J Korean Ophthalmol Soc.  2008 Oct;49(10):1619-1628.

Combination of Chemotherapy and Transpupillary Thermotherapy for Retinoblastoma

• Yang HK
• Kim JH
• Choung HK
• Kim SJ
• Yu YS

Abstract

PURPOSE
To evaluate the results of transpupillary thermotherapy combined with chemotherapy for the treatment of retinoblastoma.
METHODS
Retinoblastoma patients treated with chemotherapy and transpupillary thermotherapy from November, 2004 to October, 2007 were retrospectively reviewed. Local tumor control was assessed in terms of regression or recurrence, at 1 month after chemotherapy and each session of thermotherapy, as well as the final follow-up period. RESULT: Fifty-nine tumors were treated in 15 eyes of 11 children. Age at diagnosis was 7.4+/-6.9 months. Mean tumor diameter at the time of diagnosis was 2.2+/-2.1 disc diameters (DD) and mean tumor diameter at the time of initial thermotherapy was 1.8+/-1.7DD. Mean number of thermotherapy sessions for each tumor was 1.3+/-0.5. Total tumor regression was obtained for 96.6% of tumors after a mean follow-up of 22.3+/-10.7 months. The initial tumor size before thermotherapy was significantly smaller in the group of tumors showing total regression after the first session of thermotherapy. The time required for total regression after initial thermotherapy was related to the initial tumor size before thermotherapy.
CONCLUSIONS
Transpupillary thermotherapy combined with chemotherapy is an effective modality for treating retinoblastoma, and the initial tumor diameter before treatment is a strong predictive factor of successful treatment response.

Keyword

Chemotherapy; Retinoblastoma; Transpupillary thermotherapy

MeSH Terms

Child
Eye
Follow-Up Studies
Humans
Hyperthermia, Induced
Recurrence
Retinoblastoma
Retrospective Studies

Figure

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  Figure 1. Multiple retinoblastomas treated with initial chemotherapy and thermotherapy for all the tumors. (A) and (B) Retinoblastomas before any treatment. Initial base diameters were 1.5DD (A, white arrow) and 4DD (B, hollow arrow). Combined chemotherapy and thermotherapy were applied to both masses. (C) One month after initial thermotherapy combined with systemic chemotherapy, both masses showed total regression; DD=disc diameter.

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  Figure 2. Multiple retinoblastomas treated with initial chemotherapy and further local thermotherapy for one tumor. (A) Two months after initial chemotherapy, showing no regression of the inferonasal 3DD mass, and partial regression of the 6DD macular mass. Thermotherapy was applied on the inferonasal mass (white arrow). (B) Immediately after thermotherapy, capillary dilatation and hemorrhage was found of the overlying vessels of the inferonasal mass (white arrow). (C) One month after thermotherapy, the inferonasal mass was much flattened down and showed nearly total regression; DD=disc diameter.

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  Figure 3. Cumulative regression rate after increased number of transpupillary thermotherapy sessions combined with chemoreduction. A cumulative total of 72.9% (43/59), 89.8%(53/39), 96.6% (57/59) of tumors showed total regression after 1, 2, and 3 sessions of thermotherapy combined with chemotherapy.

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  Figure 4. The distribution of initial tumor size (base diameter) before thermotherapy, according to the response pattern after one session of thermotherapy combined with systemic chemotherapy. Initial tumor size before thermo- therapy was smaller in the group of tumors that showed total regression after one session of thermotherapy combined with chemotherapy ( p=0.01); DD=disc diameter; SDV=standard deviation.

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  Figure 5. Scattergram showing the relationship of initial tumor size (base diameter) before thermotherapy and the time to total tumor regression after initial thermotherapy (mo). The best fit line portrays the positive correlation with statistical significance (R2=0.424, p<0.01); DD=disc diameter; mo=months.

Reference

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