StereoTactic radiotherapy for wet Age-Related macular degeneration (STAR): Study protocol for a randomized controlled clinical trial

James E Neffendorf, Riti Desai, Yanzhong Wang, Joanna Kelly, Caroline Murphy, Barnaby Reeves, Usha Chakravarthy, S Wordsworth , Cornelius Lewis, Janet Peacock, Shahir Uddin, Joe O'Sullivan, Timothy L Jackson

Research output: Contribution to journalArticle (Academic Journal)peer-review

11 Citations (Scopus)
208 Downloads (Pure)


The standard of care for neovascular age-related macular degeneration (nAMD) involves ongoing intravitreal injections of anti-angiogenic drugs targeting vascular endothelial growth factor (VEGF). The most commonly used anti-VEGF drugs are ranibizumab, bevacizumab, and aflibercept. The main objective of the STAR trial is to determine if stereotactic radiotherapy can reduce the number of anti-VEGF injections that patients with nAMD require.

STAR is a multicentre, double-masked, randomised, sham-controlled clinical trial. It evaluates a new device (Oraya, Newark, California, USA) designed to deliver stereotactic radiotherapy (SRT) to nAMD lesions. The trial enrols participants with chronic, active, nAMD. Participants receive a single SRT treatment (16 Gray or sham) with a concomitant baseline intravitreal injection of 0.5 mg ranibizumab. Thereafter, they attend every month for 24 months and ranibizumab is administered at the visit if retreatment criteria are met. The primary outcome is the number of pro re nata ranibizumab injections during the first 24 months. Secondary outcomes include visual acuity, lesion morphology, quality of life and safety. Additional visits occur at 36 and 48 months to inspect for radiation retinopathy.
The target sample size of 411 participants (randomised 2:1 in favour of radiation) is designed to detect a reduction of 2.5 injections against ranibizumab monotherapy, at 90% power, and a significance level (alpha) of 0.025 (one-sided two-sample t-test). This gives 97% power to detect non-inferiority of visual acuity at a five letter margin. The primary analyses will be by intention-to-treat.

The safety and efficacy outcomes will help determine the role of SRT in the management of chronic, active nAMD.
Original languageEnglish
Article number560
Number of pages12
Publication statusPublished - 24 Nov 2016

Structured keywords

  • BTC (Bristol Trials Centre)
  • Centre for Surgical Research


  • Anti-vascular endothelial growth factor
  • VEGF
  • neovascular age-related macular degeneration
  • wet age-related macular degeneration
  • radiation
  • ranibizumab
  • STAR study
  • stereotactic radiotherapy

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