title: Efficacy of combined orbital radiation and systemic steroids in the management of Graves' orbitopathy.
abstract: OBJECTIVE
  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.
authors.affiliation: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sun Hyup
authors.initials: SH
authors.lastname: Han
authors.affiliation: Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Byeong Jae
authors.initials: BJ
authors.lastname: Son
authors.affiliation: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
authors.forename: Tyler Hyungtaek
authors.initials: TH
authors.lastname: Rim
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ki Chang
authors.initials: KC
authors.lastname: Keum
authors.affiliation: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. yoonjs@yuhs.ac.
authors.forename: Jin Sook
authors.initials: JS
authors.lastname: Yoon
mesh_terms: D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005094:Exophthalmos / Q000503:physiopathology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000503:physiopathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology; D009801:Oculomotor Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology; D009915:Orbit / Q000000981:diagnostic imaging / Q000528:radiation effects*; D020551:Pulse Therapy, Drug; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: Graves’ orbitopathy; Orbital radiation; Systemic steroids; Thyroid-associated orbitopathy