Innovations in retinoblastoma treatment and reflection to enucleation rate of 362 eyes of 262 CASES: Twenty years retrospective assessment at Ankara University.

Abstract

e22509 Background: Enucleation used as the first-line tx option for RB, dx in advanced stages. Methods: To evaluate the enucleation rates of RB cases in 20 years period, to emphasize the recent developments in the tx of RB that contribute to the improvement of tx outcomes. Results: 262 patients, with the dx of RB between June 1998 &December 2018 in Ankara University Departmant of Pediatric Oncology were evaluated retrospectively. The M / F ratio was 1.2, mean age at dx 19.39 mos; 22.7 mos for unilateral &14.1 mos for bilateral dx. 61.8% of the patients had unilateral, 38.2% bilateral RB. 362 eyes were evaluated, 12.5% of the patients had a family history of RB bilateral dx was more frequent. The initial findings were leucocori in 58%& strabismus in 27.9%, similar to the literature. According to ICRB, 6% of the patients were diagnosed in Group A, 22% in Group B, 19% in Group C, 22% in Group D and 31% in Group E. Patients with bilateral dx were diagnosed at an earlier stage. Enucleation, in 50.5% of 362 eyes analyzed. There was no enucleated eye in Group A. In group B,10.1% of the eyes were enucleated, as of recurrence. 32.3% of eyes in Group C, 60.7% of eyes in Group D and 92.9% of eyes in Group E were enucleated. Enucleation was performed in 25.4% of the eyes within the first month after dx as of the advanced stage. 33.7% of of the eyes who did not have enucleation at the time of dx required enucleation at FU. The most common causes of enucleation were tumor recurrence, total retinal detachment & vitreous hemorrhage. The tx methods other than enucleation are systemic CT, RT & local treatments; cryotherapy, thermotherapy, episcleral brachytherapy, intravitreal CT & intraarterial CT. Systemic CT applied to 77% of the patients.CT protocol were VEC and ICE.RT was applied to 17% of the patients. After 2012, radiotherapy was used only in 2 patients with systemic involvement. Cryotherapy was performed in 48.3% of the eyes, thermotherapy in 38.6%, episcleral brachytherapy in 3.8% of the eyes included.Intraarterial CT to be used after 2004 was applied to 16.6% of eyes dx & intravitreal CT was used after 2009 was applied to13.2% of eyes. Enucleation was avoided in 84.6% of eyes in which these two tx modalities were applied together. Enucleation rates of 56.3% &61.2% between 1998-2004 and 2004-2009, respectively; with active use of intraarterial and intravitreal CT, decreased to 40.2% between 2009-2018. Conclusions: It was observed that enucleation rates &RT gradually decreased with using systemic CT and local treatment methods.