title: Radiotherapy with or without surgery for patients with idiopathic sclerosing orbital inflammation refractory or intolerant to steroid therapy.
abstract: OBJECTIVE
  To evaluate the outcomes of patients with idiopathic sclerosing orbital inflammation (ISOI) treated with radiotherapy with or without surgery.
  
  
  METHODS
  We retrospectively reviewed 22 patients with histopathologically confirmed ISOI who had been refractory or intolerant to steroid therapy and treated with radiation with or without surgery. The radiation dose ranged from 20 to 40 Gy (median, 20 Gy) at 2 Gy per fraction. Presenting signs and treatment outcomes were assessed.
  
  
  RESULTS
  Proptosis was the most common sign at presentation, seen in 19 (86.3%) patients, followed by restriction of extraocular movements in 10 (45.4%) patients. Response to radiotherapy was complete in 15 (68.1%) patients, partial in 3 (13.6%) patients, and none in 4 (18.2%) patients. At the median follow-up of 34 months, 14 (63.6%) patients had progression-free state of symptoms and signs, with the progression-free duration ranging from 3 to 75 months (median, 41.5 months), whereas 8 (36.4%) patients had recurrent or persistent disease although they had received radiotherapy. Of the 14 progression-free patients, 6 underwent a bimodality treatment of debulking surgery of ocular disease and radiotherapy. They had had no recurrent disease. Cataract was the most common late complications, and 2 patients experienced a Grade 3 cataract.
  
  
  CONCLUSIONS
  Our study suggests that for patients with ISOI who are refractory or intolerant to steroid therapy, 20 Gy of radiotherapy appears to be effective for the control of disease with acceptable complications, especially when it is combined with surgery.
authors.affiliation: Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Yeon-Sil
authors.initials: YS
authors.lastname: Kim
authors.forename: Suk Woo
authors.initials: SW
authors.lastname: Yang
authors.forename: Won-Kyung
authors.initials: WK
authors.lastname: Cho
authors.forename: Sang Nam
authors.initials: SN
authors.lastname: Lee
authors.forename: Kyung Ji
authors.initials: KJ
authors.lastname: Lee
authors.forename: Mi-Ryeong
authors.initials: MR
authors.lastname: Ryu
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Jang
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005094:Exophthalmos / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016727:Orbital Pseudotumor / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D013256:Steroids