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Mai Tsukikawa, Andrew W Stacey, Didi Fabian, Victoria Smith, Zishan Naeem, John Ainsworth, Manoj Parulekar, Ashwin Reddy, Mandeep Sagoo; Adjuvant use of laser in eyes with macular retinoblastoma treated with primary systemic chemotherapy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2323. doi: https://doi.org/.
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There is conflicting evidence whether adjuvant use of laser in addition to primary systemic chemotherapy to treat macular retinoblastoma has long term effects on visual outcomes and tumor recurrence rates.
A multi-centre, retrospective review was conducted of patients treated at the two national centres in the United Kingdom. The medical records of all patients with the diagnosis of macular retinoblastoma seen at the Royal London Hospital between 1999 and 2009 and Birmingham Children’s Hospital between 2002 and 2006 were reviewed. Patients were included in the study if they were treated with primary systemic chemotherapy and had a tumor within the macula. Eyes undergoing other primary treatments such as enucleation or radiation were excluded.
A total of 91 eyes from 76 patients met criteria for inclusion. A total of 67 eyes underwent primary chemotherapy alone while 24 eyes underwent chemotherapy plus adjuvant laser. Age at presentation was similar between groups (chemotherapy: 9.1 months, laser: 11.5 months, p=0.525). There was a trend for longer follow up time in the chemotherapy group (89.1 months vs. 68.5 months in the laser group). The International Classification of Retinoblastoma (IIRC) between the two groups were similar. Tumor control without use of additional therapies was achieved in 21 eyes (31.7%) in the chemotherapy group and 10 eyes (41.7%, p=0.36) in the laser group. The mean time to first relapse was significantly longer in the chemotherapy group (14.2 months) compared to the laser group (9.0 months, p=0.04). More eyes in the chemotherapy group (31 eyes, 46.3%) required cryotherapy to peripheral tumors compared to the laser group (3 eyes, 12.5%, p=0.03). Group D eyes had higher globe salvage rates in the chemotherapy group (21 of 29) compared to the laser group (1 of 7, p=0.005). There was no difference in the visual acuity outcomes between the two groups: Vision better than LogMAR 0.5 (chemotherapy: 31%, laser: 25%, p=0.28).
These results fail to demonstrate any difference in visual outcomes or tumor recurrence rates in eyes with macular retinoblastoma treated with and without adjuvant laser. The use of laser should be judicious as scars are inevitable and this retrospective dataset may not be powered to see long term differences in visual acuity or tumor recurrence rates.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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