Park Junhee, Lee Jeong Eun
Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Radiat Oncol J. 2025 Jun;43(2):88-98. doi: 10.3857/roj.2025.00115. Epub 2025 Jun 25.
This study aims to evaluate the efficacy of radiotherapy (RT) in patients with steroid-resistant thyroid eye disease (TED) by assessing clinical outcomes in orbital inflammation and exophthalmos.
Sixty-two patients with confirmed TED and resistance to intravenous steroid therapy were treated with RT. Most patients received intravenous methylprednisolone (500 mg weekly for 6 weeks, followed by 250 mg weekly for 6 weeks). After steroid treatment, patients underwent RT with a total dose of 20 Gy delivered in 10 fractions. Clinical parameters were assessed at five time points: initial presentation, post-intravenous steroid therapy, and 1, 6, and 12 months after RT. Inflammation was evaluated using clinical activity score (CAS). Exophthalmos was quantified through posterior scleral distance (PSD) measurements on computed tomography imaging. Statistical analysis involved repeated measures analysis of variance and Cohen's d effect size calculations.
CAS showed significant reduction from baseline (mean, 3.309) to 12 months post-RT (mean, 0.187), with the largest effect size observed between baseline and 12 months (Cohen's d = 10.88). PSD showed worsening after intravenous steroid therapy but gradually improved after RT, approaching baseline values at 12 months. Disease reactivation occurred in only two patients, and three required strabismus correction surgery. Minimal adverse events were reported during follow-up.
RT demonstrated significant efficacy in treating steroid-resistant TED, with sustained improvements in both orbital inflammation and exophthalmos. These findings suggest RT as a viable alternative for patients unresponsive to steroid therapy, offering meaningful long-term clinical benefits with minimal adverse effects.
本研究旨在通过评估眼眶炎症和眼球突出的临床结局，来评价放射治疗（RT）对激素抵抗性甲状腺眼病（TED）患者的疗效。
62例确诊为TED且对静脉注射类固醇治疗耐药的患者接受了RT治疗。大多数患者接受静脉注射甲泼尼龙（每周500mg，共6周，随后每周250mg，共6周）。类固醇治疗后，患者接受RT，总剂量为20Gy，分10次给予。在五个时间点评估临床参数：初次就诊时、静脉注射类固醇治疗后、RT后1个月、6个月和12个月。使用临床活动评分（CAS）评估炎症。通过计算机断层扫描成像测量后巩膜距离（PSD）来量化眼球突出。统计分析包括重复测量方差分析和科恩d效应量计算。
CAS从基线（平均3.309）显著降低至RT后12个月（平均0.187），在基线和12个月之间观察到最大效应量（科恩d = 10.88）。PSD在静脉注射类固醇治疗后恶化，但RT后逐渐改善，在12个月时接近基线值。仅2例患者疾病复发，3例需要斜视矫正手术。随访期间报告的不良事件极少。
RT在治疗激素抵抗性TED方面显示出显著疗效，眼眶炎症和眼球突出均持续改善。这些发现表明，RT是对类固醇治疗无反应患者的一种可行替代方案，能带来有意义的长期临床益处，且不良反应最小。
