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J. J. Augsburger, A. H. Shaikh, Z. M. S. Correa; Comparative Impacts of Primary Chemotherapy versus Primary EBRT on Ocular Preservation and Survival in Bilateral Retinoblastoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2013.
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To determine and compare the rates of ocular preservation and survival in children with bilateral retinoblastoma treated initially by either chemotherapy or bilateral external beam radiation therapy (EBRT).
Retrospective chart review of all patients with retinoblastoma evaluated and treated by the senior author (JJA) between 1980 and 2007. Exclusion criteria were unilateral ocular involvement, prior treatment of any type, and/or any concurrent treatment (i.e., within one month following the start of the primary chemotherapy or EBRT), and cases evaluated exclusively for a second opinion. The frequency of subsequent enucleation of the eyes was calculated for subgroups defined by the International Classification of Intraocular Retinoblastoma (ICIR), and the frequency of death was calculated for the children in the two treatment subgroups.
The total number of retinoblastoma patients evaluated was 300. Of these, 253 cases were excluded for the reasons specified in the preceding paragraph. Of the 47 previously untreated bilateral cases, initial treatment consisted of chemotherapy for both eyes in 10, bilateral EBRT in 15, primary enucleation of the worse eye followed by EBRT to the better eye in 6, primary enucleation of the worse eye followed by chemotherapy in 1, enucleation of the worse eye and cryotherapy and/or laser therapy to the better eye in 5, cryotherapy and/or laser therapy to both eyes in 3, and other methods or combinations of methods (including plaque radiotherapy) in 7. The table bellow summarizes the enucleation frequencies in the two groups.Two deaths occurred in the 15 children in the EBRT group (one due to metastasis, the other due to pineoblastoma) but no deaths occurred in the 10 children in the chemotherapy group.
This small comparative study suggests that primary EBRT for bilateral retinoblastoma may yield a slightly higher ocular preservation rate than does primary chemotherapy but that chemotherapy results in a more favorable survival prognosis.
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