中华眼底病杂志

中华眼底病杂志

放射治疗在渗出型老年性黄斑变性中的应用及研究进展

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渗出型老年性黄斑变性(wAMD)以脉络膜新生血管(CNV)的进行性生长为主要特征。抗血管内皮生长因子(VEGF)药物在控制CNV的发展和改善视功能中已取得一定成果,但其仍存在频繁注射、容易耐药等不足。放射治疗(放疗)可使局部炎症细胞群失效,CNV在无周细胞覆盖下不稳定且无VEGF存在,血管内皮细胞被诱导凋亡。因此,放疗被认为是抗VEGF治疗的一类潜在辅助治疗手段。目前临床试验治疗wAMD主要运用黄斑前近距离放疗和远距离立体定向放疗(SRT)。其中,SRT或许可作为接受抗VEGF治疗患者的首选辅助治疗方式。了解放疗用于wAMD治疗的进展,可为wAMD的临床研究提供参考。

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

关键词: 湿性黄斑变性/治疗; 放射疗法; 血管生成抑制剂; 综述

Key words: Wet macular degeneration/therapy; Radiotherapy; Angiogenesis inhibitors; Review

引用本文: 周亦凡, 刘海芸, 孙晓东. 放射治疗在渗出型老年性黄斑变性中的应用及研究进展. 中华眼底病杂志, 2017, 33(6): 652-655. doi: 10.3760/cma.j.issn.1005-1015.2017.06.029 复制

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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.