Radiotherapy for Graves' orbitopathy: results of a national survey.
BACKGROUND
Graves' orbitopathy (GO) is a widely accepted indication for radiation therapy (RT). In conjunction with the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD), a national survey was conducted in order to assess whether or not there is a consensus on the indication for RT and various treatment factors which were studied.


METHODS
A questionnaire was circulated to 190 RT institutions to obtain relevant data concerning the patients' workload, stage-dependent indication, and diagnostic procedures, which were considered to be necessary. Further questions addressed details on radiation technique and dose-fractionation schedules, the combined use of corticoids, and salvage RT after previous treatment failure following RT.


RESULTS
With a response rate of 152/190 (80%), the survey is nationally representative. Based on the case workload, an estimated annual number of 1,600 GO cases are treated in German radiotherapy departments. With an 88% consensus, stages II-V are the typical indications. 85% considered imaging studies necessary for indication and only 48% for laboratory tests. 76% of the institutions used total doses in the range of 15-20 Gy, and conventional fractionation was most common (57%). 82% used a face mask fixation and 67% CT-based treatment planning. Approximately 50% would prescribe salvage RT, and total doses in the range of 20-40 Gy were considered to be acceptable.


CONCLUSIONS
The survey revealed a consensus concerning most of the factors studied. We recommend to review the patterns of care for RT of other entities of benign diseases and to implement a quality assurance program both on national and international levels.
Heyd
Reinhard
R
Radiation Clinic, Offenbach Hospital, Offenbach, Germany.
Seegenschmiedt
M Heinrich
MH
Strassmann
Gerd
G
Micke
Oliver
O
Makoski
Hans-Bruno
HB
Zamboglou
Nikolaos
N
D019583:Dose Fractionation, Radiation; D005094:Exophthalmos / Q000532:radiotherapy; D005858:Germany / Q000453:epidemiology; D006111:Graves Disease / Q000453:epidemiology / Q000532:radiotherapy*; D019538:Health Care Surveys; D006801:Humans; D011878:Radiotherapy / Q000379:methods; D011879:Radiotherapy Dosage; D011795:Surveys and Questionnaires