Rationale for radiotherapy in thyroid eye disease.
Rationale for radiotherapy in thyroid eye disease.
复制标题
甲状腺眼病放射治疗的基本原理。
DOI：
10.1016/j.ajo.2009.07.034
复制
发表时间：
2009
影响因子：
4.2
通讯作者：
Feldon,StevenE
中科院分区：
文献类型：
--
作者：
Perry,JulianD;Feldon,StevenE
LOW-DOSE ORBITAL RADIOTHERAPY (20 GY) REMAINS a common medical therapy for treatment of thyroid eye disease (TED). Since the early 1970s, when clinical series using the common current dose suggested a clinical benefit in at least some patients, 1 orbital radiotherapy has been used in an attempt to reduce inflammation and alter the course of the disease. Over the past 4 decades, a wealth of data has produced conflicting results regarding its effect. 2–7Factors implicated in the variable response to radiotherapy include issues regarding patient selection, natural history of the disease, outcome measures, and the use of adjunct corticosteroid therapy. 8 Inclusion criteria that encompass long-standing disease limit interpretation of some existing prospective studies. 9 No study to date has surmounted the challenges involving the timing of radiotherapy and defining the therapeutic goals of this intervention. Existing studies fail to use a standardized technique. Also, nuanced therapy to optimize the treatment field has not been scrutinized adequately. Although the existing data suffer from limitations, critical appraisal should allow for evidence-based practice. Recently, Bradley and associates published a systematic literature review for the American Academy of Ophthalmology. 10 They found 14 studies meeting their criteria for evidence-based medicine, including five observational studies (level II or III) and 9 single-center, randomized clinical trials (level I). They concluded that “there is a lack of level I evidence either to support or refute its efficacy.” Thus, justification for treatment must rely on anecdotal therapeutic response combined with a relative lack of short-term risks (long-term complications remain unstudied).
