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The new Therapeutic Approach for Retinoblastoma: Indications, Technique and Results in a Serie of 239 Patients
Desjardins L., Lumbroso L., Levy C., Doz F., Dendale R., Vedrenne J., Bours D., Zucker J. M., Asselain B.,
Institut Curie (Paris)
Since 1994 We have tried to lower the indications of external beam radiation in the managment of retinoblastoma. The use of transpupillary thermotherapy alone or associated with systemic chemotherapy, is a therapeutic modality of ocular retinoblastoma located posteriorly or at the equator. Tumours located in the peripheral retina can be treated by cryotherapy or iodine 125 plaques. All these treatment can be used alone or associated on the same eye and sometimes after an initial chemotherapy to reduce the tumour volume. We present the results on tumour control with these treatments.
Patients and methods: Retrospective case series of patients treated for retinoblastoma in a single institution from October 1994 to December 1999. Data collected includes general characteristics of the treated children, tumours characteristics and the results of the treatments on the local tumour control.
Results: During the study period 239 children have been treated (111 unilateral and 128 bilateral cases) and 109 of them (147 eyes, 372 tumours) could be treated conservatively without external beam. The median follow up is 55 months. 194 tumours have been treated by chemothermotherapy and 18 by thermotherapy alone. Tumour control is obtained in 87.11% of lesions after chemothermotherapy and 77.8% after thermotherapy. 134 tumours were treated by cryotherapy; success rate was 76 % 26 tumours were treated by iodine plaque as a primary treatment with success in 85 % of cases. All together 43 % of eye were enucleated (80 % of unilateral), 40 % were treated conservatively without external beam and 17% were irradiated.
Discussion: The new therapeutic approach of retinoblastoma includes diode laser hyperthermia on the tumour bed and its use alone or in association with systemic administration of carboplatin. The results of this serie of patients show the efficacy of this approach.
Conclusions: thermotherapy and chemothermotherapy allow an excellent local tumour control and eye preservation in selected cases of retinoblastoma without external beam radiation.