The use of orbital radiotherapy for Graves' ophthalmopathy: quantitative review of the evidence.
OBJECTIVE
To systematically evaluate the efficacy of orbital radiotherapy in the treatment of Graves' ophthalmology.


METHODS
Pertinent studies were selected through an electronic search of Cochrane Library, Medline, Embase and Chinese Biomedical Database. Studies meeting selected criteria were reviewed systematically by meta-analysis. The treatment effect was measured as risk difference (RD) of treatment failure, and pooled estimates were computed according to a random effect model.


RESULTS
A total of 18 studies were included in this meta-analysis, 8 cohort and 10 randomized. Orbital radiotherapy alone was significantly more effective than a vehicle control [pooled RD = -0.26, 95% confidence interval (CI) = -0.41 to -0.10] and as effective as oral corticosteroids (pooled RD = -0.10, 95% CI = -0.20 to -0.00). The combination of orbital radiotherapy and oral corticosteroids was markedly more effective than other treatment modalities (pooled RD = -0.27, 95% CI = -0.36 to -0.17). Orbital radiotherapy combined with intravenous methylprednisolone was more efficacious than other treatment modalities (pooled RD = -0.18, 95% CI = -0.30 to -0.07).


CONCLUSIONS
Orbital radiotherapy appears to be an effective treatment for Graves' ophthalmology and seems to have an increased effect when given with systemic corticosteroids. Orbital radiotherapy combined with intravenous methylprednisolone seems to have the best documented efficacy.
Wei
Rui-Li
RL
Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China. ruiliwei@gmail.com
Cheng
Jin-Wei
JW
Cai
Ji-Ping
JP
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D015331:Cohort Studies; D003131:Combined Modality Therapy; D006111:Graves Disease / Q000532:radiotherapy*; D006801:Humans; D007262:Infusions, Intravenous; D008775:Methylprednisolone / Q000008:administration & dosage; D009915:Orbit / Q000528:radiation effects*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D008775:Methylprednisolone