∼0,9). Der modifizierte ATA-Score besserte sich in den einzelnen Symptomkategorien zwischen 47% (Stadium VI) und 87% (Stadium V). Der OI-Score reduzierte sich im Mittel um sechs Punkte. Das subjektive Befinden besserte sich um +70±25%. Akute oder chronische Nebenwirkungen traten nicht auf. In multivariater Analyse waren das „männliches Geschlecht” (p=0,08)., die „Symptomdauer vor Radiotherapie >1 Jahr” (p=0,14) und die „hohe Symptomkategorie” (p=0,11) tendenziell negative Prognosefaktoren.

Schlußfolgerung

Die Radiotherapie ist auch bei schwerer progredienter endokriner Orbitopathie effektiv. Zur Bewertung sind mindestens zwölf Monate Nachbeobachtung und einheitliche Bewertungskriterien erforderlich.

Abstract

Background

This study compares 4 classifications in patients with progressive refractory Graves orbitopathy (GO) and examines their prognostic value in long-term follow-up.

Patients and Methods

From 1984 to 1994, 60 consecutive patients (49 female, 11 male) received 20 Gy (10×2 Gy) radiotherapy with 6 MV Linac photons. Ocular symptoms and functional impairment was evaluated according to 4 GO-classification systems: Werner-, modified ATA- and Stanford-Score and Ophthalmopathy-Index (OI) according to Grussendorf [26, 27]. In addition, all patients noted their subjective response on a linear scale (0 to 100%).

Results

Improvement was achieved within 1 year after radiotherapy according to the Werner-Score in 28 (47%) patients in ≥1 symptom category, according to the modified ATA-score in 48 (80%), the Stanford-score in 47 (78%) and the OI-Score in 55 (92%) patients (reduction of >2 points). The Werner-Score correlated less to the other scores (coeffizient r<0.5) than the other scores among themselves (r ∼0.9). The ATA-Score improved in the different symptom categories between 47% (stage VI) and 87% (stage V). The OI-Score was reduced by a mean of 6 points. The patients reached a mean subjective improvement of +70±25%. Acute or chronic side effects were not observed. In multivariate analysis the “male gender” (p=0.08), a “symptom duration prior to radiotherapy >1 year” (p=0.14) and a “high symptom category” (p=0.11) indicated a negative prognostic trend.

Conclusions

External radiotherapy is effective for severe, progressive GO after pretreatment. A minimum follow-up of at least 12 months and standardized classification and success criteria are required.

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Authors and Affiliations

  1. Klinik für Strahlentherapie der Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Deutschland

    Ludwig Keilholz, Stefan Barth & Rolf Sauer

  2. Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Deutschland

    Gabriele Gusek-Schneider & Gottfried O. H. Naumann

  3. Medizinische Klinik I (Abteilung Endokrinologie) mit Poliklinik der Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Deutschland

    Johannes Hensen

  4. Nuklearmedizinische Klinik der Universität Erlangen-Nürnberg, Erlangen-Nürnberg, Deutschland

    Friedrich Wolf

  5. Klinik für Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfried-Krupp-Krankenhaus Essen, Alfried-Krupp-Straße 21, D-45117, Essen

    M. Heinrich Seegenschmiedt

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Seegenschmiedt, M.H., Keilholz, L., Gusek-Schneider, G. et al. Endokrine Orbitopathie: Vergleich der Langzeitergebnisse und Klassifikationen nach Radiotherapie. Strahlenther Onkol 174, 449–456 (1998). https://doi.org/10.1007/BF03038622

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