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Sameh Soliman, Zhao Xun Feng, Brenda L Gallie; Evaluating laser photocoagulation for discrete retinoblastoma tumors. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2814.
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To evaluate outcomes of primary and secondary (post-chemoreduction) laser therapy for discrete retinoblastoma (endophytic tumor with definitive borders and attached retina in Group A, B, C eyes (International Intraocular Retinoblastoma Classification, 2005).
A retrospective review of records of children with retinoblastoma (02/2004-12/2018). Data collected included age at diagnosis, initial tumor largest basal diameter (LBD) in disc diameters (DD) and location, initial treatment decision, laser sessions (technique/number), treatment span (from diagnosis to last laser therapy), tumor recurrence. Receiver-operating characteristic (ROC) analysis was used to determine the threshold LBD to predict successful treatment by laser alone.
Eligible were 217 tumors in 88 eyes of 71 patients. Laser therapy was applied to 116 primary tumors (54%) and 101 tumors (46%) after systemic or periocular chemotherapy. Tumor control was achieved in 98 tumors (85%) after median 3 (range 1-15) laser sessions, while 18 (15%) required additional systemic (8) or periocular (9) chemotherapy or both (1). ROC analysis identified ≤3 DD LBD tumors were less likely to require additional treatment than > 3 DD (11% vs 100%, p < 0.001). Following chemoreduction, Regression occurred in 74 (79%) of all tumors, while 20 (21%) had no change/size increase. Tumors ≤ 3 DD in LBD at diagnosis were more likely to show no size regression following primary systemic chemotherapy (17% vs 82%, P < 0.01). Central tumors regressed more than equatorial and peripheral tumors (size change, 4 DD vs 0.5 DD; P = 0.001). Complete tumor regression was seen in 42 tumors after one laser session (95% ≤ 1DD). A stable scar was achieved in 211 tumors after a median 3.4 months (median 3 laser sessions). Tumor recurred in 90/211 and full control with only laser therapy was achieved in 87 (90%) recurrent tumors and 3 tumors in 2 eyes required enucleation. Tumor recurrence was not different between tumors treated with primary laser or secondary laser after chemotherapy (P>0.05).
Laser photocoagulation is an effective treatment decision for tumors ≤ 3 DD regardless of prior chemotherapy.
This is a 2020 ARVO Annual Meeting abstract.
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