Is concomitant treatment with steroids and radiotherapy more favorable than sequential treatment in moderate-to-severe graves orbitopathy?

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 c linical 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