Brachytherapy for retinoblastoma: a 13 year experience
https://doi.org/10.18027/2224-5057-2021-11-2-5-12
Abstract
Brachytherapy (BT) is a method of radiation therapy with radioactive source contacting the tumor. It was proposed by P. Moore and H. Stallard in 1929. Despite those 50 years of experience with the use of BT in ophthalmic oncology, there are only a few studies on the use of Ru-106 BT for retinoblastoma (RB), and no publications on the use of Sr-90 BT have been found.
Purpose. To present our own experience with the use of ruthenium and strontium ophthalmic applicators for BT in retinoblastoma.
Materials and methods. 120 patients (137 eyes and 194 RB foci) received BT as a local treatment in the period from 2007 to 2020. At the time of treatment the age of the patients varied from 4 to 109 months (mean age 26 months). In 32% of cases (44 eyes) there were monofocal lesions, and in 68% of cases (93 eyes) — multifocal. In 36 cases (30%) BT was performed in the single eye. 79 patients (87 eyes) were treated with the use of ruthenium ophthalmic applicators (OAs), 25 patients (26 eyes) — with the use of strontium OAs, and for the treatment of 16 patients (24 eyes) both ruthenium and strontium OAs were used.
Results. Clinically complete tumor regression was achieved in 62 % of cases (120 foci), partial tumor regression — in 31% of cases (60 foci). In 6% of cases (12 foci) continuous tumor growth was observed, and tumor recurrence occurred in 1% of cases (2 foci) within 4 to 6 months after BT. Local tumor control was achieved in 93% of cases.
The single eyes were preserved in 92% of cases. BT complications of different intensity were reported in 38% of cases (46 patients — 49 eyes) with the mean follow-up duration of 55 months (3 to 157 months). In 92 % of cases (42 patients — 45 eyes) complications were associated with the use of ruthenium OAs, and only in 8% of cases (4 patients — 4 eyes) — with the use of strontium OAs. Risk factors for radiation-induced complications were identified: focus size (height more than 2.5 mm [P =0.0005], extension more than 7.3 mm [P <0,0001]), sclera dose more than 626 Gr (P = 0,0002), and the central localization of the tumor (P <0.0001).
Conclusions. Ruthenium-106 and strontium-90 brachytherapy is a highly effective treatment modality for the management of RB.
About the Authors
A. A. Yarovoy
S.N. Fedorov Ophthalmic Microsurgery
Russian Federation
Competing Interests:
Russian Federation
Andrey A. Yarovoy - MD, PhD, DSc, Head of the Ophthalmic Oncology and Radiology Department, S.N. Fedorov Eye Microsurgery.
Moscow.
Competing Interests:
No
V. A. Yarovaya
S.N. Fedorov Ophthalmic Microsurgery
Russian Federation
Competing Interests:
Russian Federation
Vera A. Yarovaya - Ophthalmologist, Ophthalmic Oncology and Radiology Department, S.N. Fedorov Ophthalmic Microsurgery.
Moscow.
Competing Interests:
No
E. S. Kotova
S.N. Fedorov Ophthalmic Microsurgery
Russian Federation
Competing Interests:
Russian Federation
Elena S. Kotova - postgraduate student, S.N. Fedorov Eye Microsurgery.
Moscow.
Competing Interests:
No
T. L. Ushakova
N.N. Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuing Professional Education
Russian Federation
Competing Interests:
Russian Federation
Tatiana L. Ushakova - MD, PhD, DSc, Leading Researcher, Surgical Department No. 1 of the Research Institute of Pediatric Oncology and Hematology, N.N. Blokhin National Medical Research Center of Oncology, Professor of the Pediatric Oncology Department, Russian Medical Academy of Continuing Professional Education.
Moscow.
Competing Interests:
No
A. V. Golanov
The N.N. Burdenko Research Institute of Neurosurgery of the Russian Academy of Medical Sciences
Russian Federation
Competing Interests:
Russian Federation
Andrey V. Golanov - MD, PhD, DSc, corresponding member of the Russian Academy of Medical Sciences, Head of Radiosurgery and Radiotherapy Department with a day hospital at the N.N. Burdenko Research Institute of Neurosurgery of the Russian Academy of Medical Sciences, the Business Center of Neurosurgery.
Moscow.
Competing Interests:
No
A. M. Chochaeva
S.N. Fedorov Ophthalmic Microsurgery
Russian Federation
Competing Interests:
Russian Federation
Amina M. Chochaeva - postgraduate student, S. N. Fedorov Ophthalmic Microsurgery.
Moscow.
Competing Interests:
No
D. P. Volodin
S.N. Fedorov Ophthalmic Microsurgery
Russian Federation
Competing Interests:
Russian Federation
Denis P. Volodin - resident, S. N. Fedorov Ophthalmic Microsurgery.
Moscow.
Competing Interests:
No
V. G. Polyakov
N.N. Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuing Professional Education
Russian Federation
Competing Interests:
Russian Federation
Vladimir G. Polyakov - MD, PhD, DSc, Academician of the Russian Academy of Medical Sciences, Head of the Surgical Department No. 1, Adviser to the Director of the Research Institute of Pediatric Oncology and Hematology, N.N. Blokhin National Medical Research Center of Oncology, Head of the Pediatric Oncology Department, Russian Medical Academy of Continuing Professional Education.
Moscow.
Competing Interests:
No
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Review
For citations:
Yarovoy A.A., Yarovaya V.A., Kotova E.S., Ushakova T. ., Golanov A.V., Chochaeva A.M., Volodin D.P., Polyakov V.G. Brachytherapy for retinoblastoma: a 13 year experience. Malignant tumours. 2021;11(2):5-12. (In Russ.) https://doi.org/10.18027/2224-5057-2021-11-2-5-12
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