Clinical outcome and regression patterns of retinoblastoma treated with systemic chemoreduction and focal therapy: A prospective study.
OBJECTIVE
To prospectively study the clinical outcome and regression patterns of early retinoblastoma (Groups A and B) after systemic chemotherapy and focal consolidation in Indian children.


METHODS
Group A eyes were treated with focal therapy (transpupillary thermotherapy/cryotherapy) and Group B with systemic chemoreduction and focal therapy. Outcome measures were efficacy and safety of treatment, risk factors for treatment failure, regression patterns, and factors predictive of regression patterns.


RESULTS
Of 119 eyes (216 tumors), 14 (11.8%) were Group A and 105 (88.2%) were Group B eyes. The mean follow-up was 22.6 months. Tumor control was achieved in 111/119 eyes (93.3% overall, 100% Group A, 92.4% Group B). Eight Group B eyes (6.7%) had treatment failure. No serious systemic side-effects were noted. Risk factors for failure included larger tumors (P = 0.001) and proximity to posterior pole (P = 0.014). Regression patterns were Type 4 (50.2%), Type 3 (31.7%), Type 1 (11.1%), and Type 2 (7%). Factors predictive of Type 4 regression were smaller tumors, anterior location, younger age; Type 3 regression was associated with larger tumors, macular location, and older age.


CONCLUSIONS
Systemic chemoreduction and focal therapy provided effective tumor control in Indian children. Factors predictive of regression patterns included age, tumor size and its location, and the modality of treatment.
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Bhavna
B
Chawla
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Amit
A
Jain
Department of Pediatrics, Pediatric Oncology Division, All India Institute of Medical Sciences, New Delhi, India.
Rachna
R
Seth
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Rajvardhan
R
Azad
Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
V K
VK
Mohan
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Neelam
N
Pushker
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Supriyo
S
Ghose
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007223:Infant; D008297:Male; D009887:Ophthalmoscopy; D011446:Prospective Studies; D019572:Retinal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D012175:Retinoblastoma / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography
D000970:Antineoplastic Agents