Can Salvage Radiotherapy Preserve Useful Vision in Bilateral Retinoblastoma?

August 20, 2009

Salvage external beam radiotherapy (EBRT) can preserve useful vision in patients with bilateral retinoblastoma after failed chemotherapy and focal treatments, researchers report in the British Journal of Ophthalmology.

In this retrospective case series, the researchers looked at rate of eye preservation, rate of tumor control, visual potential, visual acuity and radiation-induced side-effects after EBRT in 36 eyes. The media follow up period was 40 months. Thirty-two of the eyes received lens-sparing radiotherapy, and four received whole-eye radiation.

The rate of eye preservation was 83.3% with 66.7% of eyes requiring no further treatment. Of the 30 preserved eyes, 20 eyes (66.7%) had had extramacular tumors without retinal detachment and the potential for central vision. The radiation- induced side effects were limited to cataracts and dry eyes in these patients. There were no second cancer occurrences or deaths found.

The researchers note that using EBRT may be worthwhile because of the opportunity to preserve the eye and the small risk of second cancers.

In a second study in the same issue of BJO, researchers looked at 15 children who were treated with primary chemotherapy for group D heritable retinoblastoma to evaluate the ocular survival and event-free survival following primary multi-agent chemotherapy.

Of the 18 eyes studied, 11% were treated successfully with chemotherapy alone, 50% underwent successful salvage therapy and 39% of the eyes were enucleated. Ocular survival of these patients was 67%; however, event-free survival was only 34% at 2 years.

Multi-agent chemotherapy is generally not enough to save the eyes of patients with group D retinoblastoma, the authors note.

Read the abstracts/articles here and here as well as an related editorial here (log in/purchase may be required).




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