Abstract
To explore the clinical efficacy and prognostic factors of chemoreduction combined with topical treatment of advanced intraocular retinoblastoma (RB). A total of 22 eyes from 17 children with RB were selected for the study and treated with chemoreduction combined with topical cryotherapy, transpupillary thermotherapy (TTT) or episcleral plaque brachytherapy. Clinical and follow-up data were retrospectively analyzed. All children received 2~6 courses of chemoreduction treatment, (4.5±0.8 courses on average); 17 eyes from 13 children were treated by chemoreduction combined with cryotherapy or TTT and 5 eyes from 4 children with chemoreduction combined with 125I episcleral plaque brachytherapy. The eye retention rate was 81.8% (18/22), among which 38.9% (7/18) featured restored or maintained good vision. Postoperative follow-up period was 7 to 34 months, (18.6 ± 5.2 months on average). The recurrence rate was 41.2% (7/17), among which 57.1% (4/7) were controlled by supplementing or appending cryotherapy or TTT treatment during the follow-up period. The tumor basal diameter and thickness were significantly reduced (P<0.05 or P<0.01) after treatment. All children demonstrated different degrees of hair loss, 70.6% (12/17) with different degrees of gastrointestinal reactions, 5.88% (1/17) with neutropenia and 11.8% (2/17) being seriously infected during the chemotherapeutic treatment. Univariate and logistic regression analysis showed that tumor basal diameter before treatment had a significant effect on the prognosis (P<0.01). Chemoreduction combined with topical therapy can effectively control RB in the short term, and tumor basal diameter before treatment is an independent risk factor for prognosis.
Highlights
Retinoblastoma (RB) is a kind of embryonic malignant tumor originated from the primitive stem cells in nuclear layer of the retina, the most common intraocular malignant tumor in infants, and a serious harm to children’s vision and lives (Shields et al, 2010)
Materials and Methods: A total of 22 eyes from 17 children with RB were selected for the study and treated with chemoreduction combined with topical cryotherapy, transpupillary thermotherapy (TTT) or episcleral plaque brachytherapy
All children received 2~6 courses of chemoreduction treatment, (4.5±0.8 courses on average); 17 eyes from 13 children were treated by chemoreduction combined with cryotherapy or TTT and 5 eyes from 4 children with chemoreduction combined with 125I episcleral plaque brachytherapy
Summary
Retinoblastoma (RB) is a kind of embryonic malignant tumor originated from the primitive stem cells in nuclear layer of the retina, the most common intraocular malignant tumor in infants, and a serious harm to children’s vision and lives (Shields et al, 2010). The primary goal of treating RB is to save children’s lives, followed by preservation of eyeballs, and the consideration of useful vision. The common treatments include ophthalmectomy, evisceration, external beam radiation therapy, chemoreduction, transpupillary thermotherapy (TTT), cryotherapy, laser photocoagulation, episcleral plaque brachytherapy (Peterson et al, 2011). Some developed countries gradually use chemotherapy as the first-line therapy instead of traditional therapeutic regimens to avoid the trauma and pain caused by traditional therapeutic regimens, which greatly improves the OS rate and QOL of children. Children with advanced intraocular RB were treated by chemoreduction combined with topical treatment, and the clinical follow-up data was retrospectively analyzed as follows
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