Radiotherapy in Graves Ophthalmopathy at National Taiwan University Hospital

Purpose: To evaluate and discuss the radietion therapeutic results of Graves' ophthamopathy treated at National Taiwan University Hospital (NTUH). Materials & Methods: This retrospective study was to review the 16 patients with Graves' ophthalmopathy whom treated with radiation therapy at National Taiwan University Hospital from 1992 to 1997. There were Smen and 8 women, aged from 14 to 63 years old, with a mean age of 42.9 years old. Most of the patients presented with soft tissue signs, eye muscle impairment and proptosis. Patients received 20Gy in 2Gy per fraction to volume that included the entire area of abnormality and usually extended from the posterior globe to the anterior clinoids process.Results: Sixty-three percent (10/16) of the patients responded successfully to radiotherapy. There was 62.5% (10/16) of the patients presenting with these signs demonstrated significant improvement. Patients with proptosis improved after treatment was 83.3% (5/6), respectively. Only 40.0% (4/10) of the patients showed improvement in the restriction of eye movement. Improvement of visual acuity was found in 60.0% (3/5) of the patients.Conclusion: Radiotherapy with a dosage of 20Gy is effective in preventing exacerbation of active inflammatory ophthalmopathy in patients with Graves' disease and eliminates the side effects associated with protracted use of corticosteroid. It is recommended that radiotherapy can be considered to treat patients who fail after steroid administration or have a contraindication to steroid. Surgical management such as orbit decompression may reserved for patients who have progressing or disabling proptosis after radiation therapy.