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Lilangi Ediriwickrema, Jesse L Berry, Rima Jubran, Thomas C Lee, A. Linn Murphree, Jonathan W Kim; Long-Term Outcomes of Group C Eyes in Retinoblastoma Patients Treated With Chemoreduction and Low-Dose IMRT as Salvage. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3089.
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To evaluate outcomes of Group C eyes of unilateral and bilateral retinoblastoma patients treated with primary chemoreduction and intensity modulated radiotherapy (IMRT) as salvage.
Retrospective chart review of patients diagnosed with unilateral and bilateral retinoblastoma and designated Group C in at least one eye from January 1, 1991 to December 31, 2011. Overall, 36 Group C eyes of 36 patients were included; 26 had bilateral disease. Primary chemoreduction (CRD) with vincristine, etoposide, and carboplatin with local consolidation was administered, followed by external beam radiation in the form of low-dose intensity-modulated radiation therapy (IMRT) as salvage for persistent or recurrent tumor. Primary outcome measure was globe salvage.
Of the 26 Group C eyes in patients with bilateral retinoblastoma, none were enucleated primarily; 5 of the 10 unilateral Group C eyes were enucleated primarily. Thus, CRD and local therapy was used to treat 31 retinoblastoma eyes. CRD cured 22 of 31 (71%) Group C eyes. Recurrences were found in 9 eyes; five underwent secondary enucleation due to poor visual prognosis, and four received low dose IMRT as salvage therapy. Of the 4 irradiated eyes, 100% were salvaged and none required enucleation (Figure 1). Final visual acuity ranged from 20/20 to no light perception with 13 eyes having 20/80 or better visual acuity in the bilateral retinoblastoma patients. Average follow-up was 98 months (range 22 to 211 months). Chemoreduction was well tolerated by all patients.
Estimates of eye survival of Group C eyes in bilateral patients at 12 months is 91.7%; at 60 months eye survival is estimated to be 87.5% (Figure 2). Systemic treatment for retinoblastoma demonstrated an extremely high rate of globe preservation with acceptable complications and many eyes retaining functional vision.
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