Paolo P Limone1, Lavinia Bianco2, Marco Mellano3, Francesca Garino1, Fabiana Giannoccaro1, Annalisa Rossi2, Claudia Airaldi2, Daniela Nassisi2, Eva Gino4, Maurilio Deandrea1, Bruno Oldani3, Maria Grazia Ruo Redda5. 1. Endocrinology, Diabetes and Metabolism Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Centre for Thyroid Diseases, Turin, Italy. 2. Department of Oncology, Radiation Oncology, Azienda Ospedaliera Ordine Mauriziano di Torino, Centre for Thyroid Diseases, Turin, Italy. 3. Ophtalmology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Centre for Thyroid Diseases, Turin, Italy. 4. Medical Physics Unit - Azienda Ospedaliera Ordine Mauriziano di Torino, "Centre for Thyroid Diseases", Via Magellano 1, 10128, Turin, Italy. 5. Department of Oncology, Radiation Oncology, Azienda Ospedaliera Ordine Mauriziano di Torino, Centre for Thyroid Diseases, Turin, Italy. mariagrazia.ruoredda@unito.it.
Abstract
PURPOSE: Glucocorticoids (GCs) and external radiotherapy (RT) are used for treating moderate-to-severe Graves' orbitopathy (GO). We aimed to assess whether GCs and RT were more effective when administered concomitantly or sequentially. METHODS: We retrospectively analyzed clinical outcomes [assessed by Clinical Activity Score (CAS) and NOSPECS classification] in 73 patients treated with both i.v. GCs and RT. The patients were divided in two groups: In group A (53 patients), RT was delivered concomitantly with GCs, and in group B (20 patients) RT was administered subsequently to the end of methylprednisolone. RESULTS: At baseline, CAS (median 4.0) and the percentage of patients encompassing the various grades of the classes 2, 3 and 4 of the NOSPECS score were similar in both groups. Six months after RT, CAS decreased to 2 in both groups (p = 0.0003 vs baseline) as well as NOSPECS class 4 (p < 0.0001 vs baseline). NOSPECS class 2 improved more in group A than in group B (p = 0.016). The median cumulative dose of GCs was lower in group A than in group B (median 4.500 vs 6000 mg, p < 0.007); the overall length of therapy was shorter in group A than in group B (68 vs 106 days, p < 0,02). The most common acute adverse effect was transient conjunctivitis (five in group A and three in group B); seven patients (five in group A and two in group B, age between 60 and 66 years) developed cataract, requiring surgery in five cases. CONCLUSIONS: Concomitant administration of GC and RT showed a favorable effect in moderate-to-severe GO, thus suggesting that RT should be carried out early during steroid therapy, when clinical symptoms do not improve or deteriorate after the first i.v. administrations of GCs.
PURPOSE: Glucocorticoids (GCs) and external radiotherapy (RT) are used for treating moderate-to-severe Graves' orbitopathy (GO). We aimed to assess whether GCs and RT were more effective when administered concomitantly or sequentially. METHODS: We retrospectively analyzed clinical outcomes [assessed by Clinical Activity Score (CAS) and NOSPECS classification] in 73 patients treated with both i.v. GCs and RT. The patients were divided in two groups: In group A (53 patients), RT was delivered concomitantly with GCs, and in group B (20 patients) RT was administered subsequently to the end of methylprednisolone. RESULTS: At baseline, CAS (median 4.0) and the percentage of patients encompassing the various grades of the classes 2, 3 and 4 of the NOSPECS score were similar in both groups. Six months after RT, CAS decreased to 2 in both groups (p = 0.0003 vs baseline) as well as NOSPECS class 4 (p < 0.0001 vs baseline). NOSPECS class 2 improved more in group A than in group B (p = 0.016). The median cumulative dose of GCs was lower in group A than in group B (median 4.500 vs 6000 mg, p < 0.007); the overall length of therapy was shorter in group A than in group B (68 vs 106 days, p < 0,02). The most common acute adverse effect was transient conjunctivitis (five in group A and three in group B); seven patients (five in group A and two in group B, age between 60 and 66 years) developed cataract, requiring surgery in five cases. CONCLUSIONS: Concomitant administration of GC and RT showed a favorable effect in moderate-to-severe GO, thus suggesting that RT should be carried out early during steroid therapy, when clinical symptoms do not improve or deteriorate after the first i.v. administrations of GCs.
Authors: C Marcocci; L Bartalena; M L Tanda; L Manetti; E Dell'Unto; R Rocchi; G Barbesino; B Mazzi; M P Bartolomei; P Lepri; F Cartei; M Nardi; A Pinchera Journal: J Clin Endocrinol Metab Date: 2001-08 Impact factor: 5.958
Authors: Michaela Cellina; Maurizio Cè; Giovanni Irmici; Carlo Martinenghi; Sara Marziali; Natallia Khenkina; Anna Maria Ierardi; Giancarlo Oliva; Gianpaolo Carrafiello Journal: Emerg Radiol Date: 2022-04-14