title: [Functional results of retinoblastoma treatment with local treatment used in isolation or associated with chemotherapy].
abstract: BACKGROUND
  Because of long-term complications of external beam radiation in retinoblastoma, a new therapeutic modality using chemotherapy and local treatments is used whenever possible. We conducted a retrospective study to evaluate visual results.
  
  
  METHODS
  We studied visual acuity and ocular side effects in children presenting uni- or bilateral retinoblastoma in whom we were able to achieve conservative management without external beam treatment. The treatments that were used included chemotherapy, chemothermotherapy, diode laser, iodine 125 plaque brachytherapy, and cryotherapy. The initial characteristics (diameter, subretinal or vitreous seeding, and location) of each tumor, the treatments used, their results, and the visual function after age 4 years were recorded.
  
  
  RESULTS
  We treated 429 children for retinoblastoma at the Curie Institute between October 1994 and December 2002. Two hundred twenty-seven eyes had conservative treatment without external beam. We were able to study the visual function in 102 eyes at a median age of 67 months. The median follow-up after the end of the treatment was 5 years. The mean visual acuity was 20/37 and 60% of the children had visual acuity of more than 20/40. Macular alteration was observed in 34 eyes. Statistical analysis showed that a larger tumor diameter of the retinal surface (p<0.0003) and location close to the macula (p<0.0001) were the most significant risk factors for vision loss.
  
  
  CONCLUSIONS
  The visual results of the treatment of retinoblastoma by chemotherapy and local treatments is good when the tumors are not located close to the macula. Larger tumors also have a worse prognosis for vision.
authors.affiliation: Institut Curie, 26, rue d'Ulm, 75005 Paris. laurence.desjardins@curie.net
authors.forename: L
authors.initials: L
authors.lastname: Desjardins
authors.forename: M Charif
authors.initials: MC
authors.lastname: Chefchaouni
authors.forename: L
authors.initials: L
authors.lastname: Lumbroso
authors.forename: C
authors.initials: C
authors.lastname: Levy
authors.forename: B
authors.initials: B
authors.lastname: Asselain
authors.forename: D
authors.initials: D
authors.lastname: Bours
authors.forename: R
authors.initials: R
authors.lastname: Dendale
authors.forename: M
authors.initials: M
authors.lastname: Estève
authors.forename: J
authors.initials: J
authors.lastname: Michon
authors.forename: F
authors.initials: F
authors.lastname: Doz
mesh_terms: D002675:Child, Preschool; D003131:Combined Modality Therapy; D006801:Humans; D020127:Recovery of Function; D019572:Retinal Neoplasms / Q000188:drug therapy / Q000628:therapy*; D012175:Retinoblastoma / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies; D014792:Visual Acuity