16-Gy Low-Voltage X-ray Irradiation Followed by As-Needed Ranibizumab Therapy for AMD: 6-Month Outcomes of a “Radiation-First” Strategy

Moshfeghi, Andrew A; Cantón, Virgilio Morales; Quiroz‐Mercado, Hugo; Vélez-Montoya, Raúl; Lopez-Miranda, M. J.; Shusterman, E. Mark; Sanislo, Steven R.; Gertner, Michael; Moshfeghi, Darius M.

doi:10.3928/15428877-20110804-03

Cited by 16 publications

(10 citation statements)

References 32 publications

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“…At 6-month follow-up, the 16-and 24-Gy doses, in conjunction with baseline loading of ranibizumab, resulted in improvement in visual acuity with a decreased need for injections [59,70,79]. There were no incidences of cataract progression, radiation retinopathy, and optic neuropathy in any group [59,70,79]. At 6 months, the mean change in visual acuity was ?6.4 ± 9.8 ETDRS letters.…”

Section: Low-voltage Stereotactic Radiotherapy (Srt) In Amdmentioning

confidence: 85%

Brachytherapy in Neovascular AMD

Grewal

Vajzovic

2015

Curr Ophthalmol Rep

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Neovascular age-related macular degeneration (AMD) has a complex pathophysiology, and although anti-VEGF therapy has been one of the most significant and successful advances, it is not effective for all patients with neovascular AMD. The potential role of radiation in the management of neovascular AMD has been suggested for several years. While previous work focused on the role of radiation alone, recent trials have evaluated the role of ionizing radiation as a synergistic treatment with anti-VEGF drugs, with endpoints being to reduce choroidal neovascular lesions faster, preserve visual acuity, and extend the treatment interval between injections. We review the current evidence available for the safety and efficacy of radiation in conjunction with anti-VEGF treatment for neovascular AMD delivered using three approaches-epimacular brachytherapy involving a pars plana vitrectomy (Vidion Neovista, Inc., Newark, CA, USA), episcleral brachytherapy without a pars plana vitrectomy (Salutaris Medical Devices, Tucson, AZ), and low-voltage stereotactic radiotherapy (IRay,

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Section: Low-voltage Stereotactic Radiotherapy (Srt) In Amdmentioning

confidence: 85%

Brachytherapy in Neovascular AMD

Grewal

Vajzovic

2015

Curr Ophthalmol Rep

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“…Oraya Therapy ™ Stereotactic Radiotherapy for wet AMD provides a noninvasive delivery of a one-time single fraction dose to the macula (Gertner et al, 2010; Moshfeghi et al, 2011). The goal of Oraya Therapy is to deliver a dose significant enough to arrest choroidal neovascularization without damaging other non-targeted tissues of the eye and head.…”

Section: Introductionmentioning

confidence: 99%

Influence of eye size and beam entry angle on dose to non-targeted tissues of the eye during stereotactic x-ray radiosurgery of AMD

Cantley

Hanlon²,

Chell³

et al. 2013

Phys. Med. Biol.

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Age-related macular degeneration is a leading cause of vision loss for the elderly population of industrialized nations. The IRay® Radiotherapy System, developed by Oraya® Therapeutics, Inc., is a stereotactic low-voltage irradiation system designed to treat the wet form of the disease. The IRay System uses three robotically positioned 100 kVp collimated photon beams to deliver an absorbed dose of up to 24 Gy to the macula. The present study uses the Monte Carlo radiation transport code MCNPX to assess absorbed dose to six non-targeted tissues within the eye - total lens, radiosensitive tissues of the lens, optic nerve, distal tip of the central retinal artery, non-targeted portion of the retina, and the ciliary body – all as a function of eye size and beam entry angle. The ocular axial length was ranged from 20 to 28 mm in 2 mm increments, with the polar entry angle of the delivery system varied from 18 to 34 degrees in 2 degree increments. The resulting data showed insignificant variations in dose for all eye sizes. Slight variations in the dose to the optic nerve and the distal tip of the central retinal artery were noted as the polar beam angle changed. An increase in non-targeted retinal dose was noted as the entry angle increased, while the dose to the lens, sensitive volume of the lens, and ciliary body decreased as the treatment polar angle increased. Polar angles of 26 degrees or greater resulted in no portion of the sensitive volume of the lens receiving an absorbed dose of 0.5 Gy or greater. All doses to non-targeted structures reported in this study were less than accepted thresholds for post-procedure complications.

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“…This system has been described in detail previously 21. In brief, it consists of the following components: (1) a precision-controlled x-ray tube, (2) a patient interface, (3) an eye stabilising device that optically couples the patient's eye to the x-ray delivery system, (4) an eye tracking system that monitors X, Y and rotational movements of the eye for dose determination and safety gating, (5) graphical user interface and (6) treatment planning software.…”

Section: Introductionmentioning

confidence: 99%

“…We recently published 6 months safety and efficacy data from a phase I trial using two different treatment strategies: (1) 16 Gy radiation plus two loading injections of ranibizumab, followed by monthly as needed ranibizumab and (2) 16 Gy radiation followed by monthly as needed ranibizumab 21 23. In this paper, we discuss the extended follow-up of this novel, stereotactically-targeted, low-voltage x-ray therapy in patients with neovascular AMD who received the radiation-first strategy.…”

Section: Introductionmentioning

confidence: 99%

16 Gy low-voltage x-ray irradiation followed by as needed ranibizumab therapy for age-related macular degeneration: 12 month outcomes of a ‘radiation-first’ strategy

et al. 2012

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16-Gy Low-Voltage X-ray Irradiation Followed by As-Needed Ranibizumab Therapy for AMD: 6-Month Outcomes of a “Radiation-First” Strategy

Abstract: Low-voltage x-ray treatment followed by ranibizumab rescue demonstrates an independent visual acuity stabilizing effect for patients with wet AMD.

Cited by 16 publications

References 32 publications

Brachytherapy in Neovascular AMD

Brachytherapy in Neovascular AMD

Influence of eye size and beam entry angle on dose to non-targeted tissues of the eye during stereotactic x-ray radiosurgery of AMD

16 Gy low-voltage x-ray irradiation followed by as needed ranibizumab therapy for age-related macular degeneration: 12 month outcomes of a ‘radiation-first’ strategy

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