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Thermochemotherapy in hereditary retinoblastoma

¹ Department of Ophthalmology, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany
² Department of Ophthalmology, University Hospital Benjamin Franklin, Free University Berlin, Hindenburgdamm 30, 12200 Berlin, Germany
³ Department of Paediatric Oncology, University of Essen, Hufelandstraße 55, 45122 Essen, Germany

Correspondence to:
Correspondence to:
Dr A O Schueler, Department of Ophthalmology, University Essen, Hufelandstrasse 55, 45122 Essen, Germany;
andreas.schueler{at}uni-essen.de

Background/aim: The combination of chemotherapy and transpupillary thermotherapy, thermochemotherapy (TCT) has become an established part of the treatment plan in advanced retinoblastoma. The aim of this study was to identify safe indications, the complications as well as the limitations of this new treatment for retinoblastoma.

Methods: Tumour response and side effects of TCT with an indirect laser ophthalmoscope (spot size about 400 µm) in 55 tumours of 26 children with bilateral retinoblastoma were analysed. Using the Reese-Ellsworth classification system, nine of 35 eyes were classified as type I, 13 eyes as type II, 10 eyes as type III, and three eyes as type V. The mean age of the children was 0.74 (SD 0.61) years. The mean tumour height was 3.5 (2.3) mm with a mean diameter of 6.1 (4.1) mm. Treatment parameters were 4.3 (1.6) (median 5) thermochemotherapy sessions with a mean energy of 539 (211) mW and a mean duration of 13.5 (5.6) minutes. Chemotherapy courses (vincristine, etoposide, and carboplatin) were repeated every 3 weeks. The mean follow up period was 1.25 (0.6) years.

Results: Local recurrence occurred in 21 tumours (38%), with a mean onset of 3.2 (2.9) months after TCT. The risk of tumour recurrence was correlated with tumour height. The recurrence rate was 17% for tumours with a height less than 2 mm, 37% for tumours with a height between 2 and 4 mm, and 63% for larger retinoblastomas. Multivariate analysis identified fish flesh regression after TCT (p = 0.0007) as the most important risk factor for tumour recurrence besides tumour height (p = 0.001) and the necessity of increased laser power during TCT sessions (p = 0.018). Complications during therapy included transient corneal opacification in two eyes (6%), focal iris atrophy (three eyes, 8.5%), peripheral lens opacity (two eyes, 6%), circumscribed transient retinal detachment (one eye, 3%) and diffuse choroidal atrophy (one eye, 3%).

Conclusion: TCT using an indirect laser ophthalmoscope with a spot size of about 400 µm was efficient for retinoblastoma with a tumour height less than 4 mm. In larger tumours, the recurrence rate was unacceptably high. Fish flesh regression after TCT correlates with a higher rate of local tumour recurrence. Treatment related complications occurred in less than 9% of the treated eyes.

Keywords: retinoblastoma; chemotherapy; hyperthermia; laser coagulation

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				D S Gombos, P A Cauchi, J L Hungerford, P Addison, P G Coen, and J E Kingston Vitreous relapse following primary chemotherapy for retinoblastoma: is adjuvant diode laser a risk factor? Br. J. Ophthalmol., September 1, 2006; 90(9): 1168 - 1172. [Abstract] [Full Text] [PDF]

				R Murthy, S G Honavar, M Naik, and V A P Reddy Thermochemotherapy in hereditary retinoblastoma Br. J. Ophthalmol., November 1, 2003; 87(11): 1432 - 1432. [Full Text]

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