Article
Taming of the shrew retinoblastomas
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Published: | June 15, 2011 |
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A 18 month old boy with bilateral sporadic retinoblastoma (right > left) received according international recommendations a systemic intravenous polychemotherapy with 6 cycles each 3 weeks, 4 cycles with thermotherapy. 3 months after finishing chemotherapy relapses on both eyes occurred. We treated with external beam radiotherapy of both eyes up to 50 Gray about 5 weeks. 6 months after finishing radiotherapy a relapse on the better left eye occurred. Superselective intraarterial chemotherapy failed because of a strong anastomosis between ophthalmic and meningeal artery. We treated with intravitreal methotrexate-injections 2x weekly about 4 weeks and 1x weekly about further 4 weeks. The righte eye developed a relapse around 11 months after radiotherapy. Superselective intraarterial chemotherapy with 5 mg Melphalan succeeded on the right eye. To date both eyes are showing inactive tumours. Following examinations under anaesthesia are necessary. MRI-imaging showed no extraocular growth, but an atypical enhancement of the left optic nerve. Recurrent retinoblastoma are presenting a special challenge. Therapeutical options are combined with known potential complications. Recent additonal therapeutical options are demonstrating relevant successes but also compromises.