[Endocrine orbitopathy: comparison of the long-term result and classification after radiotherapy].
BACKGROUND
This study compares 4 classifications in patients with progressive refractory Graves orbitopathy (GO) and examines their prognostic value in long-term follow-up.


METHODS
From 1984 to 1994, 60 consecutive patients (49 female, 11 male) received 20 Gy (10 x 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. 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 > or = 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 (coefficient r < 0.5) than the other scores among themselves (r approximately 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.
Klinik für Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfried-Krupp-Krankenhaus Essen.
M H
MH
Seegenschmiedt
L
L
Keilholz
G
G
Gusek-Schneider
S
S
Barth
J
J
Hensen
F
F
Wolf
G O
GO
Naumann
R
R
Sauer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000145:classification* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000145:classification* / Q000532:radiotherapy*; D011379:Prognosis
Endokrine Orbitopathie: Vergleich der Langzeitergebnisse und Klassifikationen nach Radiotherapie.