104例Graves’眼病放疗后远期临床观察

Long-terra results of radiotherapy for 104 patients with Graves＇orbitopathy

目的观察Graves’眼病放疗后的远期临床疗效和副反应及肿瘤发生情况。方法1979-1999年间104例Graves’眼病患者接受常规分割放疗，其中球后＋垂体照射56例，球后照射15～20Gy后缩野照射垂体25～35Gy；球后48例照射20Gy。随访7．5～25．0年，中位13．3年。结果组织受累治疗、角膜受累治疗、突眼治疗、视力改变治疗，眼外肌受累治疗后有效率分别为88．4％、75．1％、55．6％、68．8％、64．4％，总有效率为71．1％。12例放疗后2．5～18．3年（中位11．2年）诊断白内障。1例放疗后3．2年确诊左眼放射性视网膜炎。随访期间3例行开眶术，2例行眼肌手术，1例行眼睑缘缝合术。9例放疗后诊断恶性肿瘤，但所发肿瘤位置均未在放疗照射野范围内。结论放疗可有效控制进展期Graves’眼病病情，并能取得较好疗效，使临床症状得以改善，同时也是较为安全的治疗方法，副反应较其他治疗方法为少。

Objective To evaluate the long-term outcome and the sequelae of Graves＇orbitopathy treated with radiotherapy, and to specify the prognostic factors. Methods From 1979 to 1999, 104 patients with progressive Graves＇orbitopathy were treated with conventional orbital radiotherapy. Post globe and pituitary irradiation of 25-35 Gy was given to 56 patients, which was followed by a boost of 15-20 Gy to the pituitary. Follow-up time was 7.5 - 25.0 years. The result of radiotherapy was analyzed. Results Overall response rate was 71.1%. The response rate of patients with soft-tissue infiltration, corneal involvement, proptosis, sight loss and extraocular muscle dysfunction was 88.4% , 75. 1%, 55. 6%, 68. 8% and 64.4%, respectively. Twelve patients （ 11.5% ） developed cataracts 2.5-18.3 years （ median 11.2 years） after irradiation. One patient developed left-eye retinopathy 3.2 years after irradiation. No patient developed secondary tumor within the irradiation field. Conclusions Orbital radiotherapy for progressive Graves＇orbitopathy, being effective and safe, can control the disease progression and improve the symptoms. The side effect of radiotherapy is fewer than other treatment modalities.