Evaluate The Radiotherapy Curative Effect Of Moderate-to-severe Active TAO

Objective:1. To investigate the clinical value of orbital CT measuring retrobulbar volume in the retrobulbar radiotherapy for Moderate-to-severe active TAO.2. To study on the application of radiomuclide orbital imaging in the retrobulbar radiotherapy for TAO.Methods:37 cases Moderate-to-severe active TAO were chosen in the first hospital of Shanxi Medical University in 2010.10~2013.12.All the cases were two eyes extruding.And 22 cases were chosen to be the Radiotherapy group,who were received Orbital radiotherapy and poor curative effect with injct triamcinolone acetonide. We reviewing 15 cases be the injection group, who were heavy inflammatory response and were only injected with triamcinolone acetonide. Selected patients are: CAS score ≧ 3 points, exophthalmos ≧ 18 mm, orbital ECT(+), no diabetes, high blood pressure and orbital surgery. The radiotherapy group used Varian linear accelerator, three dimensional conformal radiotherapy and CT positioning.With B pillow and head membrane.Hands placed on both sides of the body.Using the 6 Mv-X ray,two field and the same weight of DT 2400 c Gy/12 Fx/200 c Gy,and making 95% PTV all at a dose of 2400 c Gy. During radiotherapy 18 cases take prednisone, 30 mg, p.j., Po, Qd.Two weeks later the Radiotherapy then gradually reducing withdrawal. Four cases take Hydrocortisone,120 mg,p.j., ivgtt,Qd. After the Radiotherapy take prednisone, 30 mg, p.j., Po, Qd.Two weeks later then gradually reducing withdrawal. All the radiotherap patients before and after the treatment were measured to corrected visual acuity、exophthalmos、take photos、and take 99mTc-DTPA ECT.Taking examing SPECT/CT schedule a follow-up, integrating with the Eclips system, and getting the retrobulbar volume. All the patients were followed for 1~3 years.Results:1. Before radiotherapy corrected visual acuity was 0.04~1.50, after was 0.10~1.50.The average increase was0.10±0.20;Before radiotherapy exophthalmos were 18 mm~29 mm, after were 16 mm~25 mm during follow-up after radiotherapy, the decrease was 2.5 ±2.0 mm on average; Before radiotherapy CAS score was 3~6 points, CAS score was 0~5 points during follow-up after radiotherapy, the decrease was 3.00±1.195 on average;2. CT showed that the Orbital volume is reduced, there’s a positive correlation with the CAS score decrease(r=0.589,P=0.021<0.05);3. The study found that there’s a positive correlation between the decrease of OR/Bi and the CASi score(r=0.533,P=0.041<0.05)of the injection group.The OR/B in ECT were decreased after radiotherapy. And there’s a positive correlation with the CAS score decrease(r=0.664,P=0.007<0.05). It’s better than the injection group. But because of the less number of cases, this results need to be verified.4. All patients in radiotherapy group after treatment were getting different benefit, and have a better curative effect recently in 1~3 years. And having a better effect in uptake ratios(P=0.004) 、the CAS score(P=0.001) and exophthalmos(P=0.000) in radiotherapy group.During the follow-up, 15 patients were no serious untoward effect, due to the short time,we should continue to track. Conclusions:1. Retrobulbar radiotherapy combined with hormone therapy have a good effect on Moderate-to-severe active TAO.Under the premise of strictly control the indicatio ns of radiotherapy, choosing three dimensional conformal retrobulbar radiotherapy of DT 2400 c Gy/12 Fx/200 c Gy, and combined with glucocorticoid treatment,It is safe,in crease the efficacy, and reduce the side effect. It’s worthy of recommendation;2. Retrobulbar radiotherapy combined with glucocorticoid therapy is better than single injection of triamcinolone acetonide.3.CAS score, OBI in radionuclide orbital imaging and retrobulbar volume chang e is the effective index to evaluate the effect of TAO. combined with subjective clinica l score and function imaging image, it’s useful to accurately determine the eye inflam mation activity degree, guide post treatment method for the correct choice, timely co ntrol of the disease occurrence and development.The study found that active TAO co uld judge recently(1~3 year) curative effect by the decreased of OBI in orbital ECT.The retrobulbar radiotherapy were better than the group which single inject triamcinol one acetonide. But because of the small number of cases, the results need to be verified.