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A retrospective study on the efficacy of total absorbed orbital doses of 12, 16 and 20 Gy combined with systemic steroid treatment in patients with Graves’ orbitopathy

  • Oculoplastics and Orbit
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Abstract

Background

Graves’ disease (GD) is an autoimmune disease that typically affects the thyroid gland. Thirty to sixty percent of patients also suffer from orbital inflammation. Retrobulbar radiotherapy for Graves’ orbitopathy (GO) has been used for decades, though there is no direct evidence for the influence of dose and fractionation schedules on various signs and symptoms. Indeed, optimal fractionation schedules and recommended total irradiation doses are still a matter of discussion. Our aim was to investigate treatment efficacy of retrobulbar irradiation for GO at different total absorbed doses and fractionation schedules.

Methods

A retrospective evaluation of 129 patients who were examined before, as well as 6–8 months after irradiation with different treatment schedules at eight radiotherapeutic departments. Total absorbed doses were 12, 16, or 20 Gy. All patients were additionally treated with systemic application of corticosteroids. Treatment efficacy was evaluated through assessment of proptosis, horizontal and vertical ocular motility and of clinical activity (CAS). Overall group and individual responses were evaluated. Treatment response was defined as inactivation of GO, reduction of proptosis by at least 2 mm, improvement of motility by ≥8° or unchanged normal parameters.

Results

Prior to irradiation, neither age, disease duration, gender distribution, smoking behavior or serologic parameters, nor clinical activity or severity stages varied significantly between groups. Neither did outcome measures, except proptosis, differ significantly. Retrobulbar irradiation led to inactivity of GO in approximately 80% of patients, with no significant group difference. After irradiation with 16 and 20 Gy, vertical motility improved in a significantly higher percentage of patients than after irradiation with 12 Gy. Median improvement of vertical motility in responding patients was excellent in all groups (15° at 12 Gy, 10° at 16 Gy, 10° at 20 Gy). Horizontal motility did not change significantly.

Conclusion

If the aim of retrobulbar irradiation is primarily to reduce soft-tissue signs, lower doses are sufficient. If a patient also suffers from dysmotility, doses exceding 12 Gy may be more effective.

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Conflict of interest statement

The authors declare no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. The authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.

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Authors and Affiliations

  1. Endocrine Orbitopathy Research and Therapy in Essen (EORTE), Center for Ophthalmology, University Duisburg-Essen, University Hospital Essen, Essen, Germany

    Kristian T. M. Johnson, Joachim Esser & Anja K. Eckstein

  2. Department of Radiation Oncology, University Duisburg-Essen, University Hospital Essen, Essen, Germany

    Andrea Wittig & Werner Sauerwein

  3. Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, University Hospital Essen, Essen, Germany

    Christian Loesch

  4. Abteilung für Erkrankungen des Vorderen Augenabschnittes, Zentrum für Augenheilkunde am Universitätsklinikum Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Kristian T. M. Johnson

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  1. Kristian T. M. Johnson
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  2. Andrea Wittig
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  3. Christian Loesch
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  4. Joachim Esser
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Correspondence to Kristian T. M. Johnson.

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The contribution of Johnson and Wittig should be considered equal.

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Johnson, K.T.M., Wittig, A., Loesch, C. et al. A retrospective study on the efficacy of total absorbed orbital doses of 12, 16 and 20 Gy combined with systemic steroid treatment in patients with Graves’ orbitopathy. Graefes Arch Clin Exp Ophthalmol 248, 103–109 (2010). https://doi.org/10.1007/s00417-009-1214-3

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  • DOI: https://doi.org/10.1007/s00417-009-1214-3

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