Thermochemotherapy in hereditary retinoblastoma

Abstract

Br J Ophthalmol 2003;87:90-95 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.

Conservative treatment of retinoblastoma: a prospective phase II randomized trial of neoadjuvant chemotherapy followed by local treatments and chemothermotherapy

“…1,2 Numerous conservative treatment modalities have been published: cryoapplication, thermotherapy alone or combined with systemic chemotherapy, plaque radiotherapy, or even exclusive chemotherapy. [3][4][5][6][7][8][9][10][11][12] More recently, periocular, intraarterial, and intravitreal administration of chemotherapy have been used and are still under evaluation. These last modalities were developed during the study period.…”

Beta-Ray Brachytherapy of Retinoblastoma: Feasibility of a New Small-Sized Ruthenium-106 Plaque

“…Brachytherapy was the primary treatment in 6 tumours. In 7 eyes, brachytherapy was used as secondary treatment for recurrences following combined treatment with laser coagulation (n = 5), cryocoagulation (n = 3) or thermochemotherapy (n = 3) [12] . Demographic data of the treated tumours and of the therapy parameters are listed in table 1 .…”

Retinoblastoma

“…The infrared laser is focused directly on the tumor surface using either an ophthalmic microscope adapter or a large spot size indirect ophthalmoscope adapter. When using the indirect ophthalmoscope for TTT, it is important to ensure that the correct adapter is being used, as adapters designed for diode photocoagulation will not provide a continuous wavelength delivery necessary for hyperthermia (Lumbroso et al 2003;Schueler et al 2003).…”