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Primary laser therapy as monotherapy for discrete retinoblastoma
  1. Sameh Soliman1,2,
  2. Zhao Xun Feng2,
  3. Brenda Gallie2,3
  1. 1Ophthalmology, Alexandria University Faculty of Medicine, Alexandria, Egypt
  2. 2Ophthalmology, The Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3Ophthalmology, The University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Sameh Soliman, Ophthalmology, Alexandria University Faculty of Medicine, Alexandria 42121, Egypt; samehelsayedsoliman{at}yahoo.com

Abstract

Background/aim Laser photocoagulation is less invasive than chemotherapy (systemic, intra-arterial or periocular) and brachytherapy. We studied the safety and efficacy of laser as primary monotherapy for discrete retinoblastoma with well-defined borders and attached retina.

Methods A single-institution retrospective non-comparative review (2004–2018) of discrete retinoblastoma tumours managed with primary laser (532 or 810 nm wavelength, 0.5–1 s duration and power titrated until desired tumour whitening). Efficacy was evaluated by tumour long-term stability avoiding non-laser therapies. Safety was evaluated by frequency of laser-related complications and uncontrollable tumour progression.

Results Eligible were 112 tumours in 55 eyes of 44 patients. Laser monotherapy (median 2 sessions) achieved initial remission in 95/112 (85%) tumour. Initial encircling only laser photocoagulation was associated with tumour progression (9/11, one tumour had vitreous seeding) compared with direct or combined photocoagulation techniques (0/94 and 0/7 tumours, respectively, p<0.001). Direct laser had no vitreous seeding, haemorrhage or injury to vital structures. Tumour recurrences developed in 52/112 (46%) tumour but repeat laser achieved long-term stability, except five tumour recurrences that required invasive therapy. Receiver operating characteristic analysis identified threshold largest basal diameter of 3 disc diameters (DD) for successful laser monotherapy, where 92/106 (87%) of tumours ≤3 DD and 0/6>3 DD achieved long-term stability with laser monotherapy (p<0.001). Overall, 35/55 (64%) eyes and 24/44 (55%) patients achieved long-term stability with laser monotherapy. No eye was enucleated for uncontrollable tumour progression.

Conclusions Discrete retinoblastoma ≤3 DD can be effectively and safely managed with laser monotherapy, sparing a significant proportion of patients/eyes from more invasive therapies.

  • treatment lasers
  • neoplasia

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Footnotes

  • Contributors Conceptualisation: SS and BG; methodology: SS and ZXF; validation: SS and ZXF; data curation: SS and ZXF; writing—original draft preparation: SS, ZXF and BG; writing—review and editing: SS, ZXF and BG; image construction: SS, ZXF and BG. Supervision: SS and BG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by SickKids Research Ethics Board and follows the Declaration of Helsinki.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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