Radiation therapy for retinoblastoma: a retrospective review of 120 patients.

PURPOSE: To characterize the patient population and treatment outcomes in patients with Retinoblastoma (RB) referred for External Beam Orbital Radiotherapy (EBORT) to King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia from 1976 to 1993. METHODS AND MATERIALS: A retrospective study of 120 patients with RB affecting a total of 192 eyes. Patients were divided into three groups. Group A are 60 patients (64 eyes) treated with EBORT to the intact eye to preserve vision. Reese-Ellsworth (RE) Staging was: 1: 12%; 2: 10%; 3: 12%; 4: 23%; and 5: 43%. Twenty-eight patients (47%) also received Vincristine, Adriamycin, and Cyclophosphamide chemotherapy (C/T). Mean follow-up, per patient, was 48.5 months. Standard treatment until 1992 was 45 Gy in 12 fractions of 3.75 Gy, three times weekly over 18 days. Assuming the alpha/beta ratio for early effects and tumor control at 10, Tk = 21 days, Tpot = 5 days, then the Biological Equivalent Dose (BED) was 62 Gy10 for early effects, and 101 Gy3 for late effects. Group B are 28 patients (28 eyes) treated for curative intent with EBORT to the orbit for locally advanced disease, usually after enucleation (24 eyes). Nineteen patients (83%) also had C/T. Mean follow-up was 22.6 months. Group C are 37 patients with advanced disease treated with radiotherapy for palliation. Seventeen (46%) also received C/T. Mean follow-up was 11.7 months. RESULTS: Group A-following EBORT useful vision was retained in RE Stage 1 to 5: 7 of 7, 6 of 6, 4 of 8, 10 of 15, and 7 of 28 eyes, respectively. There was no significant difference between patients who received adjuvant chemotherapy and those who did not. Complications included cataract (27%), retinopathy (25%), vitreous hemorrhage (19%), and orbital deformities (11%). In Group B the local control rate was 71%. In Group C, 10 (27%) of the 37 patients were alive at last contact, and 27 (73%) were either terminal or dead of disease. None of Group A or B patients had positive CSF cytology, bone scan, or bone marrow examination. In Group C 19% had positive CSF cytology, and bone marrow, and 14% had a positive bone scan. CONCLUSIONS: 1) EBORT preserved useful vision in a significant proportion of patients even in eyes with advanced RE Stage RB, but longer follow-up is likely to reveal an even higher complication rate with this regime. 2) High dose per fraction probably contributed to the increased complications. 3) Chemotherapy did not demonstrate any effect on retaining vision in this study. 4) For disease that is confined to within the eye clinically and radiologically, invasive procedures for CSF cytology, bone marrow examination, and bone scan do not seem warranted. 5) The optimum technique, fractionation, and dosage for RB is still not well defined.

Gastro-duodenal morbidity of para-aortic and iliac lymph node irradiation using a single anterior 16 MV X-ray field.

Eighty-one patients with testicular tumours received para-aortic and iliac lymph node irradiation using 16 MV X-rays through a single anterior field. Eleven of 62 patients with seminoma (18%) and 11 of 19 with teratoma (58%) developed dose-related gastro-duodenal complications. There were no long-term sequelae. The average follow-up is 4.3 years (range 9 months to 8 years). With this method of treatment the structures anterior to the nodes receive a higher dose than the nodes themselves, and it is not suitable when the patient's antero-posterior separation necessitates an applied dose greater than 4000 cGy in 20 daily fractions over 28 days (1351 RET).

Once weekly irradiation in breast cancer.

Eighty-four elderly patients with carcinoma of the breast were treated with a once-weekly schedule using 650 cGy per fraction to a total of six fractions. According to the TNM classification there were 8 patients with Stage I, 29 patients with Stage II, 45 patients with Stage III, and 2 patients with Stage IV disease. Primary surgical treatment included biopsy, that is, truecut needle biopsy or open biopsy in 53 patients and excision biopsy in 13 patients; the remaining 18 patients had mastectomy. The average age of patients was 69.2 years with the oldest 91 years of age. Ten patients died of concomitant causes during the follow-up period at an average age of 84.5 years. Patients included in this report had at least a 36 month follow-up period with the longest being 94 months. Acute reactions were noticeably less than those with daily treatment. Only one of the 36 patients, where the breast was preserved, had severe delayed skin reaction. Of the 37 patients with Stage I and II, 24 were alive and disease-free at the time of reporting. Three died of concomitant causes, 2 are alive with disease, and the remaining 8 patients died of recurrent of progressive disease. There were 45 patients with Stage IIIA and IIIB and in this group 11 are alive and disease-free, 7 died of concomitant causes, 12 died of progressive breast cancer, and the remaining 4 patients are alive with disease. The two remaining Stage IV patients died of their disease. Once-weekly treatment was well tolerated by all patients and the early local control result is encouraging. We are continuing to assess this type of fractionation in selected elderly patients, especially in those who live away from our center.