Эффективность брахитерапии при ретинобластоме

Abstract

Purpose. To assess the tumor control and complications of ruthenium 106 (Ru-106) and strontium 90 (Sr-90) plaques radiotherapy for retinoblastoma. Material and methods. The study included 60 children with retinoblastoma who were treated in the Ocular Oncology and Radiology Service at the S. Fyodorov Eye Microsurgery Federal State Institution with plague radiotherapy between 2006 and 2015. The mean patient age at the plaque treatment was 22 months (from 5 to 74 months). Prior this treatment the management of the retinoblastoma was carried out in one hundred tumors (92% of cases) and included various combinations of treatments such as systemic and/or local chemotherapy, external beam radiotherapy, laser coagulation, thermotherapy and cryotherapy. Five retinoblastomas (8%) were managed by plaque radiotherapy without any previous treatment. The Ru-106 plaques were used in 68.5% of cases (72 tumor foci) and the Sr-90 plaques – in 31.5% of cases (33 tumors). The mean doses to the tumor apex were 89 Gy for Ru-106 and 190 Gy for Sr-90 plaques, and to the tumor base were 348 Gy for Ru-106 and 757 Gy for Sr-90 plaques. Results. A complete tumor control was achieved in 87% of cases during a mean follow-up of 3.5 months. The failures after the plaque radiotherapy in 11% of cases were controlled with the thermotherapy and in 6% of cases with the repeated plaque radiotherapy. Radiation complications included nonproliferative retinopathy in 19% of cases, proliferative retinopathy – 4%, papillopathy – 11%, retinal detachment – 2%, vitreous hemorrhage – 18%, cataract – 3%, glaucoma and scleral necrosis – 0%. The mean follow-up period was 27 months (from 2 to 72 months). Conclusion. Plaque radiotherapy should be considered as an important and effective option for retinoblastoma, especially in resistant and recurrent tumors after a failure of other methods to achieve the tumor control. Complications such as radiation retinopathy and papillopathy, vitreous hemorrhage and retinal detachment should be anticipated, depending on the location, size of the tumor and previous treatment.