Journal Article

Efficacy of combined orbital radiation and systemic steroids in the management of Graves’ orbitopathy

Han, Sun Hyup, Yoon, Jin Sook, Kim, Ji Won, Son, Byeong Jae, Keum, Ki Chang, Rim, Tyler Hyungtaek

2016

Overview

Purpose To compare the efficacy and safety of combination therapy with orbital irradiation and systemic steroids versus steroid monotherapy in the management of active Graves’ orbitopathy (GO). Methods The clinical charts of 127 patients with active inflammation due to GO who received intravenous steroid pulse therapy as a first-line treatment with or without orbital radiotherapy between 2010 and 2014 were reviewed. Patients were divided into two treatment groups: 1) combined orbital radiotherapy and steroid pulse therapy (SRT group) and 2) steroid pulse therapy only (ST group). Primary outcome measures included clinical activity score (CAS); NOSPECS classification; ocular motility impairment; and exophthalmos at 1, 3, 6, and 12 months after treatment. The secondary outcome measure was the change in orbital, extraocular muscle (EOM), and fat volume after treatment measured by orbit computed tomography. Results Sixty-eight patients were included in the SRT group, and 59 patients were in the ST group. In both treatments, CAS and NOSPECS were significantly reduced. In the comparison of the degree of change from baseline between the groups, the SRT group demonstrated more improvement in NOSPECS and scores of ocular motility. Orbital, EOM, and fat volume significantly decreased in the SRT group; however, only fat volume was reduced in the ST group. Compressive optic neuropathy after treatment developed in 0 % of the SRT group and 3.4 % (2/59) of the ST group. Reactivation of inflammation occurred in 11.8 % (8/68) of the SRT group and 28.8 % (17/59) of the ST group. Conclusions Orbital radiotherapy in combination with steroid treatment significantly improved ocular motility by reducing EOM volume in patients with active GO.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Combined Modality Therapy / Dose Fractionation / Exophthalmos - physiopathology / Female / Glucocorticoids - administration & dosage / Graves Ophthalmopathy - drug therapy / Graves Ophthalmopathy - physiopathology / Graves Ophthalmopathy - radiotherapy / Humans / Male / Medicine / Medicine & Public Health / Methylprednisolone - administration & dosage / Middle Aged / Ocular Motility Disorders - diagnostic imaging / Ocular Motility Disorders - physiopathology / Oculomotor Muscles - diagnostic imaging / Oculomotor Muscles - physiopathology / Oculoplastics and Orbit / Ophthalmology / Orbit - diagnostic imaging / Orbit - radiation effects / Pulse Therapy, Drug / Retrospective Studies / Tomography, Optical Coherence / Treatment Outcome