The use of orbital radiotherapy for Graves' ophthalmopathy: quantitative review of the evidence

Abstract

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.