Clinical Impact of Radiotherapy in Steroid-Refractory Graves' Orbitopathy

TL;DR

This study shows that radiotherapy can effectively reduce eye bulging and pain in patients with a thyroid-related eye condition who do not respond to steroids.

Contribution

The study provides evidence for radiotherapy as an effective second-line treatment for steroid-refractory Graves' orbitopathy.

Findings

Radiotherapy significantly reduced exophthalmos (p=0.005) and retrobulbar pain (p=0.04).

Local control was 90% with recurrence-free survival rates of 100%, 90%, and 90% at one, three, and five years.

Abstract

Background: Graves' orbitopathy (GO) is the most common extrathyroidal manifestation of Graves' disease. Treatment options depend on its severity. Orbital radiotherapy is recommended as a second-line treatment in patients who are refractory or intolerant of glucocorticoid treatment. This study aimed to analyze the clinical outcome after radiotherapy in patients diagnosed with Graves' orbitopathy who are refractory to glucocorticoids.

Methods: We retrospectively analyzed the clinical data of 10 patients with Graves' orbitopathy who did not respond to glucocorticoid management. They were treated with retrobulbar radiotherapy between January 2010 and January 2021, with a schedule of 20 Gy in 10 fractions. The variables analyzed were ocular movements, exophthalmos, diplopia, retrobulbar pain, ectropion, visual acuity, eyelid closure, and conjunctival hyperemia.

Results: Categorical variables were compared before and after radiotherapy treatment in the evaluated patients. A statistically significant response to radiotherapy was observed in the following outcomes: exophthalmos (p=0.005) and retrobulbar pain (p=0.04). One case of local recurrence was observed at 20 months of follow-up, achieving a local control of 90%. Recurrence-free survival (RFS) at one, three, and five years was 100%, 90%, and 90%, respectively.

Conclusions: Radiotherapy is an effective and well-tolerated treatment that reduces exophthalmos and retrobulbar pain and can prevent disease progression.

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