Abstract
BackgroundWe aimed to explore the efficacy of orbital radiotherapy (RT) in patients with moderate-to-severe active Graves’ orbitopathy (GO), including long-lasting disease, and to determine the predictive factors associated with treatment response.MethodsThis was a retrospective study of 62 moderate-to-severe active GO patients treated with RT. Demographic data and ophthalmic findings prior to RT and at 3 and 6 months afterward were analyzed. Computed tomography was performed before and after RT to compare orbital volume change. We used logistic regression to determine the predictive factors for treatment response. Subjects were divided into early- and late-active phase groups based on GO duration of 24 months and treatment outcomes were compared with each other to observe the effects of RT timing on treatment response.ResultsForty (64.5%) and forty-six (74.1%) patients experienced improvements in GO at 3 and 6 months after radiotherapy, respectively. Ocular parameters such as clinical activity score (CAS), proptosis, extraocular muscle (EOM) limitation, and compressive optic neuropathy (CON) were improved by RT. Volumes of EOM significantly decreased after RT. The enlargement of EOMs and EOM limitation were predictive factors for a good response to RT. At 6 months after RT, 22 (68.8%) patients of late-active phase group exhibited improvement in GO, which is comparable to the number of 24 (80.0%) patients of early-active phase group. In the late-active phase group, CAS, diplopia, and visual acuity were improved significantly, but there was no change in EOM limitation.ConclusionsIn moderate-to-severe active GO patients, orbital RT may help improve high CAS, proptosis, EOM limitation, and CON. The orbital RT in long-lasting active GO patients may be considered as treatments for the relief of symptoms including high CAS and poor visual acuity.
Highlights
We aimed to explore the efficacy of orbital radiotherapy (RT) in patients with moderate-to-severe active Graves’ orbitopathy (GO), including long-lasting disease, and to determine the predictive factors associated with treatment response
Factors predicting orbital radiotherapy response Factors associated with a good response to RT in the univariable analysis included concurrent oral steroid use during RT; extraocular muscles (EOM) limitation of < 30° (OR: 5.63, 95% CI: 1.56–20.31, P = 0.008); decreased visual acuity (VA) (OR: 7.64, 95% CI: 1.56–37.47, P = 0.012); and the sum of EOM volume (OR: 1.18, 95% CI: 0.99–1.41, P = 0.050) (Table 4)
The patients in our study had limited conditions, which were refractory to high-dose IV steroids or were not eligible for treatment with high-dose IV steroids, our study confirmed that orbital RT is likely to be as effective as steroid therapy, which is the primary treatment for GO
Summary
We aimed to explore the efficacy of orbital radiotherapy (RT) in patients with moderate-to-severe active Graves’ orbitopathy (GO), including long-lasting disease, and to determine the predictive factors associated with treatment response. Graves’ orbitopathy (GO) is an autoimmune disorder of the orbit, accompanied by a complex of ocular symptoms It is the most common extrathyroidal manifestation of Graves’ disease (GD) and is associated with hyperthyroidism in 90% of cases [1]. Progressive deterioration is caused by an autoimmune process and characterized by lymphocyte infiltration, cytokine secretion, and fibroblast proliferation. In this active inflammatory phase, mainstay treatment includes systemic glucocorticoid therapy and orbital radiotherapy (RT) [4]. High-dose intravenous (IV) glucocorticoid is the first-line treatment for moderate-to-severe active GO patients, with studies reporting varying success rates from 54.3 to 77% [5,6,7], but relapse is frequent when they are withdrawn or tapered
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