Results of postoperative adjuvant treatment of pediatric locally advanced retinoblastoma nemrock experience

الملخص EN

Purpose : the aim of the present study was to evaluate the role of adjuvant postoperative chemotherapy in the local control, disease free interval and overall survival by comparing retrospectively two groups of patients, group (I) received postoperative radiation therapy and the second group (II) received postoperative radiation therapy and chemotherapy.

Methods and Material : the present study is a retrospective study carried on 54 newly diagnosed patients of pediatric unilateral retinoblastoma referred to pediatric unit of KASR-EL-Aini Center of Radiation Oncology and Nuclear Medicine (NEMROCK) during the period from February 1991 till February 1996 and they were followed up till February 1999.

Their age ranged from 2 to 15 years, and all patients were treated by orbital exenteration.

The patients were divided into 2 groups.

The first group (I) included 21 patients treated by postoperative radiation therapy and the second group (II) included 33 patients treated by postoperative radiation therapy and chemotherapy in the form of Vincristine, Adriamycin and Cyclophospha-mide.

Results : after a period of follow up of 3 years 6 out of 21 patients (28.6 %) in group (I) versus 10 out of 33 patients (28 %) in group (II) developed local recurrence, with no statistically significant difference p = (0.100).

Six out of 21 patients (28.2 %) of group (I) versus 7 out of 33 patients (19.6 %) of group (II) developed distant metastases the results were statistically insignificant (p = 0.210).

The 3 year overall survival for group (I) was 19.25 % versus 50.53 % for group (II).

However this difference was not statistically significant.

The 3 year disease free survival for group (I) was 17 % with a median (DFS) of 6 months versus 33 % for group (II) with a median (DFS) of 13 months.

This difference was statistically significant (p = 0.012).

The 3 year time to local recurrence for group (I) was 51.62 % versus 37.42 %, for group (II) with a statistically significant difference (I) (p = 0.031).

The 3 year time to distant metastases was 58.29 % for group (I) versus (37.16 %) for group (II) with a statistically significant difference (I) p = (0.031).

Six patients in-group (I) developed orbital infection and cellulities (27 %).

Twelve patients developed grade (I) myelosuppression (54 %).

In group (II) all cases developed grade (II) alopecia (100 %) 3 patients developed grade (I) myelosuppression (16.8 %) 12 patients developed grade (II) myelosuppression (33.6 %) and 15 patients developed grade (III) myelosuppression (45.4 %).

Conclusion : the role of postoperative adjuvant chemotherapy was not clear.

It insignificantly reduces the incidence of distant metastases and local recurrence.

On the other hand it may significantly improve disease free survival but not the overall survival.