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Open Access 22-03-2024 | Hyperthyroidism | Mini Review

Late orbital radiotherapy combined with intravenous methylprednisolone in the management of long-lasting active graves’ orbitopathy: a case report and literature review

Authors: Martina Verrienti, Irene Gagliardi, Luisa Valente, Antonio Stefanelli, Luca Borgatti, Elena Franco, Manlio Galiè, Marta Bondanelli, Maria Chiara Zatelli, Maria Rosaria Ambrosio

Published in: Endocrine

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Abstract

Purpose

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.

Method

Relevant literature (randomized controlled studies, retrospective studies and reviews) was explored on PubMed from January 1973 to January 2024, searching “orbital radiotherapy” & “Graves disease”.

Results

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.

Conclusions

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.
Literature
2.
go back to reference L. Bartalena, G.J. Kahaly, L. Baldeschi, C.M. Dayan, A. Eckstein, C. Marcocci, M. Marinò, B. Vaidya, W.M. Wiersinga; EUGOGO, The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy. Eur. J. Endocrinol. 185(4), G43–G67 (2021). https://doi.org/10.1530/EJE-21-0479CrossRefPubMed L. Bartalena, G.J. Kahaly, L. Baldeschi, C.M. Dayan, A. Eckstein, C. Marcocci, M. Marinò, B. Vaidya, W.M. Wiersinga; EUGOGO, The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy. Eur. J. Endocrinol. 185(4), G43–G67 (2021). https://​doi.​org/​10.​1530/​EJE-21-0479CrossRefPubMed
8.
go back to reference H.B. Burch, P. Perros, T. Bednarczuk, D.S. Cooper, P.J. Dolman, A.M. Leung, I. Mombaerts, M. Salvi, M.N. Stan, Management of Thyroid Eye Disease: A Consensus Statement by the American Thyroid Association and the European Thyroid Association. Eur. Thyroid J. 32(12), 1439–1470 (2022). https://doi.org/10.1530/ETJ-22-0189CrossRef H.B. Burch, P. Perros, T. Bednarczuk, D.S. Cooper, P.J. Dolman, A.M. Leung, I. Mombaerts, M. Salvi, M.N. Stan, Management of Thyroid Eye Disease: A Consensus Statement by the American Thyroid Association and the European Thyroid Association. Eur. Thyroid J. 32(12), 1439–1470 (2022). https://​doi.​org/​10.​1530/​ETJ-22-0189CrossRef
12.
go back to reference E. Sisti, F. Menconi, M. Leo, M.A. Profilo, T. Mautone, B. Mazzi, R. Rocchi, F. Latrofa, M. Nardi, P. Vitti, C. Marcocci, M. Marinò, Long-term outcome of Graves’ orbitopathy following high-dose intravenous glucocorticoids and orbital radiotherapy. J. Endocrinol. Invest. 38(6), 661–8 (2015). https://doi.org/10.1007/s40618-015-0241-7CrossRefPubMed E. Sisti, F. Menconi, M. Leo, M.A. Profilo, T. Mautone, B. Mazzi, R. Rocchi, F. Latrofa, M. Nardi, P. Vitti, C. Marcocci, M. Marinò, Long-term outcome of Graves’ orbitopathy following high-dose intravenous glucocorticoids and orbital radiotherapy. J. Endocrinol. Invest. 38(6), 661–8 (2015). https://​doi.​org/​10.​1007/​s40618-015-0241-7CrossRefPubMed
13.
go back to reference L. Nicosia, C. Reverberi, L. Agolli, L. Marinelli, V. De Sanctis, G. Minniti, M. Valeriani, M.F. Osti, Orbital radiotherapy plus concomitant steroids in moderate-to-severe Graves’ ophthalmopathy: Good results after long-term follow-up. Int. J. Endocrinol. Metab. 27 17(1), e84427 (2019). https://doi.org/10.5812/ijem.84427CrossRef L. Nicosia, C. Reverberi, L. Agolli, L. Marinelli, V. De Sanctis, G. Minniti, M. Valeriani, M.F. Osti, Orbital radiotherapy plus concomitant steroids in moderate-to-severe Graves’ ophthalmopathy: Good results after long-term follow-up. Int. J. Endocrinol. Metab. 27 17(1), e84427 (2019). https://​doi.​org/​10.​5812/​ijem.​84427CrossRef
16.
go back to reference L. Bartalena, C. Marcocci, L. Chiovato, M. Laddaga, G. Lepri, D. Andreani, G. Cavallacci, L. Baschieri, A. Pinchera, Orbital cobalt irradiation combined with systemic corticosteroids for Graves’ ophthalmopathy: Comparison with systemic corticosteroids alone. J. Clin. Endocrinol. Metab. 56(6), 1139–1144 (1983). https://doi.org/10.1210/jcem-56-6-1139CrossRefPubMed L. Bartalena, C. Marcocci, L. Chiovato, M. Laddaga, G. Lepri, D. Andreani, G. Cavallacci, L. Baschieri, A. Pinchera, Orbital cobalt irradiation combined with systemic corticosteroids for Graves’ ophthalmopathy: Comparison with systemic corticosteroids alone. J. Clin. Endocrinol. Metab. 56(6), 1139–1144 (1983). https://​doi.​org/​10.​1210/​jcem-56-6-1139CrossRefPubMed
17.
go back to reference C.M. Ng, H.K. Yuen, K.L. Choi, M.K. Chan, K.T. Yuen, Y.W. Ng, S.C. Tiu, 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. 11(5), 322–30 (2005)PubMed C.M. Ng, H.K. Yuen, K.L. Choi, M.K. Chan, K.T. Yuen, Y.W. Ng, S.C. Tiu, 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. 11(5), 322–30 (2005)PubMed
18.
go back to reference C. Marcocci, L. Bartalena, F. Bogazzi, G. Bruno-Bossio, A. Lepri, A. Pinchera, Orbital radiotherapy combined with high dose systemic glucocorticoids is more effective than radiotherapy alone:. results of a prospective randomized study. J. Endocrinol. Invest. 14, 853–860 (1991). https://doi.org/10.1007/BF03347943CrossRefPubMed C. Marcocci, L. Bartalena, F. Bogazzi, G. Bruno-Bossio, A. Lepri, A. Pinchera, Orbital radiotherapy combined with high dose systemic glucocorticoids is more effective than radiotherapy alone:. results of a prospective randomized study. J. Endocrinol. Invest. 14, 853–860 (1991). https://​doi.​org/​10.​1007/​BF03347943CrossRefPubMed
19.
21.
go back to reference C.A. Gorman, J.A. Garrity, V. Fatourechi, R.S. Bahn, I.A. Petersen, S.L. Stafford, J.D. Earle, G.S. Forbes, R.W. Kline, H. Buettner, D.M. Robertson, E.J. Bergstralh, K.P. Offord, D.M. Rademacher, N.M. Stanley, G.B. Bartley, The aftermath of orbital radiotherapy for graves’ ophthalmopathy. Ophthalmology 109(11), 2100–7 (2002). https://doi.org/10.1016/s0161-6420(02)01293-9CrossRefPubMed C.A. Gorman, J.A. Garrity, V. Fatourechi, R.S. Bahn, I.A. Petersen, S.L. Stafford, J.D. Earle, G.S. Forbes, R.W. Kline, H. Buettner, D.M. Robertson, E.J. Bergstralh, K.P. Offord, D.M. Rademacher, N.M. Stanley, G.B. Bartley, The aftermath of orbital radiotherapy for graves’ ophthalmopathy. Ophthalmology 109(11), 2100–7 (2002). https://​doi.​org/​10.​1016/​s0161-6420(02)01293-9CrossRefPubMed
26.
go back to reference R.S. Prabhu, L. Liebman, T. Wojno, B. Hayek, W.A. Hall, I. Crocker, Clinical outcomes of radiotherapy as initial local therapy for Graves’ ophthalmopathy and predictors of the need for post-radiotherapy decompressive surgery. Radiat. Oncol. 19(7), 95 (2012). https://doi.org/10.1186/1748-717X-7-95CrossRef R.S. Prabhu, L. Liebman, T. Wojno, B. Hayek, W.A. Hall, I. Crocker, Clinical outcomes of radiotherapy as initial local therapy for Graves’ ophthalmopathy and predictors of the need for post-radiotherapy decompressive surgery. Radiat. Oncol. 19(7), 95 (2012). https://​doi.​org/​10.​1186/​1748-717X-7-95CrossRef
Metadata
Title
Late orbital radiotherapy combined with intravenous methylprednisolone in the management of long-lasting active graves’ orbitopathy: a case report and literature review
Authors
Martina Verrienti
Irene Gagliardi
Luisa Valente
Antonio Stefanelli
Luca Borgatti
Elena Franco
Manlio Galiè
Marta Bondanelli
Maria Chiara Zatelli
Maria Rosaria Ambrosio
Publication date
22-03-2024
Publisher
Springer US
Published in
Endocrine
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-024-03788-2