RADIATION THERAPY FOR OCULAR CHOROKDAL NEOVASCULARIZATION (PHASE I/II STUDY): PRELIMINARY REPORT

/Ob’ective: Choroidal neovascularization (CNV) is a major cause of severe loss of visual acuity in some Wh as age-rel &m&s. Laser has been used to treat patients the treatment method is usually treatment are very limited. Ret retinaI neovascular membranes of external photon beam radiotherapy in patients with CNV. : Between April, 1994 and July, 1995,36 patients with choroidaI neovascuiarkation (34 aqgioid streaks) were treated with radiation the using a CT simulator that enabIes real-time treabnent planning from m that h&nded the ma&a and optic disc received a dose of 10 Gy fractions/2 weeks (last 18 eyes). AU eyes were irradiated with degrees posteriorly to exclude the ipsilateral lens and the contrala lens was irradiated with less than 10% of the total reference dose. The &Id size averaged 3.0 X 2.5 cm. Records of the 17 eyes with CNV referred to our hospital in 1993, which satisikd the eligibility criteria for this study, were retrospectively anaIyzed for comparison. Results: There was no significant acute morbidity. AII patients werefollowed regularly by both andtion oncologists. Cataract formation after 1 year of the treatment was observed in received a dose of 20 Gy. One patient who had received 20 Gy comphdned of transhxlt dry-eye sensa&~ 2 months after treatment, but this had disappeared spontaneously by the fourth month. The subjective symp&oms, visual acuity, and size of the neovascuhu membrane were evaluated at 6 and 12 months after tre&mW haeacbp*t. In the group of patients irradiated with 10 Gy and with 20 Gy, respectively, subjective symptMgs improved in five and seven eyes, did not change in seven and four eyes, and deteriorated in six and six eyes at 12 mouths. Altbough visual acuity was sign&antIy decreased in the control group, tbe patients in both irra&W groups did not show such a decrease in visual acuity. The size of the neovascular membrane in the control group progressed signikntly. However, the patients in tbe 20 Gy group showed significant regression of the membrane, aIth~gh those in the 10 Gy group showed no sign&ant change in size. Conch&on: This Phase I/II study including a dose escalation study showed that radiation be us&I for CNV. The dose of 20 Gy in 10 fractions was more useful in treat&kg neovascular he dose of 10 Gy in five fractions. These results have encouraged us to start a multicenter randomized prospective study of the treatment of CNV with radiation therapy.