MAR 31, 2009
By Arun D. Singh, MD
Ocular Pathology/Oncology
The authors of this retrospective, comparative case series evaluated outcomes following chemoreduction (CRD) with low-dose (2600 cGy) prophylactic external beam radiotherapy (PEBRT) compared with CRD alone in 76 eyes of 56 patients with group E retinoblastoma. CRD with focal therapy is first-line treatment for bilateral intraocular retinoblastoma. Recurrence was significantly less in patients who received CRD with PEBRT, leading to a lower chance of subsequent enucleation or need for therapeutic radiotherapy. The authors concluded that low-dose prophylactic EBRT merits further study.
Twelve eyes were treated with CRD and PEBRT because the opposite eye had been enucleated or had group E disease. PEBRT was given routinely two months after completion of CRD at a median dose of 2600 cGy, with five eyes given more radiotherapy. The remaining 64 eyes received initial treatment with CRD only.
After two years, globe salvage was achieved in 29 (53 percent) of 55 eyes in the CRD only group and 10 (91 percent) of 11 eyes in the group that also received PEBRT. After five years, the respective globe salvage success rates were 20 (48 percent) of 42 eyes and four (80 percent) of five eyes. Thirteen eyes that were salvaged in the CRD group were also treated with therapeutic EBRT at a median dose of 3800 cGy. Visual acuity was 20/100 or better or fix and follow in nine (32 percent) of 28 salvaged eyes in the CRD group and four (40 percent) of 10 eyes in the CRD plus PEBRT group.
Financial Disclosures
Dr. Singh has no financial interests to disclose.