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Dagny Zhu, Jesse L Berry, Rima Jubran, Thomas C Lee, A. Linn Murphree, Jonathan W Kim; Long-term outcomes of Group B eyes in retinoblastoma patients treated with chemoreduction and low-dose IMRT radiation therapy as salvage: The Children’s Hospital Los Angeles Experience.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3088. doi: https://doi.org/.
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To evaluate long-term outcomes of Group B eyes of retinoblastoma patients.
Retrospective chart review of patients diagnosed with retinoblastoma and designated Group B in at least one eye from January 1, 1991 to December 31, 2011 at Children’s Hospital Los Angeles (CHLA) was done. Overall, 115 Group B eyes of 102 patients were included; 18 had bilateral disease. Primary chemoreduction (CRD) with vincristine, etoposide, and carboplatin was administered along with local consolidation. Salvage therapy if required was administered in the form of low-dose intensity-modulated radiation therapy (IMRT) as salvage for recurrent or persistent tumor. Primary outcome measure was globe salvage.
Of 115 Group B eyes, 113 were initially treated with CRD and local consolidation. Three cycles of primary CRD with local consolidation cured 98 of 113 eyes (87%). Recurrent or persistent tumors were found in 15 eyes: 8 were treated with additional cycles of CRD, 1 with proton beam, 4 with IMRT, and 2 with both additional CRD and IMRT. Of the 7 irradiated eyes, 6 (86%) were salvaged and 1 (14%) required enucleation. Of the 8 eyes treated with additional CRD, 1 (12.5%) eye was salvaged and 7 (87.5%) required enucleation. Final visual acuity ranged from 20/20 to count fingers; 92% had vision better than 20/40. Average follow-up was 2.6 years (range 0.2 - 19 years).
Three cycles of systemic CRD with local consolidation for Group B retinoblastoma demonstrated a very high rate of globe preservation. For tumor recurrences, low dose IMRT therapy offers an effective salvage treatment.
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