Korean J Ophthalmol.  2011 Dec;25(6):387-393. 10.3341/kjo.2011.25.6.387.

The Clinical Outcomes of Proton Beam Radiation Therapy for Retinoblastomas That Were Resistant to Chemotherapy and Focal Treatment

• Chang JW
• Yu YS
• Kim JY
• Shin DH
• Choi J
• Kim JH
• Kim SJ

• KMID: 1031185
• DOI: http://doi.org/10.3341/kjo.2011.25.6.387

Abstract

PURPOSE
To evaluate the clinical results of proton beam radiation therapy (PBRT) for treatment of retinoblastoma.
METHODS
Children with retinoblastoma who were treated with chemotherapy and focal treatment such as brachytherapy and thermotherapy but showed no response or developed recurrences later received PBRT. The PBRT strategy was designed to concentrate the radiation energy to the retinoblastoma and spare the surrounding healthy tissue or organs.
RESULTS
There were three patients who received PBRT. The first patient received PBRT because of an initial lack of tumor regression with chemotherapy and brachytherapy. This patient showed regression after PBRT. The second patient who developed recurrence of retinoblastoma as diffuse infiltrating subretinal seeding was taken PBRT. After complete regression, there was recurrence of tumor and the eye was enucleated. The third patient had unilateral extensively advanced retinoblastoma. Initial chemotherapy failed and tumor recurred. The tumor responded to PBRT and regressed significantly. However, the eye developed sudden multiple recurrences, so we had to perform enucleation.
CONCLUSIONS
PBRT for retinoblastoma was effective in cases of showing no response to other treatment modalities. However, it should be carefully applied when there was recurrence of diffuse infiltrating subretinal seeding or extensively advanced retinoblastoma initially.

Keyword

Antineoplastic Combined chemotherapy protocols; Laser therapy; Protons; Radiotherapy; Retinoblastoma

MeSH Terms

Child, Preschool
Combined Modality Therapy
Drug Resistance
Female
Humans
Infant
Male
Retinal Neoplasms/drug therapy/*radiotherapy/surgery
Retinoblastoma/drug therapy/*radiotherapy/surgery
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 (A) There was no significant change in the tumor size and shape after chemotherapy and brachytherapy. Therefore, we started proton beam radiation therapy (PBRT). (B) Proton dose distribution of an anterior medially oriented oblique beam with the eye rotated in the temporal direction. Radiation was concentrated to the nasal side of the tumor but there was minimal radiation distribution to surrounding normal tissue. (C) Complete regression of the tumor after PBRT.

• 

  Fig. 2 (A,B) Subretinal seeding developed after completion of chemotherapy. (C) Proton dose distribution of a right posterior oblique beam with the eye straight position. Radiation covered whole retina behind the lens and there was no radiation distribution to contralateral eye. (D,E) One month after proton beam radiation therapy, there was complete regression of subretinal seeding.

• 

  Fig. 3 (A) There was massive tumor with total retinal detachment and peripheral subretinal seeding at initial presentation. (B) Newly developed diffuse subretinal seeding around the tumor and optic disc during chemotherapy. (C) Proton dose distribution of a lateral beam orientation with the eye in a straight position. The maximum energy of radiation covered the entire retina including proximal optic nerve. (D) There was total regression of subretinal seeding and significant shrinkage of the main tumor after proton beam radiation therapy (PBRT). (E) Three weeks after PBRT, the main tumor increased and multiple tumor reoccurrences developed around the tumor and at the entire ora serrata. We performed enucleation.

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