Retinoblastoma Case 2- Tumor Board Presentation from Edward Averbukh, MD
Subject: Retinoblastoma Management Case Date: Wednesday March 7th, 2001
From: Edward Averbukh, MD Dear List Members: We have a difficult case and would like to get your comments on treatment. Case: A 5 y.o. girl with a past ocular history of bilateral retinoblastoma. One eye was enucleated. Other eye was treated (several times) with cryotherapy. She has received maximal possible chemotherapy |
Pre: New small retinoblastoma temporal to the macula (arrow)
A new small lesion (see "pre" picture), appeared temporal to the macula. It is difficult to reach with cryo due to location and scaring. I treated the lesion by applying heavy green laser around the lesion and infrared laser - first time mostly on the lesion edges. There was no regression, in fact the lesion appeared more elevated.
Then laser treatment was repeated twice - same technique (see "post" picture) - around the lesion green argon laser and on the lesion infrared diode (both through an indirect laser ophthalmoscope). However, the lesion looks much more elevated (now 4 weeks after a third treatment). That last treatment was really a heavy whitening application of both types of laser. On March 12, now 3 weeks after a very heavy laser treatment was applied to the tumor (infrared (diode) to the tumor itself and green (argon) around the lesion)
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Image after treatment.
Question: What will be your approach:
Responses From ECN Members: "The tumor could be treated with either "cutting" cryo or more laser every 4 weeks. However, this is good place to use sub-tenon's carboplatin, with the laser. Since it appears to be somewhat recalcitrant to treatment, I would recommend this at the next EUA. If the tumor continues to not respond or threatens to extend beyond the scar now demarcating it, I think that a short course of chemotherapy with the current high dose and CSA would be worthwhile." |
Dear ECN Tumor Board:
I am attaching here the last photograph of the lesion that was taken with regular fundus camera (not the Ret-cam, because there was no need for EUA).
To remind you, this monocular child was treated with full dose of chemotherapy, cryotherapy and brachytherapy (Ru-106) previously and the new lesion appeared on the edge of the previously treated area, so the scaring and the posterior location of the new lesion made the additional cryo difficult.
I applied laser through indirect laser ophthalmoscope. Periphery was treated with Argon and the lesion itself with IR (Iris Medical) laser, the total of 3 sessions few weeks apart. The lesion seemed to be growing rapidly following the laser treatment. However that was just swelling, probably due to inflammatory response, and 2 months later the tumor regressed.
Thank you all for your thoughts and advice in this difficult case.
I am attaching here the last photograph of the lesion that was taken with regular fundus camera (not the Ret-cam, because there was no need for EUA).
To remind you, this monocular child was treated with full dose of chemotherapy, cryotherapy and brachytherapy (Ru-106) previously and the new lesion appeared on the edge of the previously treated area, so the scaring and the posterior location of the new lesion made the additional cryo difficult.
I applied laser through indirect laser ophthalmoscope. Periphery was treated with Argon and the lesion itself with IR (Iris Medical) laser, the total of 3 sessions few weeks apart. The lesion seemed to be growing rapidly following the laser treatment. However that was just swelling, probably due to inflammatory response, and 2 months later the tumor regressed.
Thank you all for your thoughts and advice in this difficult case.
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