Clinical outcomes of orbital radiotherapy combined with systemic glucocorticoids for patients with Graves' ophthalmopathy refractory to steroid therapy

PurposeTo investigate the clinical outcomes of combined orbital radiotherapy and systemic glucocorticoids for patients with refractory Graves’ ophthalmopathy (GO).Materials and methodsThe records were retrospectively reviewed of six patients with active moderate-to-severe GO who had been refractory to steroid therapy alone and treated with combined orbital radiotherapy and systemic glucocorticoids. All patients had already received one or more trial of steroid therapy prior to radiotherapy. Two patients had recurrence after steroid cessation, and four were unable to taper corticosteroids partially or completely. Two patients experienced relapse compressive optic neuropathy during tapering of glucocorticoids. The radiation dose was 20 Gy at 2 Gy/fraction. Presenting signs especially for disease activity and severity, treatment outcomes, and side effects were assessed.ResultsAfter combined therapy, complete cessation of corticosteroid therapy and stabilization of disease without recurrence was achieved in all patients. The clinical activity score decreased from 6.0 to 2.5 (p = 0.04). The ophthalmopathy index decreased from 8.2 to 5.7 (p = 0.05), with significant improvement in soft tissue sign (p = 0.03) and extraocular muscle movement (p = 0.03). Both patients with relapse dysthyroid optic neuropathy regained their vision. Side effects of radiotherapy included posterior subcapsular cataract formation in one patient.ConclusionCombined orbital radiotherapy and systemic corticosteroids can help to achieve stable disease and cessation of corticosteroid without recurrence in patients with refractory GO. This technique achieves greater improvement in clinical activity, soft tissue inflammation, and ocular motility.