Chemoreduction for unilateral retinoblastoma

Area of Science:

• Ophthalmology
• Pediatric Oncology
• Cancer Treatment

Background:

• Unilateral retinoblastoma often necessitates enucleation or external beam radiotherapy.
• Conservative management aims to preserve the affected eye and vision.

Purpose of the Study:

• To evaluate the efficacy of chemoreduction combined with focal treatment for unilateral retinoblastoma.
• To determine the need for enucleation or external beam radiotherapy after conservative treatment.
• To assess factors influencing treatment outcomes and final visual acuity.

Main Methods:

• Prospective, nonrandomized, single-center clinical trial involving 30 patients with unilateral retinoblastoma.
• Treatment included 6 cycles of chemoreduction (vincristine sulfate, etoposide, carboplatin) and focal therapy (cryotherapy or thermotherapy).
• Outcomes measured included the need for enucleation or external beam radiotherapy, and final visual acuity, analyzed using Kaplan-Meier survival analysis and regression models.

Main Results:

• 68% of eyes required external beam radiotherapy or enucleation by 5 years.
• Eyes with advanced Reese-Ellsworth (RE) group V retinoblastoma had significantly higher rates of radiotherapy (50%) and enucleation (67%) compared to groups I-IV (38% radiotherapy, 29% enucleation).
• Predictive factors for radiotherapy included RE group V, tumor thickness >5mm, and vitreous seeds; for enucleation: age >12 months, RE group V, tumor base diameter >15mm, and thickness >5mm.

Conclusions:

• Chemoreduction with focal treatment is a feasible option for selected cases of unilateral retinoblastoma.
• Success is dependent on disease stage, with less advanced retinoblastoma (RE groups I-IV) achieving globe salvage in 71% of cases, sometimes with functional vision.
• Advanced RE group V retinoblastoma demonstrated poorer outcomes, highlighting the importance of early diagnosis and tailored treatment strategies.