The role of transpupillary thermotherapy in combined treatment of retinoblastoma

Abstract

Purpose Retinoblastoma (RB) is one of the most serious ophthalmic pathology in childhood. Treatment options that provide eye preservation include chemotherapy, brachytherapy, external beam radiation, cryotherapy and laser treatment. The aim of our study is to evaluate efficiency of transpupillary thermotherapy (TTT) as a part of combined treatment of RB. Methods Our group consists of 30 RB patients (34 eyes). All patients received systemic chemotherapy (Carboplatin and Vincristine). Tumor thickness before TTT varied from 0.9 to 2.6 mm, tumor base diameter varied from 2 to 10 mm. Seven patients had monolateral RB, others had bilateral lesion. Five patients were treated with brachytherapy before TTT. TTT was performed using infrared diode laser Nidec DC 3300. Exposure time was 60 seconds. Width of laser beam was from 1000 to 2000 nm. TTT power setting varied from 600 to 900 mW. Eleven patients had TTT more then once. Follow‐up period after TTT was up to 24 months. Results Control examination after TTT showed good response to the treatment in 27 eyes (79.4%).After TTT we saw hyperpigmented scar on the eye fundus at the place of previous tumor location, on OCT it looked like hyper‐reflective stripe replacing all layers of a retina. Seven eyes (20.6%) were resistant to TTT, five of them were successfully treated by additional brachytherapy. Two eyes were enucleated because of uncontrolled tumor growth. Evaluation of metastatic disease in all patients revealed no signs of metastasis at the time of treatment or during follow‐up. Conclusion TTT can be used in combined treatment of RB for small multifocal lesions. The method is rather simple and uncomplicated. Patients treated with TTT have better visual prognosis in comparison with brachytherapy.