Title: Orbital and Ocular Complications of External Beam Radiation Therapy (EBRT) for Retinoblastoma (Rb)
Authors: Dr Nibedita Acharya, Dr Usha Vasu
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.84
Abstract
Introduction: External beam radiotherapy (EBRT) was the preferred form of management of moderately advanced retinoblastoma in late 1900s. But because of its serious side-effects, and also the availability of other safer treatment options EBRT is being used less often now.
Aim: The aim of this study is to highlight the Orbital and Ocular Complications of External Beam Radiation Therapy, their recognition and prevention.
Materials and Methods: Retrospective data analysis of retinoblastoma patients who presented to our institution over past 14 years were done. The case records of patients with minimum follow up of 6 months and maximum follow up of 10 years were included in the study. The stage of retinoblastoma and type of external beam radiotherapy given to them was documented. The complications observed after external beam radiotherapy treatment were noted down. Details of the treatment given to these patients were documented.
Results: Total 46 patients were included in the study. Of this 29 children received only Unilateral EBRT (Group I) while 17 received bilateral EBRT (Group II). Contracted socket was the most common complication seen in both the groups – 17 in group I and 11 in group II. Second common complication was ocular surface abnormalities which kept on recurring in spite of treatment. Other complications observed were facial hypoplasia, radiation retinopathy, orbital cellulitis, cataract etc.
Conclusion: Since external beam radiotherapy is still used to treat the late stage of Retinoblastoma in poor Indian patients, awareness of complications of EBRT is worthwhile. Keeping the side effects in mind, it is always preferable to advise other modalities of treatment for retinoblastoma instead of EBRT.
Keywords: External beam radiotherapy, Retinoblastoma, contracted socket.
References
- Daniel M. Albert, Joan W. Miller, et al. Albert Jackobiec’s Principles and practice of Ophthalmology Vol 4; 3rd edition; Saunders Elsevier,2008.
- Murphee AL, Samuel MA, Harbour JW, et al. Retina Vol 1; 4th edition; Ryan Stephen J; Elsevier Mosby, 2006.
- Abramson DH, Ellsworth RM, Kitchin FD, Tung G: Second nonocular tumours in retinoblastoma survivors. Are they radiation induced? Ophthalmology 1984; 91:1351-1355.
- Save SJ, Grosniklaus, Someran AO. Malignant myoepithelioma after radiation for retinoblastoma. Am J Ophthalmol 115;181:1993.
- Sue C.K, Gang Chen, James F, et al. Orbital development in long term survivors of Rb. J ofClin Oncology 1997;15:1183-9.
- Imhof SM, Mourits MP, Hofman P et al. Quantification of orbital and mid-facial growth retardation after megavoltage EBRT in children with retinoblastoma. Ophthalmology 1996;103:263.
- Zeynel A. Karcioaeglu. Orbital tumors: Diagnosis and treatment. Springer 2005:403.
- Abramson DH, Beaverson KL, Chang ST, Dunkel IJ, McCormick B. Outcome following initial external beam radiotherapy in patients with Reese-Ellsworth group Vb retinoblastoma. Arch Ophthalmol. 2004;122:1316–1323.
- Chan MP, Hungerford JL, Kingston JE, Plowman PN . Salvage external beam radiotherapy after failed primary chemotherapy for bilateral retinoblastoma: rate of eye and vision preservation.Br J Ophthalmol. 2009 Jul; 93(7):891-4.
- Fontanesi JPratt CBHustu HOCoffey DKun LEMeyer D. Use of irradiation for therapy of retinoblastoma in children more than1 year old: the St. Jude Children's Research Hospital experience and review of literature. Med Pediatr Oncol. 1995;24321- 326.