Low Dose Orbital Radiotherapy for Thyroid Eye Disease

Yim, James F T Li; Sandinha, Teresa; Kerr, Jan; Ritchie, Diana; Kemp, Ewan

doi:10.3109/01676830.2011.615455

Cited by 11 publications

(2 citation statements)

References 29 publications

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“…The main rationale is its anti-inflammatory effect and the high radiosensitivity of T lymphocytes and orbital fibroblasts. Although there are several reports about the benefits of RT [ 73 , 74 , 75 ], optimal initial treatment and its combination with steroids is still controversial. Various RT regimens with different doses and fractionations have been used: 16 or 20 Gy delivered in 8–10 fx (five days/week) is usually considered the standard [ 89 ].…”

Section: Resultsmentioning

confidence: 99%

Non-Oncological Radiotherapy: A Review of Modern Approaches

Nardone

D’Ippolito

Grassi

et al. 2022

JPM

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Despite being usually delivered in oncological patients, radiotherapy can be used as a successful treatment for several non-malignant disorders. Even though this use of radiotherapy has been scarcely investigated since the 1950s, more recent interest has actually shed the light on this approach. Thus, the aim of this narrative review is to analyze the applications of non-oncological radiotherapy in different disorders. Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. This review contains a narrative report and a critical discussion of non-oncological radiotherapy approaches. In conclusion, non-oncological radiotherapy is a safe and efficacious approach to treat several disorders that needs to be further investigated and used in clinical practice.

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Section: Resultsmentioning

confidence: 99%

Non-Oncological Radiotherapy: A Review of Modern Approaches

Nardone

D’Ippolito

Grassi

et al. 2022

JPM

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“…The classic treatment for OID has been the use of high-dose oral corticosteroids 1,13 with some authors advocating addition of orbital irradiation. 14,15 This therapy is often initially successful, but relapses are common as the underlying cause is not addressed. 16,17 Steroid-sparing agents have been successfully used to help reduce the effects of long-term prednisone.…”

Section: Discussionmentioning

confidence: 99%

Rituximab Therapy for Refractory Orbital Inflammation

et al. 2014

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IMPORTANCE Orbital inflammation is a potentially blinding and disfiguring disease process that is often treated with systemic corticosteroids and immunosuppression; better treatments are needed.OBJECTIVE To determine whether rituximab, a monoclonal antibody against the B-lymphocyte antigen CD20, is effective in the treatment of refractory orbital inflammation. DESIGN, SETTING, AND PARTICIPANTSA dose-ranging, randomized, double-masked phase 1/2 clinical trial was conducted at a tertiary referral ophthalmology clinic. Ten individuals with orbital inflammation refractory to systemic corticosteroids and at least 1 other immunosuppressive agent were enrolled from January 2007 to March 2010.INTERVENTIONS Rituximab infusions were administered on study days 1 and 15 at doses of either 500 mg or 1000 mg. Initial responders with recurrent inflammation after week 24 were permitted reinfusion with an additional cycle of 2 open-label 1000-mg rituximab infusions. MAIN OUTCOMES AND MEASURESThe primary outcomes were reduction of inflammation measured with a validated orbital disease grading scale and corticosteroid dose reduction by at least 50%. The secondary outcomes were visual acuity, reduction in pain, and participantand physician-reported global health assessment. RESULTSOf 10 enrolled patients, 7 demonstrated improvement on the orbital disease grading scale at the 24-week end point with rituximab therapy. Of these 7 individuals, 4 were receiving corticosteroids at study inception and all achieved successful dose reduction. For the secondary outcome measures in the 10 participants, 7 patients and 8 patients improved in self-rated and physician global health scores, respectively, and 7 patients had reduction in pain by 25% or more at 24 weeks. Four patients who were positive responders at the week 24 end point experienced breakthrough inflammation after week 24 and received reinfusions between 24 and 48 weeks. Vision remained stable in all participants. Three of 10 patients had short-term objective or subjective worsening 2 to 8 weeks after receiving rituximab infusions, which was averted in subsequent patients with oral corticosteroids administered during the infusion and did not affect the eventual positive treatment outcome. No significant differences with regard to efficacy, toxicity, or likelihood of retreatment were noted between the dosing arms.CONCLUSIONS AND RELEVANCE Rituximab was safe and effective in 7 of 10 patients with noninfectious orbital disease, although 4 required reinfusion with rituximab to maintain control of orbital inflammation. Substantial toxicity was not noted. Rituximab should be considered in the treatment of refractory orbital inflammation. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00415506

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Graves’ ophthalmopathy treated with protracted hypofractionated low-dose adaptive radiotherapy: case report and review of the literature

Güler

Onal

Arslan

2015

Wien Klin Wochenschr

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Graves' ophthalmopathy (GO) is the most common extra-thyroidal manifestation of Graves' disease. The treatment options for GO are high-dose glucocorticoids, selenium, rituximab, cyclosporine, orbital radiotherapy (RT), and surgery. A 43-year-old male patient was referred to our clinic with complaints of severe bilateral proptosis, diplopia, and orbital pain at both globes for 1 year. Pretreatment magnetic resonance imaging revealed bilateral proptosis, the expansion of bilateral optic nerves sheath, the increase of right medial muscle thickness, and a mass at the right eyehole. Patient was treated with 1 Gy per fraction per week with a total dose of 10 Gy over 10 weeks with adoptive intensity-modulated radiotherapy technique. During RT at 3rd and 6th weeks, a moderate shrinkage of the lesions was observed. The patient has been disease free, has had no complaints for 36 months, and has not required any surgical intervention. No late side effects such as retinopathy or cataract were observed. Orbital RT with innovative techniques may be considered as an initial local treatment for GO. With adoptive protracted low dose RT, a good clinical and radiological response could be seen without increasing early and late reactions.

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Low Dose Orbital Radiotherapy for Thyroid Eye Disease

Abstract: We believe orbital radiotherapy has a definite role to play in the treatment of active thyroid eye disease. The majority of our patients experienced a reduction in their clinical activity scores after orbital radiotherapy and this was irrespective of the severity of thyroid eye disease.

Cited by 11 publications

References 29 publications

Non-Oncological Radiotherapy: A Review of Modern Approaches

Non-Oncological Radiotherapy: A Review of Modern Approaches

Rituximab Therapy for Refractory Orbital Inflammation

Graves’ ophthalmopathy treated with protracted hypofractionated low-dose adaptive radiotherapy: case report and review of the literature

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