Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
Unit of Cranio Maxillo Facial Surgery, Center for Craniofacial Deformities & Orbital Surgery-Reference Center for Rare Disease, St. Anna University Hospital of Ferrara, Ferrara, Italy.
Endocrine. 2024 Aug;85(2):576-583. doi: 10.1007/s12020-024-03788-2. Epub 2024 Mar 22.
To present a case and review the literature on Orbital Radiotherapy (OR) combined with intravenous methylprednisolone, focusing on its late application in patients with long-lasting active Graves' Orbitopathy (GO). Additionally, we suggest emerging perspective for future research in this context.
Relevant literature (randomized controlled studies, retrospective studies and reviews) was explored on PubMed from January 1973 to January 2024, searching "orbital radiotherapy" & "Graves disease".
OR is a well-established second-line treatment for moderate-to-severe active GO, providing response rates comparable to glucocorticoids. Its anti-inflammatory effect makes OR particularly suitable for early active GO, and when combined with glucocorticoids, outcomes are synergistically improved. The emergence of the new Volumetric Modulated Arc Image-Guided Radiation Therapy (VMAT-IGRT) technique enables precise radiation delivery to the target, significantly reducing associated toxicity. This technological advancement enhances the feasibility of radiotherapy in benign diseases like GO. A retrospective study indicated that late OR in patients with long-lasting active GO may improve diplopia and visual acuity, decreasing disease activity. Our case report supports this conclusion.
This report and literature review underscores the importance of considering late OR combined with intravenous methylprednisolone as a viable treatment option for GO patients with prolonged disease activity, emphasizing the crucial role of personalized therapy in managing GO. However, further investigations are warranted to validate this approach in cases of long-lasting active GO.
介绍一例病例并复习关于眼眶放射治疗（OR）联合静脉注射甲基强的松龙治疗的文献，重点关注其在持续性活动性格雷夫斯眼病（GO）患者中的晚期应用。此外，我们还提出了该领域未来研究的新视角。
在 PubMed 上搜索 1973 年 1 月至 2024 年 1 月期间的相关文献（随机对照研究、回顾性研究和综述），检索词为“orbital radiotherapy”和“Graves disease”。
OR 是中重度活动性 GO 的二线治疗方法，其缓解率可与糖皮质激素相媲美。其抗炎作用使其特别适用于早期活动性 GO，与糖皮质激素联合应用时，疗效可协同改善。新型容积调强弧形图像引导放射治疗（VMAT-IGRT）技术的出现，使得精确向靶区输送辐射成为可能，显著降低了相关毒性。这一技术进步提高了放射治疗在良性疾病如 GO 中的可行性。一项回顾性研究表明，对于持续性活动性 GO 患者，晚期 OR 可能改善复视和视力，降低疾病活动度。我们的病例报告支持这一结论。
本报告和文献复习强调了在持续性活动性 GO 患者中，考虑晚期 OR 联合静脉注射甲基强的松龙作为一种可行治疗选择的重要性，突出了个性化治疗在管理 GO 中的关键作用。然而，还需要进一步的研究来验证这种方法在持续性活动性 GO 病例中的疗效。
