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Cobalt60 plaques in recurrent retinoblastoma
D Fass1, B McCormick, D Abramson
1Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, NY, NY 10021.
Summary
Cobalt60 plaque irradiation offers a viable treatment for retinoblastoma that has recurred after external beam irradiation (ERT). This method can save eyes when other treatments are not suitable, though newer techniques are being explored.
Area of Science:
- Ophthalmology
- Radiation Oncology
- Pediatric Oncology
Background:
- Retinoblastoma recurrence after external beam irradiation (ERT) presents a treatment challenge.
- Enucleation is often considered for recurrent retinoblastoma, but eye-sparing alternatives are sought.
- Cobalt60 (60Co) plaque irradiation has been used as an alternative to enucleation.
Purpose of the Study:
- To evaluate the efficacy and outcomes of Cobalt60 (60Co) plaque irradiation in patients with recurrent retinoblastoma.
- To assess the role of 60Co plaque irradiation as an alternative to enucleation in specific patient populations.
Main Methods:
- Retrospective review of 85 patients treated with 60Co plaques between 1968 and 1987.
- 72 patients had failed prior ERT; ages ranged from 1 week to 4 years.
- Tumor doses ranged from 30-50 Gy (median 40 Gy) over 3-8 days; follow-up ranged from 2-22 years.
Main Results:
- Cobalt60 plaque irradiation successfully salvaged eyes in many patients with recurrent retinoblastoma.
- Seven deaths from metastatic disease and 10 non-ocular second tumors were reported.
- Thirty patients ultimately required enucleation due to tumor progression or complications.
Conclusions:
- Cobalt60 (60Co) plaque irradiation can be an effective treatment for salvaging eyes in retinoblastoma patients who have failed external beam irradiation (ERT).
- While effective, complications and treatment failures necessitate ongoing research into alternative methods like Iodine-125 (I125) for improved ocular tissue sparing.