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Meta-Analysis
. 2010 May 12;2010(5):CD004004.
doi: 10.1002/14651858.CD004004.pub3.

Radiotherapy for neovascular age-related macular degeneration

Jennifer R Evans  1 , Vasuki Sivagnanavel, Victor Chong
Affiliations
Meta-Analysis

Radiotherapy for neovascular age-related macular degeneration

Jennifer R Evans et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Radiotherapy has been proposed as a treatment to prevent new vessel growth in people with neovascular age-related macular degeneration (AMD).

Objectives: The aim of this review was to examine the effects of radiotherapy on neovascular AMD.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library Issue 3, 2010, MEDLINE (January 1950 to March 2010), EMBASE (January 1980 to March 2010), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to March 2010), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (March 2010) and ClinicalTrials.gov (http://clinicaltrials.gov) (March 2010). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 23 March 2010. We also wrote to investigators of trials included in the review to ask if they were aware of any other studies.

Selection criteria: We included all randomised controlled trials in which radiotherapy was compared to another treatment, sham treatment, low dosage irradiation or no treatment in people with choroidal neovascularisation secondary to AMD.

Data collection and analysis: Two review authors independently extracted the data. We combined relative risks using a random-effects model. We estimated the percentage of the variability in effect estimates that was due to heterogeneity, rather than sampling error, using I(2).

Main results: Thirteen trials (n=1154) investigated external beam radiotherapy with dosages ranging from 7.5 to 24 Gy; one additional trial (n=88) used plaque brachytherapy (15Gy at 1.75mm for 54 minutes/12.6 Gy at 4mm for 11 minutes). Most studies found effects (not always significant) that favoured treatment. Overall there was a small statistically significant reduction in risk of visual acuity loss in the treatment group. There was considerable inconsistency between trials and the trials were considered to be at risk of bias, in particular because of the lack of masking of treatment group. Subgroup analyses did not reveal any significant interactions, however, there were small numbers of trials in each subgroup (range three to five). There was some indication that trials with no sham irradiation in the control group reported a greater effect of treatment. The incidence of adverse events was low in all trials; there were no reported cases of radiation retinopathy, optic neuropathy or malignancy. Three trials found non-significant higher rates of cataract progression in the treatment group.

Authors' conclusions: This review currently does not provide convincing evidence that radiotherapy is an effective treatment for neovascular AMD. If further trials are to be considered to evaluate radiotherapy in AMD then adequate masking of the control group must be considered.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 RADIATION THERAPY VERSUS CONTROL, Outcome 1 Three or more lines visual acuity lost at 6 months.
1.2
1.2. Analysis
Comparison 1 RADIATION THERAPY VERSUS CONTROL, Outcome 2 Three or more lines visual acuity lost at 12 months.
1.3
1.3. Analysis
Comparison 1 RADIATION THERAPY VERSUS CONTROL, Outcome 3 Three or more lines visual acuity lost at 24 months.
1.4
1.4. Analysis
Comparison 1 RADIATION THERAPY VERSUS CONTROL, Outcome 4 Six or more lines visual acuity lost at 6 months.
1.5
1.5. Analysis
Comparison 1 RADIATION THERAPY VERSUS CONTROL, Outcome 5 Six or more lines visual acuity lost at 12 months.
1.6
1.6. Analysis
Comparison 1 RADIATION THERAPY VERSUS CONTROL, Outcome 6 Six or more lines visual acuity lost at 24 months.
1.7
1.7. Analysis
Comparison 1 RADIATION THERAPY VERSUS CONTROL, Outcome 7 Mean and change in visual acuity at 12 months.
1.8
1.8. Analysis
Comparison 1 RADIATION THERAPY VERSUS CONTROL, Outcome 8 Investigating heterogeneity: type of CNV.
1.9
1.9. Analysis
Comparison 1 RADIATION THERAPY VERSUS CONTROL, Outcome 9 Investigating heterogeneity: dosage.
1.10
1.10. Analysis
Comparison 1 RADIATION THERAPY VERSUS CONTROL, Outcome 10 Investigating heterogeneity: sham irradiation in control group.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

AMDLRTSG 2003 {published data only}
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Eter 2002 {published data only}
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Jaakkola 2005 {published data only}
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Kobayashi 2000 {published data only}
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Marcus 2001 {published data only}
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SFRADS 2002 {published data only}
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Valmaggia 2002 {published data only}
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References to studies excluded from this review

Avila 2009 {published data only}
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Churei 2004 {published data only}
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Eter 2001 {published data only}
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Honjo 1997 {published data only}
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Mandai 1998 {published data only}
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Tholen 2000 {published data only}
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Zambarakji 2006 {published data only}
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References to other published versions of this review

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MeSH terms