Improvement of the MRI and clinical features of Asian Graves’ ophthalmopathy by radiation therapy with steroids
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To evaluate the effectiveness of radiation therapy and steroids for Asian patients with Graves’ ophthalmopathy using the clinical activity score (CAS), and changes in external ocular muscles and eye proptosis determined by magnetic resonance imaging (MRI).
Materials and methods
We retrospectively reviewed 48 patients who received combined orbital radiation and systemic glucocorticoids in our hospital. MRI was performed both before and 1 month after treatment in all patients. We calculated the areas of five extraocular muscles and the degree of proptosis on transverse sections, and we evaluated the activity of the disease using CAS before and 1 month after treatment and toxicity.
The areas of external ocular muscles, the length of eye prominence and CAS were significantly improved by the combination of orbital radiation and steroids. The change in the area of the medial rectus muscle had a significant correlation with the change in CAS (P < 0.05). Graves’ ophthalmopathy progressed again in 4 of the 48 patients; however, there were no patients with serious side effects in a median observation period of 41.5 months.
Treatment with the combination of orbital radiation and systemic glucocorticoids is subjectively and objectively effective for Asian Graves’ ophthalmopathy without severe toxicity.
KeywordsGraves’ ophthalmopathy Extraocular muscle Magnetic resonance imaging Radiation therapy Steroids
The results of the present study were presented at the 31st annual meeting of the Japanese Society of Radiation Oncology.
Compliance with ethical standard
Conflict of interest
The authors declare that they have no conflicts of interest.
All the procedures in this study meet the standards of the institutional and/or national research committee and the 1964 Declaration of Helsinki and its later amendments. This research was conducted with the approval of the ethics review committee of Tohoku University Hospital. The reception number is 2018-1-122.
- 8.Xu L, Li L, Xie C, Guan M, Xue Y. Thickness of extraocular muscle and orbital fat in MRI predicts response to glucocorticoid therapy in Graves’ ophthalmopathy. Int J Endocrinol. 2017;2017:3196059.Google Scholar
- 9.Abalkhail S, Doi SAR, Al-Shoumer KS. The use of corticosteroids versus other treatments for Graves’ ophthalmopathy: a quantitative evaluation. Med Sci Monit 2003;9:CR477-483.Google Scholar
- 19.Ng CM, Yuen HKL, Choi KL, Chan MK, Yuen KT, Ng YW, et al. Combined orbital irradiation and systemic steroids compared with systemic steroids alone in the management of moderate-to-severe Graves’ ophthalmopathy: a preliminary study. Hong Kong Med J. 2005;11:322–30.Google Scholar
- 20.Kahaly GJ, Rösler HP, Pitz S, Hommel G. Low- versus high-dose radiotherapy for Graves’ ophthalmopathy: a randomized, single blind trial. J Clin Endocrinol Metab. 2000;85:102–8.Google Scholar
- 21.Nicosia L, Reverberi C, Agolli L, Marinelli L, De Sanctis V, Minniti G, et al. Orbital radiotherapy plus concomitant steroids in moderate-to-severe Graves' ophthalmopathy: good results after long-term follow-up. Int J Endocrinol Metab. 2019;17(1):e84427.Google Scholar