الفهرس 
Retinal EmbryogenesisOnly 14 pages are availabe for public view
 |  | from | 190 |  |  |
| | | from | 190 | | |
Abstract
Purpose: To assess the efficacy of 6 cycles of chemoreduction and focal therapy for group D retinoblastoma.
Design: Retrospective, prospective, nonrandomized, non-comparative, single-center, interventional case series.
Main outcome measures: Primary end point was ocular salvage using systemic chemotherapy, intra-ophthalmic artery Melphalan injection (IOAM), Carboplatin subconjunctival injection with focal therapy including transpupillary diode thermotherapy (TTT), brachytherapy and cryotherapy. Secondary end point (failure) was failure to control the tumor at the end of the study (resistant), enucleation or death for group D retinoblastoma at a major referral center in Egypt, namely the Eye and Laser World Center.
Participants: 30 eyes (25 patients) of group D retinoblastoma.
Methods: Patients were chosen from April 2006 (time of presentation) to June 2011 with mean follow up of about 30 months (end at July 2012). The medical records including data on sex, laterality, age at diagnosis, family history, presenting symptoms and its duration, signs (size, distance to optic nerve and foveola, involved quadrant, associated SRF or seeds),TNM staging, , prior treatment, treatment mode, tumor response, recurrence treatment, estimated final VA and ocular salvage were collected. Results: We studied 30 eyes of 25 patients with group D retinoblastoma. The most common TNM staging was T2bN0M0 (80%), followed by T3aN0M0 (16.7%) then T2aN0M0 (3.3%). Tumor control was achieved in 75.6±8.0 % over 12 months and 20 cases (54.9±9.8%) over 24-63 months. leukocoria was the most common mode of presentation (90%) followed by strabismus (30%) with 26.7% had unilateral involvement while 73.3% had bilateral involvement. Children less than 2 years of age were more affected (80%) with bilateral cases presenting in younger age group. Both hereditary and non-hereditary forms occured, but non-hereditary was the commonest (96.7%). Females were more affected than males (53.3%) with higher incidence in the left eye (53.3%). We used 2 drug-agents chemotherapy in 24 cases of cases (80%) for 6 cycles every 3-4 weeks; to allow for adequate tumor reduction. Following two cycles of systemic chemotherapy, most tumors shrink with a mean of 35% in tumor base and 50% in thickness with resolution of subretinal fluid. Focal therapy to the individual tumors was usually delivered at the second cycle.
Conclusion: Our ocular salvage rate was 66.7% in group D RB which is similar or even higher than reported in the literature. The use of chemotherapy with focal consolidation allows the ocular salvage in advanced stages that were formerly treated with enucleation. These modalities are now available in Egypt and widely propagated. The management of retinoblastoma is difficult, and the ophthalmologist often must make difficult decisions regarding the use of various treatment modalities and the diagnosis of extraretinal spread.
Key Words: Retinoblastoma, Group D, Egypt.