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DA Sussman, EM Escalona, MS Benz, D Hess, W Feuer, N Ciciarelli, A Markoe, S Toledano, TG Murray; Globe Conserving Therapy in Retinoblastoma: Comparison of Time Course of Tumor Reduction for Primary Chemoreduction Versus External Beam Radiotherapy . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2590.
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Purpose:To determine the time course and extent of tumor reduction associated with systemic chemoreduction or external beam radiotherapy in the treatment of advanced intraocular retinoblastoma. Methods:Retrospective review of all children with Reese-Ellsworth stage IV-V retinoblastoma undergoing globe-conserving therapy. Systemic chemoreduction utilized carboplatin, vincristine, etoposide with or without cyclosporine A given every three weeks for 9 cycles. External beam radiotherapy utilized a relative lens sparing technique with single daily fractionation to a total dose of 4140 to 4500 cGy. Adjunctive therapy included local ablative transpupillary diode laser therapy and/or cryotherapy. Study variables were recorded at baseline and 1,2,3,4,5,6 and 12 months post-treatment. Outcome measures included tumor size, tumor volume, regression pattern, tumor recurrence, globe conservation, treatment-related complications, metastases and survival. Tumor volumes were calculated using basal area and height values as determined by ultrasound, physical examination and photographic review. Results:Thirty-eight eyes were serially evaluated for tumor response. Median follow-up was 61 months. 37/38 (97%) eyes exhibited tumor reduction and globe conservation. A mean 82% reduction in tumor volume occurred after two cycles of chemotherapy compared with a 65% reduction at a similar time-point post-radiotherapy (p<0.05). There was no statistically significant difference in tumor volume reduction between treatment modalities at 12 months follow-up. Conclusion:Retinoblastoma tumor reduction exhibits a differential time course and extent based on the applied primary treatment. Earlier tumor reduction is associated with systemic chemoreduction therapy. Combined application of multiple treatment modalities appear to enhance tumor reduction and accelerate the time course of tumor response.
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