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Abstract
Multifocal retinoblastoma (RB) is the most severe course variant of this disease, the incidence among patients with binocular RB is 67-70%. Despite the high rates occurrence of this form in clinical practice, there is no information in the literature about the efficacy of its treatment using brachytherapy (BT) and various modifications (multifield BT, simultaneous using of two plaques). The safety of repeated irradiation is unexplored.
The aim of the study is to evaluate the efficacy of multifield BT in the treatment of multifocal RB.
Materials and methods: in the period from 2007 to 2021 BT was used as a local treatment for RB in 136 patients (146 eyes), among them 42 patients (46 eyes – 106 tumors) with multifocal RB were treated by multifield BT. The mean age at the time of treatment was 26.8 months (range, 6-67 months). Irradiation was performed in the following variants: from two fields – 36 eyes, from three fields – 8 eyes, from four fields – 1 eye, from five fields – 1 eye. BT with simultaneous using of two plaques in different parts of the fundus was performed in 6 patients (6 eyes), BT with sequential displacement plaque to the neighbouring or the opposite zone - in 15 patients (15 eyes).
Results: complete tumor regression was achieved in 70% (n=74), partial tumor regression - in 22% (n=23). Progressive disease was observed in 7% (n=8), tumor recurrence in 4 months after BT - in 1% (n=1). Local control of the tumor was achieved in 92% of cases. The only eyes were preserved in 90% of cases. BT-related complications were observed in 48% of cases (22 eyes) with mean follow-up 55 months (range, 3-157 months). A comparative analysis efficacy of multifield BT and single-field BT was performed additionally, as a result was shown that multifield BT allows to achieve a comparable tumor local control (94%; p= 0.128) with a clearly greater number of BT-related complications (46%; p=0.02), which does not significantly affect the eye-retention rate of the treatment (83%; p=0.16).
Conclusion: multifield BT has shown high efficacy and relative safety in the treatment of patients with multifocal RB.
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