Orbital Recurrence following Aggressive Laser Treatment for Recurrent Retinoblastoma

Abstract

Purpose: To report a case of a 29-month-old male with familial, bilateral retinoblastoma with orbital recurrence following aggressive laser treatment. Methods: This is a retrospective case report of a single patient. Results: A 3-week-old male was diagnosed with familial, bilateral retinoblastoma (group D OD, group A OS), and treated with 6 cycles of systemic chemotherapy and laser treatment. The patient exhibited full regression of tumors in both eyes. Two years after diagnosis, a small tumor recurrence within the macular laser scar of the right eye was discovered. The tumor recurrence was treated with argon and diode laser over 6 months. The tumor recurrence completely resolved following the laser treatments. Ten weeks after the last laser treatment, MRI revealed a large intraconal orbital mass, contiguous with the sclera of the right eye. Orbital biopsy and systemic work-up confirmed the diagnosis of retinoblastoma with no other metastatic foci. B-scan ultrasonography showed thinning of the sclera at the site of recurrence. Conclusion: This is an unusual orbital recurrence after successful treatment of intraocular disease with aggressive laser therapy. Clinicians should be aware of the rare possibility of orbital recurrence following chemoreduction with local consolidation even when fundus examinations are normal.

Adjuvant use of laser in eyes with macular retinoblastoma treated with primary intravenous chemotherapy

“…Laser has been shown to improve the success of systemic chemotherapy [5][6][7] and reduce local recurrence rates [12]. However, it has also been implicated in causing increased rates of vitreous relapse [10] and extra-scleral spread [11]. The results of this two-centered study show no difference between recurrence rates of eyes treated with chemotherapy alone versus chemotherapy plus adjuvant laser.…”

“…The vast majority of tumors (72%) respond favorably to chemotherapy alone and do not require laser [8]. The addition of laser causes a progressive scar that may affect vision [9], may increase the rate of vitreous recurrence [10], and has been shown to result in orbital recurrence [11]. Conversely, combining thermal laser with systemic chemotherapy increases the rate of tumor control compared to chemotherapy alone [12,13] and recent research suggests that the foveal anatomy can be preserved with foveal-sparing laser even with parafoveal tumors [14].…”

Risk of metastasis and orbital recurrence in advanced retinoblastoma eyes treated with systemic chemoreduction versus primary enucleation

“…One eye was thought to have developed an orbital recurrence without active intra‐ocular disease secondary to aggressive laser therapy. The patient is well without metastatic disease after treatment and was not enucleated …”

“…The patient is well without metastatic disease after treatment and was not enucleated. 29 In addition, with more effective treatment for intra-ocular retinoblastoma, more eyes with advanced disease are being treated.…”

A Review of Recurrent Retinoblastoma: Children’s Hospital Los Angeles Classification and Treatment Guidelines

“…38 Orbital recurrence has also been reported in familial RB treated with systemic chemotherapy and aggressive laser treatment for a recurrence over a period of 6 months. 39 In histologic studies of enucleated eyes undergoing biopsy, tumor cells were identified along the fine-needle aspiration biopsy tracks, 40 and reports have showed extraocular tumor extension following intraocular biopsy. 41 However, the extraocular extension following intravitreal injections is considered very minimal risk with the use of precautionary safety methods.…”