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Arezu Haghighi, Emily June Zolfaghari, Jonathan Kim, Hassan A Aziz, Kathleen McGovern, Rima Jubran, A. Linn Murphree, Jesse L Berry; Treatment of Group B Retinoblastoma with Chemotherapy Alone without Laser Consolidation Therapy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3336.
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© ARVO (1962-2015); The Authors (2016-present)
Group B retinoblastoma tumors are conventionally treated with 3-6 cycles of systemic chemotherapy and local consolidation with laser therapy. Using this treatment approach, salvage rates of Group B retinoblastoma approach 90-100%. However, the added benefit of laser consolidation therapy as well as the exact timing of this therapy has yet been elucidated. This study presents a case series of four Group B patients with tumors located within or adjacent to the fovea that were treated with chemotherapy alone without laser consolidation therapy.
A case series (4) of Group B eyes treated with chemotherapy alone were obtained from a retrospective chart review with data collection from a 20-year period spanning January 1, 1995 to January 1, 2016. Inclusion criteria included patients diagnosed at CHLA with Group B retinoblastoma in at least one eye, at least one tumor involving the posterior pole, and Retcam photos available for comparison at diagnosis, during and after the completion of chemoreduction. Patient were treated with 2-6 cycles of chemotherapy every 28 days with follow-up every 4-6 weeks during treatment. EUA was performed and Retcam images were obtained at every follow-up visit. From the Retcam images, tumor dimensions and distance of tumor to the fovea and optic nerve were recorded.
Three of four eyes in this series showed complete tumor control. One eye showed initial response to chemotherapy and 6 cycle were given—this eye was not treated with laser however there was a large late tumor recurrence, and given this was a unilateral case with tumor involving >50% of the macula it was decided to proceed with enucleation rather than further salvage therapy. One of the four eyes showed complete resolution of the tumor without scar. Amongst the salvaged eyes, a steady decline in tumor dimensions was noted at every follow-up visit with chemotherapy alone with one case showing a slight increase in tumor dimensions at the final visit; this phenomenon has been observed amongst a larger study cohort and could be attributed to an increase in the choreoretinal scar size. Final visual acuity was 20/20, 20/40, and 20/400 in the salvaged eyes, which correlated with macular involvement.
The results of this study show that in a small cohort of patients with tumors at or adjacent to the fovea, systemic chemotherapy alone without laser consolidation may be curative.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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