Purpose: To report the efficacy of combined intravitreal chemotherapy (IVC) and ruthenium-106 brachytherapy in retinoblastoma, either as first line or second line treatment following systemic chemoreduction or intraarterial chemotherapy. Methods: Retrospective data collection of 18 eyes from 18 patients treated with IVC and brachytherapy from August 2014 to December 2019. Results: The method described was our first line therapy in 6 patients, whereas it was used as second line treatment after chemoreduction in the remaining 12 patients. The eyes showed the following classification at initial presentation: 2 group B eyes, 3 group C eyes and 13 group D eyes. The mean follow-up was 19.5 months (range 2 – 53 months). Mean patient age at brachytherapy was 34.0 months (range 15 – 83 months). Median prescribed dose at the tumour base and apex was 574.5 ± 306.7Gy and 88.5 ± 12.2Gy, respectively. The ocular retention rate was 66.7%. Six eyes had to be enucleated due to uncontrollable subretinal and recurrent vitreous seeding, tumour relapse, recurrence of a solid tumour elsewhere in the eye and persistent vitreous bleeding with loss of tumour control. The mean number of intravitreal injections of Melphalan was 5.0. Two patients received a simultaneous injection of Topotecan for insufficient therapeutic response. With regard to radiogenic complications, we could observe temporary retinal and vitreous bleeding (27.8%), serous retinal detachment (44.4%) and radiogenic maculopathy and retinopathy (11.1%). None of the children showed metastatic disease during follow up. Conclusion: Ruthenium-106 plaque therapy in combination with intravitreal chemotherapy is an effective local therapy with good tumour control rates even in advanced eyes. Overall, the analysed therapeutic approach shows an acceptable side effect profile, especially when considering that EBRT and systemic polychemotherapy, or at least the number of cycles needed, with their increased incidence of adverse events can thus be avoided.


中文翻译：

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近距离放射治疗与玻璃体腔内化疗联合玻璃体种植治疗视网膜母细胞瘤

目的：报告联合玻璃体内化疗 (IVC) 和钌-106 近距离放射治疗对视网膜母细胞瘤的疗效，无论是作为全身化疗减量或动脉化疗后的一线或二线治疗。方法：对 2014 年 8 月至 2019 年 12 月接受 IVC 和近距离放射治疗的 18 名患者的 18 只眼进行回顾性数据收集。结果：所描述的方法是我们对 6 名患者的一线治疗，而在其余患者中，它被用作化学减量后的二线治疗。 12 名患者。眼睛在初始表现时显示以下分类：2 组 B 组眼睛、3 组 C 组眼睛和 13 组 D 组眼睛。平均随访时间为 19.5 个月（范围 2-53 个月）。接受近距离放射治疗的平均患者年龄为 34.0 个月（范围 15 – 83 个月）。肿瘤底部和顶点的中位处方剂量为 574。分别为 5 ± 306.7Gy 和 88.5 ± 12.2Gy。眼球滞留率为66.7%。由于无法控制的视网膜下和复发性玻璃体种植、肿瘤复发、眼睛其他部位实体瘤的复发以及持续的玻璃体出血以及肿瘤失控，不得不摘除六只眼睛。美法仑玻璃体内注射的平均次数为 5.0。两名患者因治疗反应不足而同时注射拓扑替康。关于放射源性并发症，我们可以观察到暂时性视网膜和玻璃体出血（27.8%）、浆液性视网膜脱离（44.4%）和放射源性黄斑病变和视网膜病变（11.1%）。随访期间没有儿童出现转移性疾病。结论：钌 106 斑块治疗与玻璃体内化疗相结合是一种有效的局部治疗，即使在晚期眼中也具有良好的肿瘤控制率。总体而言，所分析的治疗方法显示出可接受的副作用概况，特别是考虑到 EBRT 和全身性多化学疗法，或至少所需的周期数，因此可以避免它们增加的不良事件发生率。