Alpha-emitter Peptide Receptor Radionuclide Therapy in Neuroendocrine Tumors.

Peptide receptor radionuclide therapy (PRRT) has become mainstream therapy of metastatic neuroendocrine tumors not controlled by somatostatin analog therapy. Currently, beta particle-emitting radiopharmaceuticals are the mainstay of PRRT. Alpha particle-emitting radiopharmaceuticals have a theoretic advantage over beta emitters in terms of improved therapeutic efficacy due to higher cancer cell death and lower nontarget tissue radiation-induced adverse events due to shorter path length of alpha particles. We discuss the available evidence for and the role of alpha particle PRRT.

Scintillation Characteristics of the Single-Crystalline Film and Composite Film-Crystal Scintillators Based on the Ce3+-Doped (Lu,Gd)3(Ga,Al)5O12 Mixed Garnets under Alpha and Beta Particles, and Gamma Ray Excitations.

The crystals of (Lu,Gd)3(Ga,Al)5O12 multicomponent garnets with high density ρ and effective atomic number Zeff are characterized by high scintillation efficiency and a light yield value up to 50,000 ph/MeV. During recent years, single-crystalline films and composite film/crystal scintillators were developed on the basis of these multicomponent garnets. These film/crystal composites are potentially applicable for particle identification by pulse shape discrimination due to the fact that α-particles excite only the film response, γ-radiation excites only the substrate response, and ß-particles excite both to some extent. Here, we present new results regarding scintillating properties of selected (Lu,Gd)3(Ga,Al)5O12:Ce single-crystalline films under excitation by alpha and beta particles and gamma ray photons. We conclude that some of studied compositions are indeed suitable for testing in the proposed application, most notably Lu1.5Gd1.5Al3Ga2O12:Ce film on the GAGG:Ce substrate, exhibiting an α-particle-excited light yield of 1790-2720 ph/MeV and significantly different decay curves excited by α- and γ-radiation.

Radiopharmaceutical Treatments for Cancer Therapy, Radionuclides Characteristics, Applications, and Challenges.

Advances in the field of molecular biology have had an impact on biomedical applications, which provide greater hope for both imaging and therapeutics. Work has been intensified on the development of radionuclides and their application in radiopharmaceuticals (RPS) which will certainly influence and expand therapeutic approaches in the future treatment of patients. Alpha or beta particles and Auger electrons are used for therapy purposes, and each has advantages and disadvantages. The radionuclides labeled drug delivery system will deliver the particles to the specific targeting cell. Different radioligands can be chosen to uniquely target molecular receptors or intracellular components, making them suitable for personal patient-tailored therapy in modern cancer therapy management. Advances in nanotechnology have enabled nanoparticle drug delivery systems that can allow for specific multivalent attachment of targeted molecules of antibodies, peptides, or ligands to the surface of nanoparticles for therapy and imaging purposes. This review presents fundamental radionuclide properties with particular reference to tumor biology and receptor characteristic of radiopharmaceutical targeted therapy development.

Data on estimations of relative dose rates along central axis of symmetric and asymmetric 106 Ru/ 106 Rh applicators used in eye brachytherapy.

Beta particles radiation doses have important applications in medicine. In particular, curved and symmetric as well as curved and asymmetric applicators containing the beta emitting 106 Ru/ 106 Rh isotopes are widely used in radiotherapy for the treatment of various ocular diseases. Nevertheless, a great problem in the use of these applicators is the inaccurate determination of the dose rates around them. Difficulties arise mainly because of the very short distances involved, and in this scenario theoretical calculation methods play an important role. In this work a simple approach based on the beta-point dose function integration over the total surface of each plaque was used to estimate the dose rates along their central axis. Results of relative dose rates for concave and symmetric (CCA, CCB, CXS, CCX/Y/Z, CCD, CGD and CCC) and concave and asymmetric (CIA, CIB/CIB-2, COB and COC) ruthenium/rhodium plaque types are shown.

Comparison of light outputs, decay times, and imaging performance of a ZnS(Ag) scintillator for alpha particles, beta particles, and gamma photons.

ZnS(Ag) is a scintillator mainly used for alpha particle detection because of the high light output for alpha particles. However, the light output and decay times of ZnS(Ag) for beta particles or gamma photons are not obvious. We therefore measured and compared the light outputs and decay times of ZnS(Ag) for beta particles or gamma photons with that for alpha particles. We measured the pulse height distribution and decay times of ZnS(Ag) for Am-241 alpha particles (5.5 MeV), St-Y-90 beta particles (2.28-MeV maximum energy), and Cs-137 gamma photons (0.66 MeV). The relative light output/MeV for the beta particles and gamma photons was ~2%-~5% of that for alpha particles. Decay time for the beta particles and gamma photons was 2.7 ns-2.8 ns, while that for alpha particles was 61 ns. With the different decay times, pulse shape discrimination of the alpha and beta particles was possible for the ZnS(Ag) radiation-imaging detector. We confirmed that ZnS(Ag) is a suitable scintillator for the detection of alpha particles using energy discrimination as well as pulse shape discrimination.

Optical fiber-based ZnS(Ag) detector for selectively detecting alpha particles.

In alpha radionuclide therapy, an optical fiber-based alpha particle detector is a new tool that could possibly be employed for the direct detection of alpha particles in subjects. Thus, in the present study, we developed an optical fiber-based alpha particle detector. The alpha particle detector was made of a 1mm diameter, 10 cm long plastic double clad optical fiber drilled a 0.7 mm diameter, 2 mm depth open space at the one end of the fiber. Silver-doped zinc sulfide (ZnS (Ag)) was painted inside this open space to form a ZnS(Ag) small scintillation chamber. To conduct performance comparisons, we also developed a fiber detector using the same fiber in which a Ce-doped Lu1.8Y0·2SiO5 (LYSO(Ce)) scintillator with dimensions of 0.32 mm × 0.5 mm × 5 mm was inserted. Both fiber detectors were wrapped in aluminized Mylar and optically coupled to a position sensitive photomultiplier tube, before calculating the two-dimensional distributions, energy, and pulse shape spectra. For 5.5-MeV alpha particles, the ZnS(Ag) fiber detector produced ~ 5 times larger pulse heights and the count rate was ~2 times higher compared with those using the LYSO(Ce) fiber detector. For the maximum energy 2.28-MeV beta particles and 0.66-MeV gamma photons, the ZnS(Ag) fiber detector produced no counts, but it yielded small counts from natural alpha particles. Our results confirmed that the ZnS(Ag) fiber detector developed in this study could selectively detect alpha particles and it was insensitive to beta particles and gamma photons.

Radioimmunotherapy of Pancreatic Ductal Adenocarcinoma: A Review of the Current Status of Literature.

Pancreatic ductal adenocarcinoma (PDAC) has long been associated with low survival rates. A lack of accurate diagnostic tests and limited treatment options contribute to the poor prognosis of PDAC. Radioimmunotherapy using α- or ß-emitting radionuclides has been identified as a potential treatment for PDAC. By harnessing the cytotoxicity of α or ß particles, radioimmunotherapy may overcome the anatomic and physiological factors which traditionally make PDAC resistant to most conventional treatments. Appropriate selection of target receptors and the development of selective and cytotoxic radioimmunoconjugates are needed to achieve the desired results of radioimmunotherapy. The aim of this review is to examine the growing preclinical and clinical trial evidence regarding the application of α and ß radioimmunotherapy for the treatment of PDAC. A systematic search of MEDLINE® and Scopus databases was performed to identify 34 relevant studies conducted on α or ß radioimmunotherapy of PDAC. Preclinical results demonstrated α and ß radioimmunotherapy provided effective tumour control. Clinical studies were limited to investigating ß radioimmunotherapy only. Phase I and II trials observed disease control rates of 11.2%-57.9%, with synergistic effects noted for combination therapies. Further developments and optimisation of treatment regimens are needed to improve the clinical relevance of α and ß radioimmunotherapy in PDAC.

Estimates of relative beta radiation doses on central and lateral axes of ruthenium/rhodium COB-type plaque used in eye brachytherapy.

The 106Ru/106Rh COB-type plaque has a cut-out section that makes it suitable to be used in eye brachytherapy to treat tumours close to the optical nerve. Nevertheless, this asymmetry makes measurements and calculations of dose rates around this kind of beta applicator more difficult to perform. In this work we present a analytical and numerical method to evaluate the relative dose rates along the central axis of the COB-type plaque and a comparison is made with a result found in literature obtained by means of Monte Carlo simulation.

A multiwell applicator for conformal brachytherapy of superficial skin tumors: A simulation study.

BACKGROUND: Brachytherapy of thin skin tumors using beta particles can protect underlying sensitive structures such as the bone because of the rapid dose falloff of this type of radiation in tissue. The current work describes a skin brachytherapy applicator, based on beta radiation, that can provide the needed cell-killing radiation dose matched to the shape of individual skin tumors. MATERIALS AND METHODS: The applicator and its template were fabricated using 3D printing technology. Any clinically approved beta-emitting isotope in the form of a radioactive gel could theoretically be used in this applicator. Monte Carlo simulations were employed to study the capability of the applicator in conforming dose distribution based on the shape of the tumor. Dose profile in the shallow depth, transverse dose profiles at different depths, and the percent depth dose from this applicator were calculated. The radioisotope of choice for our calculations was Yttrium-90 (Y-90). RESULTS: Using the proposed applicator, it is possible to create a desired dose profile matching the tumor surface shape. CONCLUSION: The short-range of the beta radiation, together with the dose conforming capability of the applicator, may lead to minimal interactions with the healthy tissue around the skin lesion.

Superficial skin cancer therapy with Y-90 microspheres: A feasibility study on patch preparation.

BACKGROUND: Radiation therapy using beta particles is an interesting treatment for very superficial skin lesions. Due to their low penetration in tissue and rapid dose fall-off, beta particles can protect underlying bony structures and surrounding healthy tissue while irradiating the skin tumor. In the current work, a simple method for the fabrication of a radioactive patch for use in skin cancer therapy based on a beta-emitting isotope is presented. MATERIALS AND METHODS: The beta radiation sources were Y-90 microspheres currently used for catheter-based radioembolization of unresectable liver tumors. The microspheres were filtered through a syringe filter to trap them on the cellulose nitrate paper of the filter and create a radioactive patch. In the current study, to avoid the need for a hot laboratory, the experiment was done using nonradioactive microspheres. An optical microscope was used to verify the distribution of the particles on the filter paper. RESULTS: Visual evaluation of the patches showed that using the proposed method, therapeutic skin patches with a fairly uniform distribution of microspheres can be created. CONCLUSION: The proposed simple method may be used in creating radiotherapeutic patches using Y-90 microspheres for radiation therapy of thin skin lesions located close to sensitive structures.

Radiation therapy techniques in the treatment of skin cancer: an overview of the current status and outlook.

Nonmelanoma skin cancer (NMSC) is a major health concern due to its high incidence rate, its negative impact on the quality of life of patients as well as the associated economic burden to the healthcare system. Surgery is currently the primary treatment offered for skin cancer patients but not applicable or available in all cases. Radiation therapy (RT), with its long successful history in the management of cancer, has shown to be an effective alternative or complementary method in cutaneous oncology. Specifically, for dermatology applications, RT is very often the preferred option due to its favorable cosmetic results, besides the excellent control rate of the tumor. During the last 120 years since the introduction of treatments based on ionizing radiation, several techniques in this area have been developed. Radionuclide brachytherapy, electronic brachytherapy, X-ray therapies with kilovolt (kV) to megavolt (MV) photons and electron beam therapy are the established methods that are currently used on skin cancer patients. The purpose of this article is to overview these techniques and discuss the pros and cons of these methods in dermatology practices. Additionally, a new approach of beta RT of superficial skin tumors is discussed, which may offer exciting features in the management of NMSC.

Technical Note: Scintillation well counters and particle counting digital autoradiography devices can be used to detect activities associated with genomic profiling adequacy of biopsy specimens obtained after a low activity 18 F-FDG injection.

PURPOSE: Genomic profiling of biopsied tissue is the basis for precision cancer therapy. However, biopsied materials may not contain sufficient amounts of tumor deoxyribonucleonic acid needed for the analysis. We propose a method to determine the adequacy of specimens for performing genomic profiling by quantifying their metabolic activity. METHODS: We estimated the average density of tumor cells in biopsy specimens needed to successfully perform genomic analysis following the Memorial Sloan Kettering Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) protocol from the minimum amount of deoxyribonucleonic acid needed and the volume of tissue typically used for analysis. The average 18 F-FDG uptake per cell was assessed by incubating HT-29 adenocarcinoma tumor cells in 18 F-FDG containing solution and then measuring their activity with a scintillation well counter. Consequently, we evaluated the response of two devices around the minimum expected activities which would indicate genomic profiling adequacy of biopsy specimens obtained under 18 F-FDG PET/CT guidance. Surrogate samples obtained using 18G core needle biopsies of gels containing either 18 F-FDG-loaded cells in the expected concentrations or the corresponding activity were measured using autoradiography and a scintillation well counter. Autoradiography was performed using a CCD-based device with real-time image display as well as with digital autoradiography imaging plates following a 30-min off-line protocol for specimen activity determination against previously established calibration. RESULTS: Cell incubation experiments and estimates obtained from quantitative autoradiography of biopsy specimens (QABS) indicate that specimens acquired under 18 F-FDG PET/CT guidance that contained the minimum amount of cells needed for genomic profiling would have an average activity concentration in the range of about 3 to about 9 kBq/mL. When exposed to specimens with similar activity concentration, both a CCD-based autoradiography device and a scintillation well counter produced signals with sufficient signal-to-background ratio for specimen genomic adequacy identification in less than 10 min, which is short enough to allow procedure guidance. CONCLUSION: Scintillation well counter measurements and CCD-based autoradiography have adequate sensitivity to detect the tumor burden needed for genomic profiling during 18 F-FDG PET/CT-guided 18G core needle biopsies of liver adenocarcinoma metastases.

Thick target total bremsstrahlung spectra of lead compounds in the photon energy region 1-10keV by 90Sr beta particles.

Total bremsstrahlung spectral photon distribution generated in thick targets of lead compounds Pb(CH3COO)2·3H2O, Pb(NO3)2 and PbCl2 by 90Sr beta particles has been investigated theoretically and experimentally in the photon energy region 1-10keV. The experimental results are compared with the theoretical models describing ordinary bremsstrahlung and the theoretical model which includes polarization bremsstrahlung into ordinary bremsstrahlung, in stripped approximation. It is observed that the experimental results show better agreement with the model which describes bremsstrahlung in stripped approximation in the energy range 3-10keV. However, the results show positive deviation in the photon energy region of 1-3keV. Further, it has been found that there is a continuous decrease of polarization bremsstrahlung contribution into ordinary bremsstrahlung in the formation of total bremsstrahlung spectra with increase in photon energy. The suppression of polarization bremsstrahlung has been observed due to the presence of large fraction of low Z elements in the compounds. The results clearly indicate that polarization bremsstrahlung plays an important role in the formation of total bremsstrahlung spectra in compounds in the studied energy region.

Radionuclides in radiation-induced bystander effect; may it share in radionuclide therapy?

For many years in radiobiology and radiotherapy predominated the conviction that cellular DNA is the main target for ionizing radiation, however, the view has changed in the past 20 years. Nowadays, it is assumed that not only directed (targeted) radiation effect, but also an indirect (non-targeted) effect may contribute to the result of radiation treatment. Non-targeted effect is relatively well recognized after external beam irradiation in vitro and in vivo, and comprises such phenomena like radiation-induced bystander effect (RIBE), genomic instability, adaptive response and abscopal (out of field) effect. These stress-induced and molecular signaling mediated phenomena appear in non-targeted cells as variety responses resembling that observed in directly hit cells. Bystander effects can be both detrimental and beneficial in dependence on dose, dose-rate, cell type, genetic status and experimental condition. Less is known about radionuclide-induced non-targeted effects in radionuclide therapy, although, based on characteristics of the radionuclide radiation, on experiments in vitro utilizing classical and 3-D cell cultures, and preclinical study on animals it seems obvious that exposure to radionuclide is accompanied by various bystander effects, mostly damaging, less often protective. This review summarizes existing data on radionuclide induced bystander effects comprising radionuclides emitting beta- and alpha-particles and Auger electrons used in tumor radiotherapy and diagnostics. So far, separation of the direct effect of radionuclide decay from crossfire and bystander effects in clinical targeted radionuclide therapy is impossible because of the lack of methods to assess whether, and to what extent bystander effect is involved in human organism. Considerations on this topic are also included.

Palliative treatment of metastatic bone pain with radiopharmaceuticals: A perspective beyond Strontium-89 and Samarium-153.

PURPOSE: The present review article aims to provide an overview of the available radionuclides for palliative treatment of bone metastases beyond (89)Sr and (153)Sm. In addition, it aims to review and summarize the clinical outcomes associated with the palliative treatment of bone metastases using different radiopharmaceuticals. MATERIALS AND METHODS: A literature search was conducted on Science Direct and PubMed databases (1990 - 2015). The following search terms were combined in order to obtain relevant results: "bone", "metastases", "palliative", "care", "therapy", "treatment", "radiotherapy", "review", "radiopharmaceutical", "phosphorus-32", "strontium-89", "yttrium-90", "tin-117m", "samarium-153", "holmium-166", "thulium-170", "lutetium-177", "rhenium-186", "rhenium-188" and "radium-223". Studies were included if they provided information regarding the clinical outcomes. RESULTS AND CONCLUSIONS: A comparative analysis of the measured therapeutic response of different radiopharmaceuticals, based on previously published data, suggests that there is a lack of substantial differences in palliative efficacy among radiopharmaceuticals. However, when the comparative analysis adds factors such as patient's life expectancy, radionuclides' physical characteristics (e.g. tissue penetration range and half-life) and health economics to guide the rational selection of a radiopharmaceutical for palliative treatment of bone metastases, (177)Lu and (188)Re-labeled radiopharmaceuticals appear to be the most suitable radiopharmaceuticals for treatment of small and medium/large size bone lesions, respectively.

Radiosensitivity of Prostate Cancer Cell Lines for Irradiation from Beta Particle-emitting Radionuclide ¹77Lu Compared to Alpha Particles and Gamma Rays.

AIM: The purpose of the present study was to investigate the radiosensitivity of the prostate cancer cell lines LNCaP, DU145, and PC3 when irradiated with beta particles emitted from (177)Lu, and to compare the effect with irradiation using alpha particles or gamma rays. MATERIALS AND METHODS: Cells were irradiated with beta particles emitted from (177)Lu, alpha particles from (241)Am, or gamma rays from (137)Cs. A non-specific polyclonal antibody was labeled with (177)Lu and used to irradiate cells in suspension with beta particles. A previously described in-house developed alpha-particle irradiator based on a (241)Am source was used to irradiate cells with alpha particles. External gamma-ray irradiation was achieved using a standard (137)Cs irradiator. Cells were irradiated to absorbed doses equal to 0, 0.5, 1, 2, 4, 6, 8, or 10 Gy. The absorbed doses were calculated as mean absorbed doses. For evaluation of cell survival, the tetrazolium-based WST-1 assay was used. After irradiation, WST-1 was added to the cell solutions, incubated, and then measured for level of absorbance at 450 nm, indicating the live and viable cells. RESULTS: LNCaP, DU145, and PC3 cell lines all had similar patterns of survival for the different radiation types. No significant difference in surviving fractions were observed between cells treated with beta-particle and gamma-ray irradiation, represented for example by the surviving fraction values (mean±SD) at 2, 6, and 10 Gy (SF2, SF6, and SF10) for DU145 after beta-particle irradiation: 0.700±0.090, 0.186±0.050 and 0.056±0.010, respectively. A strong radiosensitivity to alpha particles was observed, with SF2 values of 0.048±0.008, 0.018±0.006 and 0.015±0.005 for LNCaP, DU145, and PC3, respectively. CONCLUSION: The surviving fractions after irradiation using beta particles or gamma rays did not differ significantly at the absorbed dose levels and dose rates used. Irradiation using alpha particles led to a high level of cell killing. The results show that the beta-particle emitter (177)Lu as well as alpha-particles are both good candidates for radionuclide-therapy applications in the treatment of prostate cancer.

Computational modeling of cellular effects post-irradiation with low- and high-let particles and different absorbed doses.

The use of computational methods to improve the understanding of biological responses to various types of radiation is an approach where multiple parameters can be modelled and a variety of data is generated. This study compares cellular effects modelled for low absorbed doses against high absorbed doses. The authors hypothesized that low and high absorbed doses would contribute to cell killing via different mechanisms, potentially impacting on targeted tumour radiotherapy outcomes. Cellular kinetics following irradiation with selective low- and high-linear energy transfer (LET) particles were investigated using the Virtual Cell (VC) radiobiology algorithm. Two different cell types were assessed using the VC radiobiology algorithm: human fibroblasts and human crypt cells. The results showed that at lower doses (0.01 to 0.2 Gy), all radiation sources used were equally able to induce cell death (p>0.05, ANOVA). On the other hand, at higher doses (1.0 to 8.0 Gy), the radiation response was LET and dose dependent (p<0.05, ANOVA). The data obtained suggests that the computational methods used might provide some insight into the cellular effects following irradiation. The results also suggest that it may be necessary to re-evaluate cellular radiation-induced effects, particularly at low doses that could affect therapeutic effectiveness.

Response of ionization chamber based pocket dosimeter to beta radiation.

Quantitative estimate of the response of ionization chamber based pocket dosimeters (DRDs) to various beta sources was performed. It has been established that the ionization chamber based pocket dosimeters do not respond to beta particles having energy (Emax)<1 MeV and same was verified using (147)Pm, (85)Kr and (204)Tl beta sources. However, for beta particles having energy >1 MeV, the DRDs exhibit measureable response and the values are ~8%, ~14% and ~27% per mSv for natural uranium, (90)Sr/(90)Y and (106)Ru/(106)Rh beta sources respectively. As the energy of the beta particles increases, the response also increases. The response of DRDs to beta particles having energy>1 MeV arises due to the fact that the thickness of the chamber walls is less than the maximum range of beta particles. This may also be one of the reasons for disparity between doses measured with passive/legal dosimeters (TLDs) and DRDs in those situations in which radiation workers are exposed to mixed field of gamma photons and beta particles especially at uranium processing plants, nuclear (power and research) reactors, waste management facilities and fuel reprocessing plants etc. The paper provides the reason (technical) for disparity between the doses recorded by TLDs and DRDs in mixed field of photons and beta particles.

Evaluation and comparison of human absorbed dose of (90)Y-DOTA-Cetuximab in various age groups based on distribution data in rats.

The organ radiation-absorbed doses have been evaluated for humans in six age groups and both genders based on animal data. After intravenous administration of (90)Y-DOTA-Cetuximab to five groups of rats, they were sacrificed at exact time intervals (2, 24, 48, 72, and 96 h) and the percentage of injected dose per gram of each organ was calculated by direct counting from rat data. By using the formulation that Medical Internal Radiation Dose suggests, radiation-absorbed doses for all organs were calculated and extrapolated from rat to human. The total body absorbed dose for all groups was >22 mGy due to pure ß-emission of the applied radiopharmaceutical. The effective dose resulting from an intravenously injected activity of 100 MBq is 56.7 mSv for a 60-kg female adult and 60.3 mSv for a 73-kg male adult. The results demonstrated the usefulness of this method for estimation of ß-absorbed dose in humans.

Meta-analysis of beta radiation augmentation for trabeculectomy - results in distinct ethnic groups / Meta-análise da trabeculectomia potencializada pela radiação beta - resultados em grupos étnicos distintos

PURPOSE: To conduct a systematic review with meta-analysis on the efficacy of trabeculectomy (TREC) followed by beta irradiation (BRT/TREC) compared to TREC alone for glaucoma in terms of intraocular pressure (IOP) control and adverse effects of treatment in different ethnic groups. METHODS: A meta-analysis of randomized controlled trials (RCT) was performed comparing adjunct BRT treatment for glaucoma with standard TREC after 12 months. The MEDLINE, EMBASE, LILACS, and Cochrane Library databases, Trial registers, bibliographic databases and recent studies of relevant journals were searched. Two reviewers independently reviewed relevant reports and the references from these reports were searched for additional trials, using guidelines set by QUOROM statement criteria. RESULTS: Of a total of 1,350 citations, eight studies (five cohorts, three randomized) were identified and only 3 RCT were included in this meta-analysis. Higher IOP reductions were verified in the BRT arm compared to the control arm (mean difference=1.68 mmHg, 95 percent CI= 0.61-2.68, P=0.002). Uncontrolled postoperative IOP (>21 mmHg) was less frequent when BRT was used (BRT/ TREC arm) compared to the control arm (38/218=17.4 percent versus 9/239=3.8 percent; OR=6.7; 95 percent CI 3.2-14.3, P<0.0001). Although better IOP control was observed in all patients treated with adjuvant BRT, only Black patients displayed a significant difference (P=0.005). There were no significant differences between the BRT and control arms regarding loss of visual acuity, postoperative complications and necessity of cataract surgery. CONCLUSION: Adjunct BRT increases the success rate of TREC, with better results in non Caucasian patients, and does not influence the occurrence of postoperative complications.

OBJETIVO: Realizar uma revisão sistemática com meta-análise sobre a eficácia da trabeculectomia (TREC), seguida ou não por irradiação beta (BRT/TREC) para o tratamento do glaucoma, em termos de controle da pressão intraocular (PIO) e de efeitos adversos, em diferentes grupos étnicos. MÉTODOS: Uma meta-análise de ensaios clínicos randomizados (RCT) foi realizada, comparando os resultados de 12 meses da TREC com o uso adjuvante de BRT, com aqueles da TREC padrão. Foram fontes de pesquisa as bases de dados MEDLINE, EMBASE, LILACS, Cochrane, além de sítios de registro de ensaios clínicos, estudos recentes em revistas da área e outras bases de dados bibliográficos. Dois revisores avaliaram independentemente publicações relevantes e as referências desses trabalhos foram pesquisadas para procura de ensaios adicionais, de acordo com as diretrizes estabelecidas pelos critérios do QUOROM. RESULTADOS: De um total de 1.350 citações, oito estudos (cinco coortes e três aleatorizados) foram identificados e apenas 3 RCT foram incluídos nesta meta-análise. Maiores reduções na PIO foram verificadas no braço de estudo da BRT, comparado com o braço controle (diferença média=1,68 mmHg, 95 por cento CI= 0,61-2,68, P=0,002). A frequência de PIO pós-operatória não controlada (>21 mmHg) foi menor quando utilizada a BRT (BRT/TREC) em relação ao grupo controle (38/218 =17,4 por cento versus 9/239 =3,8 por cento; OR= 6,7 IC 95 por cento 3,2 14,3, P<0,0001). Apesar do melhor controle da PIO ter sido observada em todos os pacientes do braço BRT, apenas os pacientes negros apresentaram uma diferença significativa (P=0,005). Não houve diferenças significativas entre os braços BRT e controle, em termos de perda da acuidade visual, complicações pós-operatórias e necessidade de cirurgia de catarata. CONCLUSÃO: O uso de BRT adjuvante aumenta a taxa de sucesso da TREC, com melhores resultados em pacientes não-caucasianos, não influenciando a ocorrência de complicações pós-operatórias.