Clinical Efficacy and Prognostic Factors of Chemoreduction Combined with Topical Treatment for Advanced Intraocular Retinoblastoma

Objective: To explore the clinical efficacy and prognostic factors of chemoreduction combined with topicaltreatment of advanced intraocular retinoblastoma (RB). Materials and
Methods: A total of 22 eyes from 17children with RB were selected for the study and treated with chemoreduction combined with topical cryotherapy,transpupillary thermotherapy (TTT) or episcleral plaque brachytherapy. Clinical and follow-up data wereretrospectively analyzed.
Results: All children received 2~6 courses of chemoreduction treatment, (4.5±0.8courses on average); 17 eyes from 13 children were treated by chemoreduction combined with cryotherapy orTTT and 5 eyes from 4 children with chemoreduction combined with 125I episcleral plaque brachytherapy. Theeye retention rate was 81.8% (18/22), among which 38.9% (7/18) featured restored or maintained good vision.Postoperative follow-up period was 7 to 34 months, (18.6 ± 5.2 months on average). The recurrence rate was41.2% (7/17), among which 57.1% (4/7) were controlled by supplementing or appending cryotherapy or TTTtreatment during the follow-up period. The tumor basal diameter and thickness were significantly reduced(P<0.05 or P<0.01) after treatment. All children demonstrated different degrees of hair loss, 70.6% (12/17) withdifferent degrees of gastrointestinal reactions, 5.88% (1/17) with neutropenia and 11.8% (2/17) being seriouslyinfected during the chemotherapeutic treatment. Univariate and logistic regression analysis showed that tumorbasal diameter before treatment had a significant effect on the prognosis (P<0.01).
Conclusions: Chemoreductioncombined with topical therapy can effectively control RB in the short term, and tumor basal diameter beforetreatment is an independent risk factor for prognosis.