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Thermotherapy for Retinoblastoma
Carol L. Shields, MD;
Maria Carmen M. Santos, MD;
Waltenio Diniz, MD;
Kaan Gündüz, MD;
Gary Mercado, MD;
Jacqueline R. Cater, PhD;
Jerry A. Shields, MD
Arch Ophthalmol. 1999;117:885-893.
Objective To evaluate the results of thermotherapy for retinoblastoma.
Design Prospective, nonrandomized analysis of the treatment method.
Participants A total of 188 retinoblastomas in 80 eyes of 58 patients who were treated with thermotherapy.
Main Outcome Measures Tumor response and ocular adverse effects.
Results Of 188 retinoblastomas treated with thermotherapy, mean tumor base was 3.0 mm and tumor thickness was 2.0 mm. Complete tumor regression was achieved in 161 tumors (85.6%), and 27 tumors (14.4%) developed recurrence. Using univariate analysis, the predictors of local tumor recurrence were male sex (P=.005), no color change ("no visible take") in tumor after treatment (P=.01), increasing number of treatment sessions (P=.002), and previous use of chemoreduction (P=.02). By multivariate analysis, the most important predictors of local tumor recurrence were male sex (P=.01) and previous use of chemoreduction (P=.03), the latter likely reflecting the fact that these tumors were initially larger with more ominous findings, and required chemoreduction therapy to reduce them to a size amenable to focal treatment with thermotherapy. When evaluating thermotherapy variables as a function of tumor size, it was apparent that larger tumors ( 3.0-mm base) required greater energy and time than did smaller tumors (<3.0-mm base). Comparison of treatment variables for larger vs smaller tumors was as follows: number of treatment sessions, 3.3 vs 2.3; spot size, 1.7 vs 1.3 mm; power, 540 vs 370 mW; treatment duration, 49 vs 14 minutes; and coupling of thermotherapy with chemotherapy, 79% vs 48% of cases (P .001 for each variable). Complications of thermotherapy in the 80 eyes included focal iris atrophy in 29 eyes (36%), peripheral focal lens opacity in 19 eyes (24%), retinal traction in 4 eyes (5%), retinal vascular obstruction in 2 eyes (2%), and transient localized serous retinal detachment in 2 eyes (2%). There were no cases of corneal scarring, central lens opacity, iris or retinal neovascularization, or rhegmatogenous retinal detachment. All eyes with focal lens opacity demonstrated adjacent focal iris atrophy. By multivariate analysis, the predictors of thermotherapy-induced focal iris atrophy were increasing number of treatment sessions (P=.001) and increasing tumor base (P=.02).
Conclusions Thermotherapy is used for relatively small retinoblastomas without associated vitreous or subretinal seeds. This treatment provides satisfactory control for selected retinoblastomas, with 86% of tumors demonstrating lasting regression. Tumors that measure 3.0 mm or larger in base at the time of thermotherapy require more intense treatment than smaller tumors and are at greatest risk for ocular complications such as focal iris atrophy and focal paraxial lens opacity.
From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa. The authors have no proprietary interest in any device in this study.
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