Dose Response in the Treatment of Subfoveal Choroidal Neovascularization in Age-Related Macular Degeneration: Results of a Phase I/II Dose-Escalation Study Using Proton Radiotherapy

Journal of Radiosurgery - Tập 3 - Trang 47-54 - 2000
Les T. Yonemoto1, Jerry D. Slater1, Paul Blacharski2, John O. Archambeau1, Lilia N. Loredo1, Steven C. Oeinck1, Sandra Teichman1, Michael Moyers1, James M. Slater1
1Department of Radiation Medicine, Loma Linda University Medical Center, Loma Linda
2Department of Ophthalmology, Loma Linda University Medical Center, Loma Linda

Tóm tắt

Approximately 20% of patients with subfoveal choroidal neovascularization qualify for laser photocoagulation, a treatment associated with both disease control and reduced visual acuity. No proved treatment exists for other patients. Single-fraction proton therapy was investigated as an alternative for two groups of patients: 21 patients received 8 GyE; 27 received 14 GyE. Follow-up by fluorescein angiography, visual acuity, contrast sensitivity, and reading speed were done (mean duration: 16 months). Actuarial lesion control at 21 months was 36% for 8-GyE patients and 89% for 14-GyE patients; 77% of patients with controlled lesions achieved improved/stable visual acuity, compared to 44% with uncontrolled lesions. Actuarial mean visual loss for proton-treated maculas was zero at 24 months. No treatment-related morbidity supervened, based on Radiation Therapy Oncology Group criteria. Proton therapy of 14 GyE in one fraction appears to be more effective in controlling neovascular macular degeneration than 8 GyE in one fraction, for both laser-ineligible and -eligible patients.

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Tài liệu tham khảo

Brady LW: Radiotherapy in macular degeneration. Int J Radiat Oncol Biol Phys. 36(4):963, 1996

Vision Problems in the U.S., Statistical Analysis, National Society to Prevent Blindness, Operational Research Department, 1980

Laser photocoagulation of subfoveal neovascular lesions in agerelated macular degeneration. Results of a randomized clinical trial. Macular Photocoagulation Study Group. Arch Ophthalmol 109(9):1220–1231, 1991

Freund KB, Yannuzzi LA, Sorenson JA: Age-related macular degeneration and choroidal neovascularization. Am J Ophthalmol 115(6):786–791, 1993

Krypton laser photocoagulation for neovascular lesions of agerelated macular degeneration. Results of a randomized clinical trial. Macular Photocoagulation Study Group. Arch Ophthalmol 108(6):816–824, 1990

Char D: Radiation therapy for thyroid eye disease, In Thyroid Eye Disease, Chap. 10. Boston, Massachusetts: Butterworth-Heinemann, 1997

Madreperla SA, Hungerford JL, Plowman PN, et al.: Choroidal hemangiomas: visual and anatomic results of treatment by photocoagulation or radiation therapy. Ophthalmology 104(11): 1773–1778, 1997

Hannouche D, Frau E, Desjardins L, et al.: Efficacy of proton therapy in circumscribed choroidal hemangiomas associated with serious retinal detachment. Ophthalmology 104(11):1780–1784, 1997

Augsburger JJ, Freire J, Brady LW: 1997. Radiation therapy for choroidal and retinal hemangiomas. Front Radiat Ther Oncol 30:265–280, 1997

Chakravarthy U, Gardiner TA, Archer DB, et al.: A light microscopic and autoradiographic study of non-irradiated and irradiated ocular wounds. Current eye Res 8(4):337–348, 1989

Chakravarthy U, Houston RF, Archer DB: Treatment of agerelated subfoveal neovascular membranes by teletherapy: a pilot study. Br J Ophthalmol 77(5):265–273, 1993

Bergink GJ, Deutman AF, van den Broek JF, et al.: Radiation therapy for subfoveal choroidal neovascular membranes in agerelated macular degeneration. A pilot study. Graefes Arch Clin Exp Ophthalmol 232(10):591–598, 1999

Yonemoto LT, Slater JD, Friedrichsen EJ, et al.: Phase I/II study of proton beam irradiation for the treatment of subfoveal choroidal neovascularization in age-related macular degeneration: treatment techniques and preliminary results. Int J Radiat Oncol Biol Phys 36(4):867–871, 1996

Lawton CA, Won M, Pilepich MV, et al.: Long-term treatment sequelae following external beam irradiation for adenocarcinoma of the prostate: analysis of RTOG studies 7506 and 7706. Int J Radiat Oncol Biol Phys 21(4):935–939, 1991

Pilepich MV, Asbell SO, Krall JM, et al.: Correlation of radiotherapeutic parameters and treatment related morbidity--analysis of RTOG Study 77-06. Int J Radiat Oncol Biol Phys 13(7):1007–1012, 1987

Pavy JJ, Bosset JF, Schraub S: Late complications of radiotherapy. How to score the late toxicity of radiotherapy. Bull Cancer Radiother 82(2):94–97, 1995

Kaplan EL, Meier P: 1958. Nonparametric estimation from incomplete observations. Am J Stat Assoc 53:447–457, 1995

Slater JM, Miller DW, Archambeau JO: Development of a hospitalbased proton beam treatment center. Int J Radiat Oncol Biol Phys 14(4):761–775, 1988

Moyers MF, Galindo RA, Yonemoto LT, et al.: Treatment of macular degeneration with proton beams. Med Phys 26(5):777–782, 1999

Gass JD: Pathogenesis of disciform detachment of the neuroepithelium. Am J Ophthalmol Suppl 63(3):1–139, 1967

Archambeau JO, Mao XW, Yonemoto LT, et al.: What is the role of radiation in the treatment of subfoveal membranes: review of radiobiologic, pathologic, and other considerations to initiate a multimodality discussion. Int J Radiat Oncol Biol Phys 40(5): 1125–1136, 1998

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Thông tin xuất bản

Journal of Radiosurgery

Tập 3

47-54

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