Radiation therapy for Graves' ophthalmopathy: a systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose: To evaluate the efficacy of radiotherapy (RT) with total dose of 20 Gy (RT 20 Gy) in the treatment of Graves' ophthalmopathy. Methods: A systematic review and metaanalysis of randomized controlled trials was performed comparing RT 20 Gy with or without glucocorticoid to cli nical treatments for Graves' ophthalmopathy. The MEDLINE, EMBASE, Cochrane Library databases and recent relevant journals were searched. Relevant reports were reviewed by two reviewers. Response to radiotherapy was defined as clinical success according to each trial. We also evaluated the quality of life and whether RT to produce fewer side effects than other treatments. Results: A total of 8 randomized controlled trials (439 patients) were identified. In the subgroup analysis, the overall response to treatment rates was better for: RT 20 Gy plus glucocorticoid vs glucocorticoids alone, OR=17.5 (CI95% 1.85250, p=0.04), RT 20 Gy vs sham RT, OR= 3.15 (CI95%1.596.23, p=0.003) and RT 20Gy plus intravenous glucocorticoid vs RT 20Gy plus oral glucocorticoid, OR=4.15(CI95% 1.3412.87, p=0.01). There were no differences between RT 20 Gy versus other fractionations and RT 20 Gy versus glucocorticoid alone. RT 20 Gy with or without glucocorticoids showed an improvement in diplopia grade, visual acuity, optic neuropathy, lid width, proptosis and ocular motility. No difference was seen for costs, intraocular pressure and quality of life. Conclusion: Our data have shown that RT 20 Gy should be offered as a valid the rapeutic option to patients with moderate to severe ophthalmopathy. The effecti veness of orbital radiotherapy can be increased by the synergistic interaction with glucocorticoids. Moreover, RT 20 Gy is useful to improve a lot of ocular symptoms, excluding intraocular pressure, without any difference in quality of life and costs.

Wcześniejsze leczenie choroby Gravesa lekami tyreostatycznymi lub radiojodem nie wpływa na skuteczność leczenia immunosupresyjnego orbitopatii tarczycowej

“…This treatment had already been proposed in 1983 by Bartalena et al [27], who reported a better outcome of the combined therapy. Several studies confirmed the efficacy of orbital irradiation as based on the meta-analysis by Viani et al [28], although Otsuka et al [29] found no significant differences in terms of the therapeutic effect between groups treated with steroid pulses with or without orbital irradiation. There are no large RCTs comparing the advantage of this combined treatment over IV glucocorticosteroids alone [28,30,31].…”

“…Several studies confirmed the efficacy of orbital irradiation as based on the meta-analysis by Viani et al [28], although Otsuka et al [29] found no significant differences in terms of the therapeutic effect between groups treated with steroid pulses with or without orbital irradiation. There are no large RCTs comparing the advantage of this combined treatment over IV glucocorticosteroids alone [28,30,31]. As reported in a randomised study, lower orbital doses of 12 Gy were sufficient in reducing soft tissue changes, and higher doses were required in patients with ocular motility impairment [32].…”

Complications of Hyperthyroidism

“…According to medical literature the dose of 20 Gy can be considered the optimal dose for orbital RT of TAO. The cumulative dose is usually fractionated in 10 daily doses over a 2-week period to reduce the cataractogenic effect [221]. Higher cumulative doses of RT does not improve the effectiveness of treatment [222].…”

“…Radiation retinopathy is an extremely rare complication of RT. Systemic microvascular disease due to diabetes mellitus (DM) or to previous chemotherapy may increase the risk for radiation retinopathy [221].…”

Neste fascículo dos ABO

“…A systematic review of the risks and benefits of radiotherapy, with or without the use of glucocorticoids, for the treatment of Graves' ophthalmopathy presented in this issue is the most comprehensive ever published in the world literature (2) . The authors identified 359 scientific articles on the subject in the various data sources and selected the eight ones that were randomized controlled trials, with data available.…”