Proton beam irradiation of subfoveal choroidal neovascularisation in age-related macular degeneration

Christina Flaxel, Eric J. Friedrichsen, Jodi Osborn Smith, Steven Christopher Oeinck, Paul A. Blacharski, Charles A. Garcia, H. H. Chu

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Purpose. To assess the safety and potential toxicity of proton beam radiation in the treatment of subfoveal choroidal neovascular membrane (CNVM) due to age-related manner degeneration (ARMD) in a prospective, non-randomised study. Methods. Forty-eight eyes of 46 consecutive patients with subfoveal CNVM due to ARMD, not amenable to laser photocoagulation, were treated prospectively with a single proton beam exposure. Two dose regimens were evaluated: 8 CGE (Cobalt Gray Equivalent) and 14 CGE. Patients were followed for an average of 22.1 months after proton beam treatment. Results. At the 12 month follow-up, 44% of eyes in the 8 CGE group and 75% of the eyes in the 14 CGE group had stabilised or improved visual acuity. Complex size in the 8 CGE group as measured on standard fluorescein angiography (FA), decreased or had no change initially but showed less effect over time, while the eyes treated with 14 CGE maintained decreased leakage over the follow-up period of 12 months. However, 11 eyes in the 14 CGE group experienced radiation retinopathy, with the onset between 3 and 30 months. Seven of these 11 eyes have demonstrated some visual loss but only 1 eye developed severe visual loss at 15 months after proton treatment. Conclusions. To date, 14 CGE has suggested a favourable influence on visual function and growth inhibition of CNVM. Proton beam irradiation appears to inhibit CNVM growth. The 14 CGE dose regimen appears to have a longer effect of CNVM growth than does 8 CGE, with overall stabilisation of visual function and growth inhibition. Radiation retinopathy has developed over time, but severe visual loss has been limited. On the basis of the incidence of radiation retinopathy, adjustments in the total radiation dosage and/or fractionation of the dosage should be considered.

Original languageEnglish (US)
Pages (from-to)155-164
Number of pages10
JournalEye
Volume14
Issue number2
StatePublished - Apr 2000
Externally publishedYes

Fingerprint

Choroidal Neovascularization
Macular Degeneration
Cobalt
Protons
Membranes
Radiation
Growth
Social Adjustment
Radiation Dosage
Fluorescein Angiography
Light Coagulation
Visual Acuity
Lasers
Therapeutics
Safety

Keywords

  • Age-related macular degeneration
  • Choroidal neovascularisation
  • Proton therapy
  • Radiation
  • Teletherapy

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems

Cite this

Flaxel, C., Friedrichsen, E. J., Smith, J. O., Oeinck, S. C., Blacharski, P. A., Garcia, C. A., & Chu, H. H. (2000). Proton beam irradiation of subfoveal choroidal neovascularisation in age-related macular degeneration. Eye, 14(2), 155-164.

Proton beam irradiation of subfoveal choroidal neovascularisation in age-related macular degeneration. / Flaxel, Christina; Friedrichsen, Eric J.; Smith, Jodi Osborn; Oeinck, Steven Christopher; Blacharski, Paul A.; Garcia, Charles A.; Chu, H. H.

In: Eye, Vol. 14, No. 2, 04.2000, p. 155-164.

Research output: Contribution to journalArticle

Flaxel, C, Friedrichsen, EJ, Smith, JO, Oeinck, SC, Blacharski, PA, Garcia, CA & Chu, HH 2000, 'Proton beam irradiation of subfoveal choroidal neovascularisation in age-related macular degeneration', Eye, vol. 14, no. 2, pp. 155-164.
Flaxel C, Friedrichsen EJ, Smith JO, Oeinck SC, Blacharski PA, Garcia CA et al. Proton beam irradiation of subfoveal choroidal neovascularisation in age-related macular degeneration. Eye. 2000 Apr;14(2):155-164.
Flaxel, Christina ; Friedrichsen, Eric J. ; Smith, Jodi Osborn ; Oeinck, Steven Christopher ; Blacharski, Paul A. ; Garcia, Charles A. ; Chu, H. H. / Proton beam irradiation of subfoveal choroidal neovascularisation in age-related macular degeneration. In: Eye. 2000 ; Vol. 14, No. 2. pp. 155-164.
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abstract = "Purpose. To assess the safety and potential toxicity of proton beam radiation in the treatment of subfoveal choroidal neovascular membrane (CNVM) due to age-related manner degeneration (ARMD) in a prospective, non-randomised study. Methods. Forty-eight eyes of 46 consecutive patients with subfoveal CNVM due to ARMD, not amenable to laser photocoagulation, were treated prospectively with a single proton beam exposure. Two dose regimens were evaluated: 8 CGE (Cobalt Gray Equivalent) and 14 CGE. Patients were followed for an average of 22.1 months after proton beam treatment. Results. At the 12 month follow-up, 44{\%} of eyes in the 8 CGE group and 75{\%} of the eyes in the 14 CGE group had stabilised or improved visual acuity. Complex size in the 8 CGE group as measured on standard fluorescein angiography (FA), decreased or had no change initially but showed less effect over time, while the eyes treated with 14 CGE maintained decreased leakage over the follow-up period of 12 months. However, 11 eyes in the 14 CGE group experienced radiation retinopathy, with the onset between 3 and 30 months. Seven of these 11 eyes have demonstrated some visual loss but only 1 eye developed severe visual loss at 15 months after proton treatment. Conclusions. To date, 14 CGE has suggested a favourable influence on visual function and growth inhibition of CNVM. Proton beam irradiation appears to inhibit CNVM growth. The 14 CGE dose regimen appears to have a longer effect of CNVM growth than does 8 CGE, with overall stabilisation of visual function and growth inhibition. Radiation retinopathy has developed over time, but severe visual loss has been limited. On the basis of the incidence of radiation retinopathy, adjustments in the total radiation dosage and/or fractionation of the dosage should be considered.",
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AU - Friedrichsen, Eric J.

AU - Smith, Jodi Osborn

AU - Oeinck, Steven Christopher

AU - Blacharski, Paul A.

AU - Garcia, Charles A.

AU - Chu, H. H.

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N2 - Purpose. To assess the safety and potential toxicity of proton beam radiation in the treatment of subfoveal choroidal neovascular membrane (CNVM) due to age-related manner degeneration (ARMD) in a prospective, non-randomised study. Methods. Forty-eight eyes of 46 consecutive patients with subfoveal CNVM due to ARMD, not amenable to laser photocoagulation, were treated prospectively with a single proton beam exposure. Two dose regimens were evaluated: 8 CGE (Cobalt Gray Equivalent) and 14 CGE. Patients were followed for an average of 22.1 months after proton beam treatment. Results. At the 12 month follow-up, 44% of eyes in the 8 CGE group and 75% of the eyes in the 14 CGE group had stabilised or improved visual acuity. Complex size in the 8 CGE group as measured on standard fluorescein angiography (FA), decreased or had no change initially but showed less effect over time, while the eyes treated with 14 CGE maintained decreased leakage over the follow-up period of 12 months. However, 11 eyes in the 14 CGE group experienced radiation retinopathy, with the onset between 3 and 30 months. Seven of these 11 eyes have demonstrated some visual loss but only 1 eye developed severe visual loss at 15 months after proton treatment. Conclusions. To date, 14 CGE has suggested a favourable influence on visual function and growth inhibition of CNVM. Proton beam irradiation appears to inhibit CNVM growth. The 14 CGE dose regimen appears to have a longer effect of CNVM growth than does 8 CGE, with overall stabilisation of visual function and growth inhibition. Radiation retinopathy has developed over time, but severe visual loss has been limited. On the basis of the incidence of radiation retinopathy, adjustments in the total radiation dosage and/or fractionation of the dosage should be considered.

AB - Purpose. To assess the safety and potential toxicity of proton beam radiation in the treatment of subfoveal choroidal neovascular membrane (CNVM) due to age-related manner degeneration (ARMD) in a prospective, non-randomised study. Methods. Forty-eight eyes of 46 consecutive patients with subfoveal CNVM due to ARMD, not amenable to laser photocoagulation, were treated prospectively with a single proton beam exposure. Two dose regimens were evaluated: 8 CGE (Cobalt Gray Equivalent) and 14 CGE. Patients were followed for an average of 22.1 months after proton beam treatment. Results. At the 12 month follow-up, 44% of eyes in the 8 CGE group and 75% of the eyes in the 14 CGE group had stabilised or improved visual acuity. Complex size in the 8 CGE group as measured on standard fluorescein angiography (FA), decreased or had no change initially but showed less effect over time, while the eyes treated with 14 CGE maintained decreased leakage over the follow-up period of 12 months. However, 11 eyes in the 14 CGE group experienced radiation retinopathy, with the onset between 3 and 30 months. Seven of these 11 eyes have demonstrated some visual loss but only 1 eye developed severe visual loss at 15 months after proton treatment. Conclusions. To date, 14 CGE has suggested a favourable influence on visual function and growth inhibition of CNVM. Proton beam irradiation appears to inhibit CNVM growth. The 14 CGE dose regimen appears to have a longer effect of CNVM growth than does 8 CGE, with overall stabilisation of visual function and growth inhibition. Radiation retinopathy has developed over time, but severe visual loss has been limited. On the basis of the incidence of radiation retinopathy, adjustments in the total radiation dosage and/or fractionation of the dosage should be considered.

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KW - Proton therapy

KW - Radiation

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