Abstract
Purpose :
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).
Methods :
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.
Results :
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).
Conclusions :
Laser photocoagulation is an effective treatment decision for tumors ≤ 3 DD regardless of prior chemotherapy.
This is a 2020 ARVO Annual Meeting abstract.