title: Radiotherapy for the treatment of thyroid eye disease-a prospective comparison: Is orbital radiotherapy a suitable alternative to steroids?
abstract: OBJECTIVE
  To evaluate the efficacy of orbital radiotherapy (OR) for the treatment of thyroid eye disease (TED).
  
  
  METHODS
  Thirty-five consecutive patients with active TED with contraindications to steroid therapy received a course of OR. Bilateral retrobulbar irradiation was performed with a total dose of 20 Gy. 7-points clinical activity score (7-CAS), ocular motility, visual acuity (VA), exophthalmos and eyelid retraction were prospectively evaluated at 3, 6 and 12 months and compared with baseline data.
  
  
  RESULTS
  There was a statistically significant improvement in 7-CAS at 3, 6 and 12 months post-treatment (p < 0.05). Ocular motility disturbances improved at 6 and 12 months (p < 0.05). Visual acuity remained stable; there was no significant change in exophthalmos (mean 24 mm, SD 3 mm) or eyelid retraction (marginal reflex distance mean 6 mm, SD 1.5 mm) during the follow-up period. No side effects were registered.
  
  
  CONCLUSIONS
  This study suggests that OR might be effective in reducing 7-CAS and ocular motility disturbances. No significant improvement in proptosis or eyelid retraction should be expected from this treatment. OR might be considered a suitable alternative treatment in TED for patients who cannot tolerate steroids.
authors.affiliation: Department of Neuroscience, Odontostomatological and Reproductive Sciences, University "Federico II" of Naples, via Pansini no 5, 80131, Naples, Italy. pjgrassi@libero.it.
authors.forename: P
authors.initials: P
authors.lastname: Grassi
authors.affiliation: Department of Neuroscience, Odontostomatological and Reproductive Sciences, University "Federico II" of Naples, via Pansini no 5, 80131, Naples, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Strianese
authors.affiliation: Department of Ophthalmology, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Piscopo
authors.affiliation: Department of Diagnostic Imaging and Radiotherapy, University "Federico II" of Naples, Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Pacelli
authors.affiliation: Department of Neuroscience, Odontostomatological and Reproductive Sciences, University "Federico II" of Naples, via Pansini no 5, 80131, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bonavolontà
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D049970:Graves Ophthalmopathy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000528:radiation effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids
keywords: Alternative first-line therapy; Graves ophthalmopathy; Orbital radiotherapy; Thyroid eye disease