Sophisticated small-volume, relatively low-dose radiation remains a potentially preferable option to forever-steroids across several benign ailments. Here is a Chinese retrospective cohort of 57 patients with steroid-refractory orbital inflammatory disease (a catch-all of Graves, ANCA-associated vasculitis, sarcoidosis, etc) receiving a median of 20 Gy in 10 fractions via VMAT to spare lens and lacrimal glands. The clinical target volume was inflamed orbital tissue excluding the globe. The lens plus 5-10 mm was used as an avoidance with the planning target volume excluding this region, allowing a max dose of 6 Gy to the lens. Ultimately 32 patients (56%) were able to taper off steroids completely while another 19 (33%) significantly reduced steroid dose at the expense of two cases of dry eye syndrome and one lens opacity at a median of 2 years. | Ma, Adv Radiat Oncol 2025
