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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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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| transpupillary thermotherapy | Procedure | The 810 nm red laser (Iridex Oculight SLx) is used via an indirect delivery system for transpupillary applications under general anesthesia. The goal is a gentle white spot at the tumor-retina boundary. Technique: Placement: Begin at the lesion edge, placing burns half-on and half-off the tumor. Titration: Increase power/duration until a reaction is seen. Punctate hemorrhage warns of maximum power density. Coverage: Create a perimeter with overlapping burns, then treat the entire lesion. Central thick areas may not whiten. Parameters: Set duration to 9000 milliseconds (ms) and interval to 50 ms for foot-pedal control (continuous mode). This allows for photocoagulation (1-10s) or thermotherapy (30-60s). Primary (Peripheral/Macular): Start at 300 milliwatt (mW). Chemoreduction (Large Tumors): Start at 400-500 mW; can increase to 800 mW with careful monitoring if no reaction occurs. |
| |
| Cryotherapy | Procedure | The ERBE Erbokryo AE system is utilized to treat peripheral lesions. Before use, the probe must be tested for proper ice ball formation. Technique: Localization: Position the probe tip using indirect ophthalmoscopy and scleral indentation. Freezing: Center the tip under the tumor. The ice ball must extend 1-2 mm beyond the tumor apex to encompass potential vitreous seeds. Monitoring: Control the lateral spread to minimize damage to healthy retina. Cycles: Apply double or triple freeze-thaw cycles for maximum efficacy. Precautions: Limit treatment to 2-3 sites per session to reduce the risk of secondary serous or rhegmatogenous retinal detachment. | ||
| Brachytherapy |
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of Globe salvage for treatment with Brachytherapy | The number of eyes that were not enucleated due to the success of brachytherapy in regressing the tumour in these eyes, compared to the total number of eyes that were treated with brachytherapy. | Baseline |
| Percentage of Globe salvage for treatment with cryotherapy | The number of eyes that were not enucleated due to the success of cryotherapy in regressing the tumour in these eyes, compared to the total number of eyes that were treated with cryotherapy. | Baseline |
| Percentage of Globe salvage for treatment with transpupillary thermotherapy | The number of eyes that were not enucleated due to the success of transpupillary thermotherapy in regressing the tumour in these eyes, compared to the total number of eyes that were treated with transpupillary thermotherapy. | Baseline |
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Inclusion Criteria:
Exclusion Criteria:
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Medical records of Patients with RB who received Ru-106 plaque brachytherapy, cryotherapy, and/or TTT as salvage treatment after systemic intravenous chemotherapy (IVC) from October 2019 to April 2026
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Amr Sayed, Msc | Contact | +201096083988 | amr_mohamed_sayed3@yahoo.com |
| Name | Affiliation | Role |
|---|---|---|
| Tamer Macky, PhD | Cairo University | Study Director |
| Abdussalam Abdussalam, PhD | Cairo University | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18621794 | Background | Broaddus E, Topham A, Singh AD. Incidence of retinoblastoma in the USA: 1975-2004. Br J Ophthalmol. 2009 Jan;93(1):21-3. doi: 10.1136/bjo.2008.138750. Epub 2008 Jul 11. | |
| 18762512 | Background | Rodriguez-Galindo C, Wilson MW, Chantada G, Fu L, Qaddoumi I, Antoneli C, Leal-Leal C, Sharma T, Barnoya M, Epelman S, Pizzarello L, Kane JR, Barfield R, Merchant TE, Robison LL, Murphree AL, Chevez-Barrios P, Dyer MA, O'Brien J, Ribeiro RC, Hungerford J, Helveston EM, Haik BG, Wilimas J. Retinoblastoma: one world, one vision. Pediatrics. 2008 Sep;122(3):e763-70. doi: 10.1542/peds.2008-0518. |
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| ID | Term |
|---|---|
| D012175 | Retinoblastoma |
| ID | Term |
|---|---|
| D018302 | Neoplasms, Neuroepithelial |
| D017599 | Neuroectodermal Tumors |
| D009373 | Neoplasms, Germ Cell and Embryonal |
| D009370 | Neoplasms by Histologic Type |
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| ID | Term |
|---|---|
| D017679 | Cryotherapy |
| D001918 | Brachytherapy |
| ID | Term |
|---|---|
| D013812 | Therapeutics |
| D011878 | Radiotherapy |
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Plaque insertion is performed under general anesthesia. Precise tumor localization is achieved through simultaneous indirect ophthalmoscopy and transillumination; the tumor projection is marked on the sclera using blue ink. Muscles may be temporarily detached for proper seating. Planning and Dosimetry:Equipment: Ru-106 plaques (e.g., BEBIG) are used for tumors up to 7 mm thick and 17 mm in diameter.Dose: Following American Brachytherapy Society (ABS) guidelines, 90 gray (Gy) is delivered at 0.6-1.05 Gy/hr over 3-7 days.Margins: Calculation includes tumor height + 1 mm sclera. A 2-3 mm lateral margin and a 1 mm safety margin are maintained. Vitreous Seeds: Add 1 mm to the thickness calculation if local seeds are present. |
| 27787452 | Background | Shields CL, Say EAT, Pefkianaki M, Regillo CD, Caywood EH, Jabbour PM, Shields JA. RHEGMATOGENOUS RETINAL DETACHMENT AFTER INTRAARTERIAL CHEMOTHERAPY FOR RETINOBLASTOMA: The 2016 Founders Award Lecture. Retina. 2017 Aug;37(8):1441-1450. doi: 10.1097/IAE.0000000000001382. |
| 34044113 | Background | Shields CL, Dockery PW, Yaghy A, Duffner ER, Levin HJ, Taylor OS, Sajjadi Z, Lally SE, Shields JA, Rosenwasser R, Tjoumakaris S, Jabbour P. Intra-arterial chemotherapy for retinoblastoma in 341 consecutive eyes (1,292 infusions): comparative analysis of outcomes based on patient age, race, and sex. J AAPOS. 2021 Jun;25(3):150.e1-150.e9. doi: 10.1016/j.jaapos.2020.12.006. Epub 2021 May 24. |
| 37839559 | Background | Kaliki S, Vempuluru VS, Mohamed A, Al-Jadiry MF, Bowman R, Chawla B, Hamid SA, Ji X, Kapelushnik N, Kebudi R, Sthapit PR, Rojanaporn D, Sitorus RS, Yousef YA, Fabian ID; Global Retinoblastoma Study Group. Retinoblastoma in Asia: Clinical Presentation and Treatment Outcomes in 2112 Patients from 33 Countries. Ophthalmology. 2024 Apr;131(4):468-477. doi: 10.1016/j.ophtha.2023.10.015. Epub 2023 Oct 13. |
| 33007338 | Background | Tomar AS, Finger PT, Gallie B, Kivela TT, Mallipatna A, Zhang C, Zhao J, Wilson MW, Brenna RC, Burges M, Kim J, Khetan V, Ganesan S, Yarovoy A, Yarovaya V, Kotova E, Yousef YA, Nummi K, Ushakova TL, Yugay OV, Polyakov VG, Ramirez-Ortiz MA, Esparza-Aguiar E, Chantada G, Schaiquevich P, Fandino A, Yam JC, Lau WW, Lam CP, Sharwood P, Moorthy S, Long QB, Essuman VA, Renner LA, Semenova E, Catala J, Correa-Llano G, Carreras E; American Joint Committee on Cancer Ophthalmic Oncology Task Force. Global Retinoblastoma Treatment Outcomes: Association with National Income Level. Ophthalmology. 2021 May;128(5):740-753. doi: 10.1016/j.ophtha.2020.09.032. Epub 2020 Sep 29. |
| 29890860 | Background | Hiasat JG, Saleh A, Al-Hussaini M, Al Nawaiseh I, Mehyar M, Qandeel M, Mohammad M, Deebajah R, Sultan I, Jaradat I, Mansour A, Yousef YA. The predictive value of magnetic resonance imaging of retinoblastoma for the likelihood of high-risk pathologic features. Eur J Ophthalmol. 2019 Mar;29(2):262-268. doi: 10.1177/1120672118781200. Epub 2018 Jun 11. |
| 35433448 | Background | Schaiquevich P, Francis JH, Cancela MB, Carcaboso AM, Chantada GL, Abramson DH. Treatment of Retinoblastoma: What Is the Latest and What Is the Future. Front Oncol. 2022 Apr 1;12:822330. doi: 10.3389/fonc.2022.822330. eCollection 2022. |
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| 8261386 | Background | Servodidio CA, Abramson DH. Acute and long-term effects of radiation therapy to the eye in children. Cancer Nurs. 1993 Oct;16(5):371-81. |
| 7103809 | Background | Abramson DH, Ellsworth RM, Rozakis GW. Cryotherapy for retinoblastoma. Arch Ophthalmol. 1982 Aug;100(8):1253-6. doi: 10.1001/archopht.1982.01030040231003. |
| 16949158 | Background | Shields CL, Mashayekhi A, Sun H, Uysal Y, Friere J, Komarnicky L, Shields JA. Iodine 125 plaque radiotherapy as salvage treatment for retinoblastoma recurrence after chemoreduction in 84 tumors. Ophthalmology. 2006 Nov;113(11):2087-92. doi: 10.1016/j.ophtha.2006.04.032. Epub 2006 Sep 1. |
| 11713089 | Background | Shields CL, Shields JA, Cater J, Othmane I, Singh AD, Micaily B. Plaque radiotherapy for retinoblastoma: long-term tumor control and treatment complications in 208 tumors. Ophthalmology. 2001 Nov;108(11):2116-21. doi: 10.1016/s0161-6420(01)00797-7. |
| 39580311 | Background | Palkonda VAR, Ramachandran A, Adewara BA, Verma R, Raval V, Kaliki S. Ruthenium-106 (106Ru) plaque brachytherapy as salvage treatment for retinoblastoma following intravenous chemotherapy. Brachytherapy. 2025 Jan-Feb;24(1):76-85. doi: 10.1016/j.brachy.2024.06.008. Epub 2024 Nov 22. |
| 6438701 | Background | Schipper J. An accurate and simple method for megavoltage radiation therapy of retinoblastoma. Radiother Oncol. 1983 Aug;1(1):31-41. doi: 10.1016/s0167-8140(83)80005-x. |
| 32072842 | Background | Yousef YA, Mohammad M, Jaradat I, Shatnawi R, Banat S, Mehyar M, Al-Nawaiseh I. The role of external beam radiation therapy for retinoblastoma after failure of combined chemoreduction and focal consolidation therapy. Ophthalmic Genet. 2020 Feb;41(1):20-25. doi: 10.1080/13816810.2020.1719519. Epub 2020 Feb 19. |
| 23953635 | Background | Francis JH, Barker CA, Wolden SL, McCormick B, Segal K, Cohen G, Gobin YP, Marr BP, Brodie SE, Dunkel IJ, Abramson DH. Salvage/adjuvant brachytherapy after ophthalmic artery chemosurgery for intraocular retinoblastoma. Int J Radiat Oncol Biol Phys. 2013 Nov 1;87(3):517-23. doi: 10.1016/j.ijrobp.2013.06.2045. Epub 2013 Aug 14. |
| 39788791 | Background | Yarovoy AA, Volodin DP, Yarovaya VA. A retrospective study on ruthenium-106 and strontium-90 eye-plaques treatment for retinoblastoma: 16-years clinical experience. Brachytherapy. 2025 Mar-Apr;24(2):265-272. doi: 10.1016/j.brachy.2024.11.008. Epub 2025 Jan 9. |
| 24373763 | Background | American Brachytherapy Society - Ophthalmic Oncology Task Force. Electronic address: paulfinger@eyecancer.com; ABS - OOTF Committee. The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma. Brachytherapy. 2014 Jan-Feb;13(1):1-14. doi: 10.1016/j.brachy.2013.11.008. Epub 2013 Dec 24. |
| 18207660 | Background | Abouzeid H, Moeckli R, Gaillard MC, Beck-Popovic M, Pica A, Zografos L, Balmer A, Pampallona S, Munier FL. (106)Ruthenium brachytherapy for retinoblastoma. Int J Radiat Oncol Biol Phys. 2008 Jul 1;71(3):821-8. doi: 10.1016/j.ijrobp.2007.11.004. Epub 2008 Jan 22. |
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| D009369 | Neoplasms |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009380 | Neoplasms, Nerve Tissue |
| D019572 | Retinal Neoplasms |
| D005134 | Eye Neoplasms |
| D009371 | Neoplasms by Site |
| D015785 | Eye Diseases, Hereditary |
| D005128 | Eye Diseases |
| D012164 | Retinal Diseases |