Summary
The efficacy and toxicity of brachytherapy following ophthalmic artery chemo-surgery for retinoblastoma was investigated in 15 eyes of 15 patients. This combination was effective, even in eyes with vitreous seeding, and the toxicity appeared to be no worse than reported with other radiation/chemotherapy treatments for retinoblastoma. Brachytherapy represents a potentially valuable salvage treatment for patients with recurrent retinoblastoma following ophthalmic artery chemosurgery treatment.
Purpose
To evaluate the efficacy and toxicity of brachytherapy after ophthalmic artery chemo-surgery (OAC) for retinoblastoma.
Methods and Materials
This was a single-arm, retrospective study of 15 eyes in 15 patients treated with OAC followed by brachytherapy at (blinded institution) between May 1, 2006, and December 31, 2012, with a median 19 months' follow-up from plaque insertion. Outcome measurements included patient and ocular survival, visual function, and retinal toxicity measured by electroretinogram (ERG).
Results
Brachytherapy was used as adjuvant treatment in 2 eyes and as salvage therapy in 13 eyes of which 12 had localized vitreous seeding. No patients developed metastasis or died of retinoblastoma. The Kaplan-Meier estimate of ocular survival was 79.4% (95% confidence interval 48.7%-92.8%) at 18 months. Three eyes were enucleated, and an additional 6 eyes developed out-of-target volume recurrences, which were controlled with additional treatments. Patients with an ocular complication had a mean interval between last OAC and plaque of 2.5 months (SD 2.3 months), which was statistically less (P= .045) than patients without ocular complication who had a mean interval between last OAC and plaque of 6.5 months (SD 4.4 months). ERG responses from pre- versus postplaque were unchanged or improved in more than half the eyes.
Conclusions
Brachytherapy following OAC is effective, even in the presence of vitreous seeding; the majority of eyes maintained stable or improved retinal function following treatment, as assessed by ERG.