The advance and application of radiotherapy in exudative age-related macular degeneration_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhou Yifan ,  Liu Haiyun , Sun Xiaodong

Department of ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai Key Laboratory Of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080,China;

Corresponding author：

Liu Haiyun, Email: drliuhaiyun@126.com

Keywords：

Wet macular degeneration/therapy; Radiotherapy; Angiogenesis inhibitors; Review

DOI：

10.3760/cma.j.issn.1005-1015.2017.06.029

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Exudative or wet age-related macular degeneration (AMD) is characterized by the progressive growth of choroidal neovascularization (CNV). Anti-vascular endothelial growth factor (VEGF) drugs have been used in the control of the development of CNV and vision improvement, but there are still defects like frequent injections, drug resistance and so on. Radiotherapy can deactivate local inflammatory cell populations, and make CNV unstable in the absence of pericytes and VEGF stimulation, which induce apoptosis of the vascular endothelial cells. Therefore, radiotherapy is considered as a potential adjuvant treatment of anti-VEGF therapy. The current clinical approaches include epimacular brachytherapy (EMBT) and long-range stereotactic radiotherapy (SRT). SRT may be a preferred adjuvant treatment for patients receiving anti-VEGF therapy. Knowing the progress of radiotherapy for the treatment of exudative AMD may help us to fully understand the pathogenesis of wAMD in China

Citation： Zhou Yifan, Liu Haiyun, Sun Xiaodong. The advance and application of radiotherapy in exudative age-related macular degeneration. Chinese Journal of Ocular Fundus Diseases, 2017, 33(6): 652-655. doi: 10.3760/cma.j.issn.1005-1015.2017.06.029 Copy

1.	Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration[J]. N Engl J Med, 2006, 355(14): 1419-1431.
2.	CATT Research Group, Martin DF, Maguire MG, et al. Ranibizumab and bevacizumab for neovascular age-related macular degeneration[J]. N Engl J Med, 2011, 364(20): 1897-1908. DOI:10.1056/NEJMoa1102673.
3.	Brown DM, Kaiser PK, Michels M, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration[J]. N Engl J Med, 2006, 355(14): 1432-1444. DOI: 10.1056/NEJMoa062655.
4.	Senan S, Smit EF. Design of clinical trials of radiation combined with antiangiogenic therapy [J]. Oncologist, 2007, 12(4): 465-477.
5.	Miyamoto H, Kimura H, Yasukawa T, et al. Effect of focal X-ray irradiation on experimental choroidal neovascularization[J]. Invest Ophthalmol Vis Sci, 1999, 40(7): 1496-1502.
6.	Petrarca R, Jackson TL.Radiation therapy for neovascular age-related macular degeneration [J]. Clin Ophthalmol, 2011, 5: 57-63. DOI: 10.2147/OPTH.S16444.
7.	Trikha R, Morse LS, Zawadzki RJ, et al. Ten-year follow-up of eyes treated with stereotactic fractionated external beam radiation for neovascular age-related macular degeneration[J]. Retina, 2011, 31(7): 1303-1315. DOI: 10.1097/IAE.0b013e318203ee46.
8.	Canton VM, Quiroz-Mercado H, Velez-Montoya R, et al. 16-Gy low-voltage x-ray irradiation with ranibizumab therapy for AMD: 6-month safety and functional outcomes[J]. Ophthalmic Surg Lasers Imaging, 2011, 42(6): 468-473. DOI: 10.3928/15428877-20110804-01.
9.	Avila MP, Farah ME, Santos A, et al. Twelve-month short-term safety and visual-acuity results from a multicentre prospective study of epiretinal strontium-90 brachytherapy with bevacizumab for the treatment of subfoveal choroidal neovascularisation secondary to age-related macular degeneration[J]. Br J Ophthalmol, 2009, 93(3): 305-309. DOI: 10.1136/bjo.2008.145912.
10.	Dugel PU, Petrarca R, Bennett M, et al. Macular epiretinal brachytherapy in treated age-related macular degeneration: MERITAGE study: twelve-month safety and efficacy results[J]. Ophthalmology, 2012, 119(7): 1425-1431. DOI: 10.1016/j.ophtha.2012.01.014.
11.	Dugel PU, Bebchuk JD, Nau J, et al. Epimacular brachytherapy for neovascular age-related macular degeneration: a randomized, controlled trial (CABERNET)[J]. Ophthalmology, 2013, 120(2): 317-327. DOI: 10.1016/j.ophtha.2012.07.068.
12.	Jackson TL, Desai R, Simpson A, et al. epimacular brachytherapy for previously treated neovascular age-related macular degeneration (MERLOT): a phase 3 randomized controlled trial[J]. Ophthalmology, 2016, 123(6): 1287-1296. DOI: 10.1016/j.ophtha.2016.02.028.
13.	Singh RP, Shusterman EM, Moshfeghi D, et al. Pilot study of the delivery of microcollimated pars plana external beam radiation in porcine eyes: 270-day analysis[J/OL]. J Ophthalmol, 2012, 2012:615214[2012-07-11]. http://dx.doi.org/10.1155/2012/615214. DOI: 10.1155/2012/615214.
14.	Moshfeghi AA, Canton VM, Quiroz-Mercado H, et al. 16-Gy low-voltage x-ray irradiation followed by as-needed ranibizumab therapy for AMD: 6-month outcomes of a " radiation-first” strategy[J]. Ophthalmic Surg Lasers Imaging, 2011, 42(6): 460-467. DOI: 10.3928/15428877-20110804-03.
15.	Evans JR, Sivagnanavel V, Chong V.Radiotherapy for neovascular age-related macular degeneration[J/CD]. Cochrane Database Syst Rev, 2010(5): CD004004. DOI: 10.1002/14651858.CD004004.pub3.
16.	Jackson TL, Chakravarthy U, Kaiser PK, et al. Stereotactic radiotherapy for neovascular age-related macular degeneration: 52-week safety and efficacy results of the INTREPID study[J]. Ophthalmology, 2013, 120(9): 1893-1900. DOI: 10.1016/j.ophtha.2013.02.016.
17.	Jackson TL, Chakravarthy U, Slakter JS, et al. Stereotactic radiotherapy for neovascular age-related macular degeneration: year 2 results of the INTREPID study[J]. Ophthalmology, 2015, 122(1): 138-145. DOI: 10.1016/j.ophtha.2014.07.043.
18.	Jackson TL, Shusterman EM, Arnoldussen M, et al. Stereotactic radiotherapy for wet age-related macular degeneration (INTREPID): influence of baseline characteristics on clinical response [J]. Retina, 2015, 35(2): 194-204. DOI: 10.1097/IAE.0000000000000283.
19.	Hatz K, Zimmermann F, Kardamakis D, et al. Low-energy stereotactic radiotherapy for treatment of exudative age-related macular degeneration adjunctive to anti-VEGF therapy [J]. European Ophthalmic Review, 2015, 9(1): 25-31.DOI: http://doi.org/10.17925/EOR.2015.09.01.25.
20.	Ranjbar M, Kurz M, Holzhey A, et al. Stereotactic radiotherapy in neovascular age-related macular degeneration: Real-life efficacy and morphological evaluation of the outer retina-choroid complex [J]. Medicine (Baltimore), 2016, 95(52): 5729. DOI: 10.1097/MD.0000000000005729.
21.	Neffendorf JE, Desai R, Wang Y, et al. StereoTactic radiotherapy for wet Age-Related macular degeneration (STAR): study protocol for a randomised controlled clinical trial[J]. Trials, 2016, 17(1): 560.DOI: 10.1186/s13063-016-1676-7.
22.	Chakravarthy U, Biggart JH, Gardiner TA, et al. Focal irradiation of perforating eye injuries[J]. Curr Eye Res, 1989, 8(12): 1241-1250.
23.	Hart PM, Archer DB, Chakravarthy U.Teletherapy in the management of patients with age-related macular degeneration complicated by subfoveal neovascularisation: an overview[J]. Front Radiat Ther Oncol, 1997, 30:229-237.
24.	Chakravarthy U, Czeszynski A.Stereotactic low voltage x-ray radiotherapy for treating neovascular age-related macular degeneration[J]. Exp Rev Ophthalmol, 2014, 9(3): 153-158.
25.	Rating P, Freimuth MA, Stuschke M, et al. Adjuvant radiotherapy during anti-VEGF in neovascular age-related macular degeneration[J]. Ophthalmologe, 2017, 114(4): 370-374. DOI: 10.1007/s00347-017-0451-9.
26.	Introini U, Casalino G, Triolo G, et al. Stereotactic radiotherapy for polypoidal choroidal vasculopathy: a pilot study[J]. Ophthalmologica, 2015, 233(2): 82-88. DOI: 10.1159/000368561.

1. Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration[J]. N Engl J Med, 2006, 355(14): 1419-1431.
2. CATT Research Group, Martin DF, Maguire MG, et al. Ranibizumab and bevacizumab for neovascular age-related macular degeneration[J]. N Engl J Med, 2011, 364(20): 1897-1908. DOI:10.1056/NEJMoa1102673.
3. Brown DM, Kaiser PK, Michels M, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration[J]. N Engl J Med, 2006, 355(14): 1432-1444. DOI: 10.1056/NEJMoa062655.
4. Senan S, Smit EF. Design of clinical trials of radiation combined with antiangiogenic therapy [J]. Oncologist, 2007, 12(4): 465-477.
5. Miyamoto H, Kimura H, Yasukawa T, et al. Effect of focal X-ray irradiation on experimental choroidal neovascularization[J]. Invest Ophthalmol Vis Sci, 1999, 40(7): 1496-1502.
6. Petrarca R, Jackson TL.Radiation therapy for neovascular age-related macular degeneration [J]. Clin Ophthalmol, 2011, 5: 57-63. DOI: 10.2147/OPTH.S16444.
7. Trikha R, Morse LS, Zawadzki RJ, et al. Ten-year follow-up of eyes treated with stereotactic fractionated external beam radiation for neovascular age-related macular degeneration[J]. Retina, 2011, 31(7): 1303-1315. DOI: 10.1097/IAE.0b013e318203ee46.
8. Canton VM, Quiroz-Mercado H, Velez-Montoya R, et al. 16-Gy low-voltage x-ray irradiation with ranibizumab therapy for AMD: 6-month safety and functional outcomes[J]. Ophthalmic Surg Lasers Imaging, 2011, 42(6): 468-473. DOI: 10.3928/15428877-20110804-01.
9. Avila MP, Farah ME, Santos A, et al. Twelve-month short-term safety and visual-acuity results from a multicentre prospective study of epiretinal strontium-90 brachytherapy with bevacizumab for the treatment of subfoveal choroidal neovascularisation secondary to age-related macular degeneration[J]. Br J Ophthalmol, 2009, 93(3): 305-309. DOI: 10.1136/bjo.2008.145912.
10. Dugel PU, Petrarca R, Bennett M, et al. Macular epiretinal brachytherapy in treated age-related macular degeneration: MERITAGE study: twelve-month safety and efficacy results[J]. Ophthalmology, 2012, 119(7): 1425-1431. DOI: 10.1016/j.ophtha.2012.01.014.
11. Dugel PU, Bebchuk JD, Nau J, et al. Epimacular brachytherapy for neovascular age-related macular degeneration: a randomized, controlled trial (CABERNET)[J]. Ophthalmology, 2013, 120(2): 317-327. DOI: 10.1016/j.ophtha.2012.07.068.
12. Jackson TL, Desai R, Simpson A, et al. epimacular brachytherapy for previously treated neovascular age-related macular degeneration (MERLOT): a phase 3 randomized controlled trial[J]. Ophthalmology, 2016, 123(6): 1287-1296. DOI: 10.1016/j.ophtha.2016.02.028.
13. Singh RP, Shusterman EM, Moshfeghi D, et al. Pilot study of the delivery of microcollimated pars plana external beam radiation in porcine eyes: 270-day analysis[J/OL]. J Ophthalmol, 2012, 2012:615214[2012-07-11]. http://dx.doi.org/10.1155/2012/615214. DOI: 10.1155/2012/615214.
14. Moshfeghi AA, Canton VM, Quiroz-Mercado H, et al. 16-Gy low-voltage x-ray irradiation followed by as-needed ranibizumab therapy for AMD: 6-month outcomes of a " radiation-first” strategy[J]. Ophthalmic Surg Lasers Imaging, 2011, 42(6): 460-467. DOI: 10.3928/15428877-20110804-03.
15. Evans JR, Sivagnanavel V, Chong V.Radiotherapy for neovascular age-related macular degeneration[J/CD]. Cochrane Database Syst Rev, 2010(5): CD004004. DOI: 10.1002/14651858.CD004004.pub3.
16. Jackson TL, Chakravarthy U, Kaiser PK, et al. Stereotactic radiotherapy for neovascular age-related macular degeneration: 52-week safety and efficacy results of the INTREPID study[J]. Ophthalmology, 2013, 120(9): 1893-1900. DOI: 10.1016/j.ophtha.2013.02.016.
17. Jackson TL, Chakravarthy U, Slakter JS, et al. Stereotactic radiotherapy for neovascular age-related macular degeneration: year 2 results of the INTREPID study[J]. Ophthalmology, 2015, 122(1): 138-145. DOI: 10.1016/j.ophtha.2014.07.043.
18. Jackson TL, Shusterman EM, Arnoldussen M, et al. Stereotactic radiotherapy for wet age-related macular degeneration (INTREPID): influence of baseline characteristics on clinical response [J]. Retina, 2015, 35(2): 194-204. DOI: 10.1097/IAE.0000000000000283.
19. Hatz K, Zimmermann F, Kardamakis D, et al. Low-energy stereotactic radiotherapy for treatment of exudative age-related macular degeneration adjunctive to anti-VEGF therapy [J]. European Ophthalmic Review, 2015, 9(1): 25-31.DOI: http://doi.org/10.17925/EOR.2015.09.01.25.
20. Ranjbar M, Kurz M, Holzhey A, et al. Stereotactic radiotherapy in neovascular age-related macular degeneration: Real-life efficacy and morphological evaluation of the outer retina-choroid complex [J]. Medicine (Baltimore), 2016, 95(52): 5729. DOI: 10.1097/MD.0000000000005729.
21. Neffendorf JE, Desai R, Wang Y, et al. StereoTactic radiotherapy for wet Age-Related macular degeneration (STAR): study protocol for a randomised controlled clinical trial[J]. Trials, 2016, 17(1): 560.DOI: 10.1186/s13063-016-1676-7.
22. Chakravarthy U, Biggart JH, Gardiner TA, et al. Focal irradiation of perforating eye injuries[J]. Curr Eye Res, 1989, 8(12): 1241-1250.
23. Hart PM, Archer DB, Chakravarthy U.Teletherapy in the management of patients with age-related macular degeneration complicated by subfoveal neovascularisation: an overview[J]. Front Radiat Ther Oncol, 1997, 30:229-237.
24. Chakravarthy U, Czeszynski A.Stereotactic low voltage x-ray radiotherapy for treating neovascular age-related macular degeneration[J]. Exp Rev Ophthalmol, 2014, 9(3): 153-158.
25. Rating P, Freimuth MA, Stuschke M, et al. Adjuvant radiotherapy during anti-VEGF in neovascular age-related macular degeneration[J]. Ophthalmologe, 2017, 114(4): 370-374. DOI: 10.1007/s00347-017-0451-9.
26. Introini U, Casalino G, Triolo G, et al. Stereotactic radiotherapy for polypoidal choroidal vasculopathy: a pilot study[J]. Ophthalmologica, 2015, 233(2): 82-88. DOI: 10.1159/000368561.

Previous Article
获得性眼弓形虫病一例
Next Article
Recent advances in cellular scaffolds for retinal pigment epithelium cell transplantation

Chinese Journal of Ocular Fundus Diseases

The advance and application of radiotherapy in exudative age-related macular degeneration

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content