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Prior non-irradiative focal therapies do not compromise the efficacy of delayed episcleral plaque brachytherapy in retinoblastoma
  1. John T Lucas1,
  2. Rose McGee2,
  3. Catherine A Billups3,
  4. Ibrahim Qaddoumi2,
  5. Thomas E Merchant1,
  6. Rachel C Brennan2,4,5,
  7. Jiangrong Wu3,
  8. Matthew W Wilson2,4,6
  1. 1 Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
  2. 2 Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
  3. 3 Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
  4. 4 Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  5. 5 Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  6. 6 Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
  1. Correspondence to Dr John T Lucas, Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; john.lucas{at}stjude.org

Abstract

Background/aims Non-irradiative local therapies have shown promise in delaying or supplanting external beam radiotherapy (EBRT) and enucleation in patients with retinoblastoma. We hypothesised that prior focal therapy does not compromise the efficacy of delayed episcleral plaque brachytherapy (epBRT).

Methods We performed an institutional review board-approved medical record review of patients with retinoblastoma who were treated with I-125 epBRT prior to (primary) or following chemoreduction (delayed), alone and in combination with non-irradiative focal therapy. Clinical and treatment characteristics were retrieved. Treatment failure was defined as the need for subsequent EBRT and/or enucleation. Event-free and ocular survival rates were calculated from the date of plaque placement. The cumulative incidences (CIs) of treatment failure and enucleation were compared across strata using Gray’s test.

Results We identified 50 patients with retinoblastoma (54 eyes), who received a total of 56 plaques between January 1986 and December 2010, with a median follow-up of 8.3 years (range, 0.8–21.2 years). The median time from diagnosis to plaque placement was 12.7 months (range, 0.1–128 months). The CI and 95% CI of treatment failure and enucleation following epBRT at 5 years was 37%±7.2% and42.2%±7.3%, respectively. The lack of prior diode or green laser therapy was predictive of increased risk for treatment failure (p=0.02 and 0.03). International Classification group C or D was predictive of decreased time to enucleation (p=0.004). The use of any focal therapy was not predictive of time to treatment failure (p=0.33).

Conclusions The use of non-irradiative focal therapies prior to or following epBRT does not decrease the time to enucleation or treatment failure.

  • clinical trial
  • treatment other
  • treatment medical
  • treatment surgery
  • vision

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Footnotes

  • Contributors Conception or design of the work: RCB, MWW, JTL and TEM. Collection and assembly of data and analysis: RCB, IQ, MWW, JTL, TEM, RM and CAB. Manuscript writing: all authors. Final approval of the version to be published: all authors. Accountable for all aspects of the work: all authors.

  • Funding This work was supported by American Lebanese Syrian Associated Charities and National Institutes of Health Grants No. CA21765 and CA23099.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval St. Jude Children's Research Hospital institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are unpublished pertaining to this research study.

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