{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:37:00Z","timestamp":1790120220926,"version":"4.0.1"},"reference-count":56,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Graves\u2019 ophthalmopathy is the most common extrathyroidal manifestation of Graves\u2013Basedow disease. Radiotherapy is effective especially when used in synergy with the administration of glucocorticoids. The aim of our study was to analyze the effectiveness and safety of radiotherapy, using different protocols, to improve ocular symptoms and quality of life. Methods: We retrospectively analyzed the clinical data of two-hundred and three patients treated with retrobulbar radiotherapy between January 2002 and June 2023. Ninety-nine patients were treated with a schedule of 10 Gy in 10 fractions and one-hundred and four were treated with 10 Gy in 5 fractions. Radiotherapy (RT) was administrated during the 12 weeks of pulse steroid therapy. Patients were evaluated with a clinical exam, orbital CT, thyroid assessment, and Clinical Activity Score (CAS). Results: The median follow-up was 28.6 months (range 12\u2013240). Complete response was found in ninety-four pts (46.31%), partial response or stabilization in one hundred pts (49.26%), and progression in nine pts (4.43%). In most subjects, an improvement in visual acuity and a reduction in CAS of at least 2 points and proptosis by more than 3 mm were observed. Three patients needed decompressive surgery after treatment. Only G1 and G2 acute eye disorders and no cases of xerophthalmia or cataract were assessed. Conclusions: RT is an effective and well-tolerated treatment in this setting, especially when associated with the administration of glucocorticoids. Although the most used fractionation schedule in the literature is 20 Gy in 10 fractions, in our clinical practice, we have achieved comparable results with 10 Gy in 5 or 10 fractions with a lower incidence of toxicity.<\/jats:p>","DOI":"10.3390\/diseases13020061","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T11:31:17Z","timestamp":1739791877000},"page":"61","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Orbital Radiotherapy for Graves\u2019 Ophthalmopathy: Single Institutional Experience of Efficacy and Safety"],"prefix":"10.3390","volume":"13","author":[{"given":"Madalina","family":"La Rocca","sequence":"first","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Lo Greco","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Marano","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3282-2204","authenticated-orcid":false,"given":"Roberto","family":"Milazzotto","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"Liardo","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Acquaviva","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana","family":"La Monaca","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Salamone","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Basile","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"},{"name":"Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Foti","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"},{"name":"Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7196-2974","authenticated-orcid":false,"given":"Stefano","family":"Palmucci","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"},{"name":"Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"David","sequence":"additional","affiliation":[{"name":"Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Parisi","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3011-6779","authenticated-orcid":false,"given":"Antonio","family":"Pontoriero","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-7634","authenticated-orcid":false,"given":"Stefano","family":"Pergolizzi","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Spatola","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"},{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"},{"name":"Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e001515","DOI":"10.1136\/bmjophth-2023-001515","article-title":"Graves\u2019 Ophthalmopathy: The Clinical and Psychosocial Outcomes of Different Medical Interventions\u2014A Systematic Review","volume":"9","author":"Bello","year":"2024","journal-title":"BMJ Open Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"431","DOI":"10.4103\/ijmr.IJMR_339_19","article-title":"Effects of Infections on the Pathogenesis of Cancer","volume":"153","author":"Liardo","year":"2021","journal-title":"Indian J. Med. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.ando.2018.09.002","article-title":"Graves\u2019 Disease: Introduction, Epidemiology, Endogenous and Environmental Pathogenic Factors","volume":"79","author":"Klein","year":"2018","journal-title":"Ann. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/S0002-9394(02)01970-0","article-title":"Effect of Steroid Pulse Therapy with and without Orbital Radiotherapy on Graves\u2019 Ophthalmopathy","volume":"135","author":"Ohtsuka","year":"2003","journal-title":"Am. J. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ijrobp.2010.08.053","article-title":"The Efficacy of Radiation Therapy in the Treatment of Graves\u2019 Orbitopathy","volume":"82","author":"Matthiesen","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1089\/105072502753600124","article-title":"Thyrotropin Receptor Expression in Orbital Adipose\/Connective Tissues from Patients with Thyroid-Associated Ophthalmopathy","volume":"12","author":"Bahn","year":"2002","journal-title":"Thyroid."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1007\/s40618-020-01258-w","article-title":"Asymmetry Indicates More Severe and Active Disease in Graves\u2019 Orbitopathy: Results from a Prospective Cross-Sectional Multicentre Study","volume":"43","author":"Perros","year":"2020","journal-title":"J. Endocrinol. Investig."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1590\/S0004-27492012000500006","article-title":"Radiation Therapy for Graves\u2019 Ophthalmopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"75","author":"Viani","year":"2012","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_9","first-page":"177","article-title":"Development and Course of Exophthalmos and Ophthalmoplegia in Graves\u2019 Disease with Special Reference to the Effect of Thyroidectomy","volume":"5","author":"Rundle","year":"1945","journal-title":"Clin. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1001\/archophthalmol.2011.29","article-title":"Rundle and His Curve","volume":"129","author":"Bartley","year":"2011","journal-title":"Arch. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.numecd.2015.01.003","article-title":"Type 2 Diabetic Patients with Graves\u2019 Disease Have More Frequent and Severe Graves\u2019 Orbitopathy","volume":"25","author":"Muscia","year":"2015","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bjo.75.10.629","article-title":"Synergism between Diabetic and Radiation Retinopathy: Case Report and Review","volume":"75","author":"Viebahn","year":"1991","journal-title":"Br. J. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lanzolla, G., Vannucchi, G., Ionni, I., Campi, I., Sileo, F., Lazzaroni, E., and Marin\u00f2, M. (2019). Cholesterol Serum Levels and Use of Statins in Graves\u2019 Orbitopathy: A New Starting Point for the Therapy. Front. Endocrinol., 10.","DOI":"10.3389\/fendo.2019.00933"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"G43","DOI":"10.1530\/EJE-21-0479","article-title":"The 2021 European Group on Graves\u2019 Orbitopathy (EUGOGO) Clinical Practice Guidelines for the Medical Management of Graves\u2019 Orbitopathy","volume":"185","author":"Bartalena","year":"2021","journal-title":"Eur. J. Endocrinol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1186\/s13014-020-01663-8","article-title":"Efficacy of Orbital Radiotherapy in Moderate-to-Severe Active Graves\u2019 Orbitopathy Including Long-Lasting Disease: A Retrospective Analysis","volume":"15","author":"Choi","year":"2020","journal-title":"Radiat. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1089\/105072502753600223","article-title":"Orbital Radiotherapy for Graves\u2019 Ophthalmopathy","volume":"12","author":"Bartalena","year":"2002","journal-title":"Thyroid"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1210\/jcem-37-2-276","article-title":"Supervoltage Orbital Radiotherapy for Graves\u2019 Ophthalmopathy","volume":"37","author":"Donaldson","year":"1973","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"La Rocca, M., Leonardi, B.F., Lo Greco, M.C., Marano, G., Finocchiaro, I., Iudica, A., Milazzotto, R., Liardo, R.L.E., La Monaca, V.A., and Salamone, V. (2023). Radiotherapy of Orbital and Ocular Adnexa Lymphoma: Literature Review and University of Catania Experience. Cancers, 15.","DOI":"10.3390\/cancers15245782"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Spatola, C., Liardo, R.L.E., Milazzotto, R., Raffaele, L., Salamone, V., Basile, A., Foti, P.V., Palmucci, S., Cirrone, G.A.P., and Cuttone, G. (2020). Radiotherapy of Conjunctival Melanoma: Role and Challenges of Brachytherapy, Photon-Beam and Protontherapy. Appl. Sci., 10.","DOI":"10.3390\/app10249071"},{"key":"ref_20","unstructured":"Common Terminology Criteria for Adverse Events (CTCAE)."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.ajo.2007.10.018","article-title":"The Influence of Previous Orbital Irradiation on the Outcome of Rehabilitative Decompression Surgery in Graves Orbitopathy","volume":"145","author":"Baldeschi","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1080\/09553000500385556","article-title":"Radiation Treatment of Acute Inflammation in Mice","volume":"81","author":"Schaue","year":"2005","journal-title":"Int. J. Radiat. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1056\/NEJMoa1910434","article-title":"Teprotumumab for the Treatment of Active Thyroid Eye Disease","volume":"382","author":"Douglas","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_24","first-page":"1","article-title":"Functional and molecular aspects of anti-inflammatory effects of low-dose radiotherapy","volume":"178","author":"Kamprad","year":"2002","journal-title":"Strahlenther. Onkol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.canrad.2023.09.004","article-title":"Management of Graves\u2019 Ophthalmopathy by Radiotherapy: A Literature Review","volume":"28","author":"Beige","year":"2024","journal-title":"Cancer Radiother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1007\/s12020-024-03788-2","article-title":"Late Orbital Radiotherapy Combined with Intravenous Methylprednisolone in the Management of Long-Lasting Active Graves\u2019 Orbitopathy: A Case Report and Literature Review","volume":"85","author":"Verrienti","year":"2024","journal-title":"Endocrine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1097\/IOP.0000000000002591","article-title":"Disease Modulation Versus Modification: A Call for Revised Outcome Metrics in the Treatment of Thyroid Eye Disease","volume":"40","author":"North","year":"2024","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Han, Q., Mao, X., and Tian, S. (2024). A Retrospective Study on the Effectiveness of Intensity Modulated Radiation Therapy for Thyroid Associated Ophthalmopathy at a Single Institute. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-68809-6"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1016\/j.ophtha.2003.12.054","article-title":"Orbital Irradiation for Graves\u2019 Ophthalmopathy: Is It Safe? A Long-Term Follow-up Study","volume":"111","author":"Wakelkamp","year":"2004","journal-title":"Ophthalmology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1007\/s00417-016-3280-7","article-title":"Efficacy of Combined Orbital Radiation and Systemic Steroids in the Management of Graves\u2019 Orbitopathy","volume":"254","author":"Kim","year":"2016","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1210\/jcem-56-6-1139","article-title":"Orbital Cobalt Irradiation Combined with Systemic Corticosteroids for Graves\u2019 Ophthalmopathy: Comparison with Systemic Corticosteroids Alone","volume":"56","author":"Bartalena","year":"1983","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1365-2265.1987.tb00836.x","article-title":"Orbital Cobalt Irradiation Combined with Retrobulbar or Systemic Corticosteroids for Graves\u2019 Ophthalmopathy: A Comparative Study","volume":"27","author":"Marcocci","year":"1987","journal-title":"Clin. Endocrinol."},{"key":"ref_33","first-page":"3898","article-title":"Comparison of IMRT and VMAT Radiotherapy Planning for Graves\u2019 Ophthalmopathy Based on Dosimetric Parameters Analysis","volume":"24","author":"Wang","year":"2020","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1016\/S0161-6420(01)00632-7","article-title":"A Prospective, Randomized, Double-Blind, Placebo-Controlled Study of Orbital Radiotherapy for Graves\u2019 Ophthalmopathy","volume":"108","author":"Gorman","year":"2001","journal-title":"Ophthalmology"},{"key":"ref_35","first-page":"102","article-title":"Low- versus High-Dose Radiotherapy for Graves\u2019 Ophthalmopathy: A Randomized, Single Blind Trial","volume":"85","author":"Kahaly","year":"2000","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/S0140-6736(00)02165-6","article-title":"Radiotherapy for Graves\u2019 Orbitopathy: Randomised Placebo-Controlled Study","volume":"355","author":"Mourits","year":"2000","journal-title":"Lancet"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1089\/thy.2023.0656","article-title":"Long-Term Efficacy of Teprotumumab in Thyroid Eye Disease: Follow-Up Outcomes in Three Clinical Trials","volume":"34","author":"Kahaly","year":"2024","journal-title":"Thyroid"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1210\/jc.2009-0376","article-title":"Treatment Modalities for Graves\u2019 Ophthalmopathy: Systematic Review and Metaanalysis","volume":"94","author":"Robenshtok","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_39","unstructured":"(2024, November 10). X-Ray Treatment of Malignant Exophthalmos: A Report on 28 Patients\u2014PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/13084727\/."},{"key":"ref_40","unstructured":"(2024, November 10). The Efficacy of Intensity Modulated Radiation Therapy in Treating Thyroid-Associated Ophthalmopathy and Predictive Factors for Treatment Response|Scientific Reports. Available online: https:\/\/www.nature.com\/articles\/s41598-017-17893-y."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/0360-3016(90)90532-O","article-title":"Prognostic Factors in the Radiotherapy of Graves\u2019 Ophthalmopathy","volume":"19","author":"Petersen","year":"1990","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_42","unstructured":"(2024, November 10). A Randomized Controlled Trial of Orbital Radiotherapy Versus Sham Irradiation in Patients with Mild Graves\u2019 Ophthalmopathy\u2014PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/14715820\/."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/1748-717X-7-199","article-title":"Comparative Analysis of Dosimetric Parameters of Three Different Radiation Techniques for Patients with Graves\u2019 Ophthalmopathy Treated with Retro-Orbital Irradiation","volume":"7","author":"Lee","year":"2012","journal-title":"Radiat. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2217\/fon-2016-0330","article-title":"Intensity-Modulated Radiotherapy for Relapsed Malignant Pleural Mesothelioma","volume":"12","author":"Spatola","year":"2016","journal-title":"Future Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12177-009-9021-y","article-title":"Radiotherapy in the Treatment of Graves Ophthalmopathy-to Do It or Not?","volume":"3","author":"Zygulska","year":"2009","journal-title":"J. Ocul. Biol. Dis. Inform."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1148\/radiology.196.3.7644656","article-title":"Graves Ophthalmopathy: MR Evaluation of 10-Gy versus 24-Gy Irradiation Combined with Systemic Corticosteroids","volume":"196","author":"Nakahara","year":"1995","journal-title":"Radiology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s00417-009-1214-3","article-title":"A Retrospective Study on the Efficacy of Total Absorbed Orbital Doses of 12, 16 and 20 Gy Combined with Systemic Steroid Treatment in Patients with Graves\u2019 Orbitopathy","volume":"248","author":"Johnson","year":"2010","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s00066-021-01770-9","article-title":"Low- vs. High-Dose Radiotherapy in Graves\u2019 Ophthalmopathy: A Retrospective Comparison of Long-Term Results","volume":"197","author":"Weissmann","year":"2021","journal-title":"Strahlenther. Onkol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/S0360-3016(02)03795-1","article-title":"Retrobulbar Irradiation for Thyroid-Associated Orbitopathy: Double-Blind Comparison between 2.4 and 16 Gy","volume":"55","author":"Gerling","year":"2003","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_50","unstructured":"(2024, November 10). Efficacy of B-Cell Targeted Therapy with Rituximab in Patients with Active Moderate to Severe Graves\u2019 Orbitopathy: A Randomized Controlled Study\u2014PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/25494967\/."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/S2213-8587(16)30046-8","article-title":"Advances in Treatment of Active, Moderate-to-Severe Graves\u2019 Ophthalmopathy","volume":"5","author":"Wiersinga","year":"2017","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1210\/jc.2014-2572","article-title":"Randomized Controlled Trial of Rituximab in Patients with Graves\u2019 Orbitopathy","volume":"100","author":"Stan","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ajo.2018.07.038","article-title":"Efficacy of Tocilizumab in Patients With Moderate-to-Severe Corticosteroid-Resistant Graves Orbitopathy: A Randomized Clinical Trial","volume":"195","author":"Maneiro","year":"2018","journal-title":"Am. J. Ophthalmol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/BF03347943","article-title":"Orbital Radiotherapy Combined with High Dose Systemic Glucocorticoids for Graves\u2019 Ophthalmopathy Is More Effective than Radiotherapy Alone: Results of a Prospective Randomized Study","volume":"14","author":"Marcocci","year":"1991","journal-title":"J. Endocrinol. Investig."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1001\/jamaophthalmol.2021.6284","article-title":"Proptosis and Diplopia Response With Teprotumumab and Placebo vs the Recommended Treatment Regimen With Intravenous Methylprednisolone in Moderate to Severe Thyroid Eye Disease: A Meta-Analysis and Matching-Adjusted Indirect Comparison","volume":"140","author":"Douglas","year":"2022","journal-title":"JAMA Ophthalmol."},{"key":"ref_56","unstructured":"(2024, November 10). Teprotumumab Efficacy, Safety, and Durability in Longer-Duration Thyroid Eye Disease and Re-Treatment: OPTIC-X Study\u2014PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/34688699\/."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/2\/61\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:36:20Z","timestamp":1760027780000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/2\/61"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,17]]},"references-count":56,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["diseases13020061"],"URL":"https:\/\/doi.org\/10.3390\/diseases13020061","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,17]]}}}