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A new Small-sized Ruthenium-106 Plaque in the Treatment of Retinoblastoma
1Schüler A., 1Jurklies C., 1Anastassiou G., 2Fluehs D., 2Sauerwein W., 3Bornfeld N.,
1Universität-Gesamthochschule Essen, Zentrum für Augenheilkunde (Essen)
2Universität-Gesamthochschule Essen, Strahlenklinik (Essen)
3Universität-Gesamthochschule Essen, Zentrum für Augenheilkunde, Abt. Hinterer Augenabschnitt (Essen)
Purpose: A new small sized ruthenium-106 plaque was introduced in the treatment of retinoblastoma. It was designed to reduce the volume of radiation-induced damages to the eye. This new ruthenium-plaque has a compared to the former smallest plaque types 20% reduced diameter of the irradiation zone (8 mm).
Methods: Brachytherapy with the new plaque was used in 13 tumours in 11 children with bilateral retinoblastoma between Jan. 2000 and Dec. 2001. Mean age was 1.4 ± 1.0 years. Local tumour recurrence after preceded treatment was the indication for brachytherapy in 10 cases. The retinoblastoma had a mean diameter of 2.9 ± 0.9 mm and a mean height of 1.5 ± 0.3 mm with a mean distance to the optic disc of 6.8 ± 2.5 disc diameter. The mean dose applied to the apex was 74.2 ± 7.8 GyE (intended: 70 GyE) with a sclera contact dose of 208 ± 32 GyE.
Results: Intraoperative course and wound healing after surgery was uneventful in all cases. The mean duration of irradiation was 33.8 ± 8.3 hours. The mean follow up after brachytherapy was 1.2 ± 0.6 years. All tumours showed a complete type 0 regression after 3.5 ± 2.1 months (range: 0.5 to 6.8 months). No tumour needed additional treatment. There were no irradiation related intra- or extraocular side effects after brachytherapy during the observation period.
Conclusions: Based on these preliminary results episcleral plaque radiotherapy with the new small sized 106-ruthenium plaque seems to be a save and reliable treatment option for small- to mid-sized retinoblastoma. Advantage of the new plaque-type is a smaller treatment related visual field defect.