title: Salvage/adjuvant brachytherapy after ophthalmic artery chemosurgery for intraocular retinoblastoma.
abstract: OBJECTIVE
  To evaluate the efficacy and toxicity of brachytherapy after ophthalmic artery chemosurgery (OAC) for retinoblastoma.
  
  
  METHODS
  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.
authors: Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: francij1@mskcc.org.
authors: Jasmine H
authors: JH
authors: Francis
authors: Christopher A
authors: CA
authors: Barker
authors: Suzanne L
authors: SL
authors: Wolden
authors: Beryl
authors: B
authors: McCormick
authors: Kira
authors: K
authors: Segal
authors: Gil
authors: G
authors: Cohen
authors: Y Pierre
authors: YP
authors: Gobin
authors: Brian P
authors: BP
authors: Marr
authors: Scott E
authors: SE
authors: Brodie
authors: Ira J
authors: IJ
authors: Dunkel
authors: David H
authors: DH
authors: Abramson
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D001918:Brachytherapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial / Q000379:methods; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D009880:Ophthalmic Artery; D017063:Outcome Assessment, Health Care; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods; D019572:Retinal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D012175:Retinoblastoma / Q000188:drug therapy / Q000532:radiotherapy*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents
references: Int J Radiat Oncol Biol Phys. 1989 Jul;17(1):63-70
references: 2745209
references: J Pediatr Hematol Oncol. 2006 Jun;28(6):399-401
references: 16794512
references: Med Phys. 2004 Mar;31(3):633-74
references: 15070264
references: Ann R Coll Surg Engl. 1955 Jun;16(6):349-66
references: 14388600
references: Arch Ophthalmol. 1982 Aug;100(8):1249-52
references: 7103808
references: Ophthalmology. 2008 Aug;115(8):1398-404, 1404.e1
references: 18342944
references: Radiother Oncol. 1986 Sep;7(1):19-25
references: 3775076
references: Int J Radiat Oncol Biol Phys. 2008 Jul 1;71(3):821-8
references: 18207660
references: Surv Ophthalmol. 1974 Sep-Oct;19(2):85-100
references: 4612808
references: Trans Ophthalmol Soc U K. 1962;82:473-534
references: 13983306
references: Ophthalmology. 1989 Apr;96(4):530-7
references: 2726184
references: Ophthalmic Res. 2006;38(1):8-12
references: 16166817
references: Ophthalmic Paediatr Genet. 1987 Jun;8(2):89-93
references: 3658343
references: Jpn J Clin Oncol. 2003 Dec;33(12):601-7
references: 14769836
references: Ophthalmologica. 1966;151(2):214-30
references: 5918560
references: Int J Radiat Oncol Biol Phys. 2012 Sep 1;84(1):59-65
references: 22575488
references: Doc Ophthalmol. 2009 Aug;119(1):13-22
references: 19169884
references: Acta Ophthalmol Suppl. 1989;194:3-63
references: 2559573
references: PLoS One. 2012;7(9):e44322
references: 23028521
references: Int Ophthalmol Clin. 1993 Summer;33(3):107-18
references: 8407174
references: Ophthalmology. 2001 Nov;108(11):2116-21
references: 11713089
references: Int J Radiat Oncol Biol Phys. 1991 Aug;21(3):625-7
references: 1869458
references: Ophthalmology. 2006 Nov;113(11):2087-92
references: 16949158
references: Retina. 2012 Feb;32(2):387-95
references: 21878842
references: Int J Radiat Oncol Biol Phys. 2001 Oct 1;51(2):399-409
references: 11567814
references: Arch Ophthalmol. 2011 Jun;129(6):732-7
references: 21320950
references: Pediatr Blood Cancer. 2004 Aug;43(2):134-9
references: 15236279
references: Cancer. 1990 Jul 1;66(1):21-6
references: 2354405
references: J Pediatr Ophthalmol Strabismus. 1994 Jul-Aug;31(4):242-5
references: 7807301
references: Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1212-21
references: 16682139
references: Br J Ophthalmol. 1930 Apr;14(4):145-52
references: 18168859
references: Br J Radiol. 1980 Nov;53(635):1052-60
references: 7426931
references: Ophthalmic Paediatr Genet. 1993 Mar;14(1):39-42
references: 8345955