External radiotherapy in macular degeneration: Our technique, dosimetric calculation and preliminary subjective response

Radiotherapy for age-related macular degeneration: no more pilot studies please

“…A differential survival response might therefore be exploited with CNV destroyed through DNA breaks that normal tissues have time to repair before undergoing cell division. [11][12][13][14][15] Although radiation dose fractionation with multiple small treatments over many days is commonly used to reduce normal tissue complications in the treatment of malignancies, since CNV is not a true neoplasm, arguments have been made that there may be no therapeutic advantage to dose fractionation, 16 especially if the volume irradiated can be restricted to the region of macula (it is an axiom of radiotherapy that the probability of complications is proportional to the size of the target volume). In the journal this month, however, a radiotherapy trial is reported which shows no benefit in AMD.…”

“…18 Since then a multitude of small pilot studies using standard fractions of 2-3 Gy with a total dose of 10-20 Gy have been published, some showing better maintenance of visual acuity in treated eyes, [11][12][13][14]19 while others failed to show any benefit. 15,[20][21][22] Overall, prior to the study by Hoeller et al there have been 10 randomised control trials (RCT), 15,[23][24][25][26][27][28][29][30]30,31 three nonrandomised trials 15,21,32 and eight case series each with over 100 people in the study 22,[33][34][35][36][37][38][39] (see Table 1).…”