Prognostic factors in the radiotherapy of graves' ophthalmopathy

Petersen, Ivy A.; Kriss, Joseph P.; McDougall, I. Ross; Donaldson, Sarah S.

doi:10.1016/0360-3016(90)90532-o

Cited by 145 publications

(19 citation statements)

References 16 publications

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“…One review journal provided strong evidence for a causal association between smoking and the development of TAO, with a risk ratio/odds ratio >2 in most studies, although the quality of the studies varied [17]. Thyroid status was influential in determining the clinical course of ophthalmopathy in several reports [5,7,8,20-22]. In the past, euthyroid Graves' disease was reported to be a predictor of poor prognosis in patients who receive orbital irradiation [22].…”

Section: Discussionmentioning

confidence: 99%

“…Thyroid status was influential in determining the clinical course of ophthalmopathy in several reports [5,7,8,20-22]. In the past, euthyroid Graves' disease was reported to be a predictor of poor prognosis in patients who receive orbital irradiation [22]. In one recent report, patients in a normal thyroid function group were significantly older, more likely to be male, and had less severe ophthalmopathy than did patients in an abnormal thyroid function group [5].…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors Associated with the Severity of Thyroid-Associated Orbitopathy in Korean Patients

Lee

Yoon

2010

Korean J Ophthalmol

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PurposeThe purpose of this study is to identify risk factors for severe thyroid-associated orbitopathy (TAO) and compressive optic neuropathy in Korean patients.MethodsThis study was a retrospective comparative case series. All TAO patients who were first seen at our institution between 2005 and 2009 and who had follow-up periods of at least 6 months were included. Patients were divided into mild or moderate and severe TAO groups. Cases were also segregated based on the presence or absence of optic neuropathy. Demographics, smoking status, comorbidities, thyroid hormonal status, thyroid autoantibody levels, and clinical presentations were assessed.ResultsA total of 99 patients (83 with mild to moderate courses and 16 with severe courses; 90 without optic neuropathy and 9 with optic neuropathy) were included in this study. On multiple logistic regression analysis, smoking status was a predictive risk factor for a severe course of TAO and the development of optic neuropathy (odds ratios = 6.57 and 10.00, respectively). Other factors such as age, gender, free T4 level, thyroid binding-inhibiting immunoglobulin, and a history of diabetes were not predictive of severe TAO or optic neuropathy.ConclusionsAlthough various factors may influence the severity of TAO and the development of optic neuropathy, this study showed that smoking was a risk factor for severe TAO and the development of optic neuropathy. Therefore, it is important for patients with Graves' disease to refrain from smoking. Frequent and careful observation should also be performed in current smokers, as TAO patients who smoke are susceptible to a severe course and/or optic neuropathy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with the Severity of Thyroid-Associated Orbitopathy in Korean Patients

Lee

Yoon

2010

Korean J Ophthalmol

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“…Nonsurgical management of Graves' ophthalmopathy during its evolving inflammatory phase includes systemic corticosteroids and external beam irradiation 7 . In patients who fail these methods or in those with longstanding and stable Graves' disease with cosmetically objectionable proptosis, surgical decompression may be considered 8 …”

Section: Introductionmentioning

confidence: 99%

Balanced orbital decompression for graves' ophthalmopathy

1998

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“…Secondly, the median total dose of postoperative RT in our patients was 20 Gy, which was much lower than in other studies (O'Sullivan et al 1995, Blanco et al 2001, Chin et al 2002, Lee et al 2005, Berger et al 2007, Horoschak et al 2009, Heyd et al 2010). The doses as low as 20 Gy in 10 fractions came from the general prescribed doses for benign diseases such as thyroid ophthalmopathy (Petersen et al 1990), orbital pseudotumor (Lanciano et al 1990), and heterotopic ossification (MacLennan et al 1984). Treatment of PVNS with total doses of < 30 Gy has been associated with recurrence rates of 4–14% after median 3.5 years of follow-up (Ustinova et al 1986, Kotwal et al 2000, Blanco et al 2001).…”

Section: Discussionmentioning

confidence: 99%

Low-dose external beam radiotherapy as a postoperative treatment for patients with diffuse pigmented villonodular synovitis of the knee

Park¹,

Kim²,

Kim³

et al. 2012

Acta Orthopaedica

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Background and purposePigmented villonodular synovitis (PVNS) is a rare proliferative disorder involving synovial membranes, and patients with PVNS have a variable prognosis. We retrospectively analyzed clinical outcomes after synovectomy plus low-dose external beam radiotherapy for diffuse PVNS of the knee.MethodsWe reviewed the medical records of 23 patients who underwent postoperative radiotherapy between 1998 and 2007. 19 patients had primary disease and 4 had recurrent disease with an average of 2.5 prior surgeries. After synovectomy (17 arthroscopic surgeries; 6 open), all 23 patients received 4-MV or 6-MV external beam radiotherapy with a median dose of 20 (12–34) Gy in 10 fractions.ResultsAt a median follow-up of 9 (0.8–12) years, 4 patients had recurrent disease, with a median disease-free interval of 5 years. Of these 4 patients, 3 received salvage synovectomy and regained local control. Univariate analysis showed that age, sex, history of trauma, and total dose of radiation were not predictive of local control. 22 patients reported excellent or good joint function, and 1 who refused salvage synovectomy had poor joint function. None of the patients experienced grade 3 or higher radiation-related toxicity or radiation-induced secondary malignancies.InterpretationPostoperative external beam radiotherapy is an effective and acceptable modality to prevent local recurrence and preserve joint function in patients with diffuse PVNS of the knee. Low-dose (20 Gy) radiotherapy appears to be as effective as moderate-dose treatment (around 35 Gy).

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Prognostic factors in the radiotherapy of graves' ophthalmopathy

Cited by 145 publications

References 16 publications

Risk Factors Associated with the Severity of Thyroid-Associated Orbitopathy in Korean Patients

Risk Factors Associated with the Severity of Thyroid-Associated Orbitopathy in Korean Patients

Balanced orbital decompression for graves' ophthalmopathy

Low-dose external beam radiotherapy as a postoperative treatment for patients with diffuse pigmented villonodular synovitis of the knee

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