Retinoblastoma Consolidation in Egyptians

Retinoblastoma

This analysis will evaluate the investigators' institution's specific experience using Ru-106 isotopes, cryotherapy, or transpupillary thermotherapy (TTT) to treat persistent or recurrent RB in patients who previously underwent systemic IVC or IAC. The investigators aim to detail the demographics, clinical indications, success rates-specifically local control and globe salvage-, predictive factors for success, and complications of each modality of treatment within a tertiary eye care setting in Egypt.

As the most prevalent pediatric eye malignancy, retinoblastoma (RB) represents roughly 11% of cancers identified during an infant's first year, with the vast majority (95%) being diagnosed by age five. While medical priorities in developed nations have transitioned from merely saving the eye to actively preserving vision, clinical reality differs elsewhere; over 90% of children with RB live in developing or underdeveloped regions, where the disease often remains undetected until it has reached advanced stages that jeopardize the eye. (RB) is managed through a diverse range of therapeutic strategies, including systemic chemotherapy (IVC), intra-arterial (IAC) and intravitreal (IViC) approaches, cryotherapy, laser-based treatments, plaque radiotherapy, and surgical enucleation. Each of these methods presents a unique profile of clinical advantages and potential complications. Currently, systemic IVC is the most common frontline treatment, frequently used in tandem with consolidating focal therapies such as laser therapy, cryotherapy, or Plaque Brachytherapy. Plaque brachytherapy remains a vital tool for treating thicker tumors that are not suitable for laser or cryotherapy. It is particularly prioritized in salvage scenarios where preserving the eye is critical, such as when the patient's other eye has already been enucleated. A significant clinical benefit of plaque therapy is its localized nature; unlike external beam radiation therapy (EBRT), it does not elevate the risk of secondary malignancies in the patient. Whether utilized as an initial treatment or as a rescue measure following IVC or IAC, focal plaque radiotherapy has demonstrated eye salvage success rates between 55% and 79% for new or recurrent focal tumors. Ruthenium-106 (Ru-106) plaque radiotherapy has a long-standing history as both a primary intervention and a rescue therapy for tumors that fail to regress or recur after chemoreduction with a wide range of prescribed apex doses and treatment results. Research indicates that using isotopes like Ruthenium-106 and Iodine-125 results in impressive local tumor control (60%-90%) and high globe preservation rates. To the best of the investigators' knowledge, no previous research analysis has been done on the outcomes of consolidation therapy using Ru-106, laser, or cryotherapy for retinoblastoma in the Egyptian population.

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