title: Radiotherapy for moderate-to-severe Graves' ophthalmopathy: improved outcomes with early treatment.
abstract: OBJECTIVE
  The purpose of this review is to quantify the response to radiotherapy delivered early in the active inflammatory phase of moderate-to-severe Graves' ophthalmopathy.
  
  
  METHODS
  A retrospective review of radiotherapy delivered early in the active phase of Graves' ophthalmopathy was performed. All 47 cases had moderate-to-severe ophthalmopathy, and 30 cases had optic neuropathy. Variables examined included exophthalmos, color vision, and resistance to retropulsion. Statistical analyses comparing these variables at presentation and at 3 and 6 months after radiotherapy were performed. Subset analyses comparing responses of patients with symptoms lasting longer or less than 6 months were also performed.
  
  
  RESULTS
  At 6 months after radiotherapy, there was improvement in exophthalmos in 74.5% of cases and improvement in retropulsion in 83.0%, and all cases of previous color deficiency improved. The mean improvement in exophthalmos was 1.38 mm, color vision was two plates, and retropulsion was 1 grade. On subset analyses, there was a trend toward greater improvement in patients treated earlier in the course of their symptoms.
  
  
  CONCLUSIONS
  Radiotherapy may play an important role in the treatment of Graves' ophthalmopathy, especially for patients with optic neuropathy. Early intervention (symptoms < 6 months) with radiotherapy may be the optimal timing for this treatment.
authors.affiliation: Department of Radiation Oncology, Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA. alpertt@upstate.edu
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Alpert
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Alpert
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Bersani
authors.forename: Seung S
authors.initials: SS
authors.lastname: Hahn
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bogart
authors.forename: Chung T
authors.initials: CT
authors.lastname: Chung
mesh_terms: D000704:Analysis of Variance; D005260:Female; D006111:Graves Disease / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome