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Globe conserving treatment of the only eye in bilateral retinoblastoma

¹ Ocular Oncology Service, St Bartholomew’s and Moorfields Eye Hospital London, UK
² Medical Statistics, Research and Development, Moorfields Eye Hospital, London, UK
³ Department of Paediatric Oncology, St Bartholomew’s Hospital, London, UK
⁴ Department of Radiotherapy, St Bartholomew’s Hospital, London, UK

Correspondence to:
Correspondence to:
Mr John Hungerford
Ocular Oncology Service, St Bartholomew’s and Moorfields Eye Hospitals, City Road, London EC1V 2PD, UK; John.Hungerford{at}bartsandthelondon.nhs.uk

Aims: To quantify the rates of eye preservation and patient survival, local tumour relapse and recurrence, and development of new tumours in the remaining eye of children with bilateral retinoblastoma with one eye already enucleated. Also, in the same children, to describe the types of primary and secondary treatment procedures, and to define the anatomical outcome.

Methods: This is a retrospective observational case series report. The study participants consisted of 107 patients with bilateral retinoblastoma with one eye enucleated within 1 month of baseline examination and had their remaining eye treated conservatively. The main outcome measure were: primary treatment failures, new tumours, enucleation of the only eye, death, remission, and anatomical outcomes (retinal detachment, vitreous haemorrhage, and cataract).

Results: The median age at diagnosis was 8.4 (range 0.2–44, SD 10.1) months with a median ophthalmic follow up of 44.3 (8.1–114, SD 10.1) months. In 22 of the 107 patients (21%) the treated eye was in Reese Ellsworth groups I or II and in the remaining 85 (79%) in groups III–V at diagnosis. The primary treatment was cryotherapy in 14% (15/107) of eyes, radioactive plaque brachytherapy in 3.7% (4/107), and chemotherapy in 10% (11/107). It was lens sparing radiotherapy in 37% (40/107), whole eye radiotherapy in 29% (31/107), combined radiotherapy and chemotherapy in 2.8% (3/107), chemothermotherapy in 0.9% (1/107), and combined focal therapy in 1.8% (2/107). The primary treatment failed to achieve local tumour control during the follow up period in 37% (40/107) of eyes. In 17 eyes failure was due to inadequate control of the presenting tumour, in 16 to development of a new tumour, and in eight eyes to a combination of both. 35 (88%) of the 40 failures were managed by secondary conservative treatment and the remaining five were treated by enucleation of the only eye. There were eight (7.4%) deaths and the 3 year survival rate was 93% (100/108). Anatomical results included vitreous haemorrhage in four cases, tractional retinal detachment also in four cases, and 24 children required cataract surgery.

Conclusions: Aggressive conservative treatment achieved a good rate of globe salvage without impairing survival.

Keywords: globe conservation; bilateral retinoblastoma; children

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