Optic nerve invasion treated with multidisciplinary therapy including proton irradiation in a patient with unilateral retinoblastoma

DOI
  • Yanagisawa Ayano
    Department of Pediatrics, National Hospital Organization Nagoya Medical Center
  • Hattori Hiroyoshi
    Department of Pediatrics, National Hospital Organization Nagoya Medical Center
  • Ichikawa Daisuke
    Department of Pediatrics, National Hospital Organization Nagoya Medical Center
  • Sekimizu Masahiro
    Department of Pediatrics, National Hospital Organization Nagoya Medical Center
  • Kubota Toshinobu
    Ophthalmology, National Hospital Organization Nagoya Medical Center
  • Ogino Hiroyuki
    Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center
  • Ito Yasuhiko
    Department of Pediatrics, Nagoya City University West Medical Center
  • Ono Manabu
    Department of Pediatrics, National Hospital Organization Nagoya Medical Center
  • Futamura Masaki
    Department of Pediatrics, National Hospital Organization Nagoya Medical Center
  • Goto Masahiko
    Department of Pediatrics, National Hospital Organization Nagoya Medical Center
  • Horibe Keizo
    Department of Pediatrics, National Hospital Organization Nagoya Medical Center
  • Maeda Naoko
    Department of Pediatrics, National Hospital Organization Nagoya Medical Center

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Other Title
  • 視神経浸潤に対し陽子線療法を含む集学的治療を行った片側性網膜芽細胞腫の1例

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Abstract

<p>A two-year-old girl was diagnosed as having right retinoblastoma (international classification E) after her mother noticed right eye leukocoria for one month. Contrast-enhanced magnetic resonance imaging (MRI) demonstrated a left–right difference in the optic nerve diameter without any orbital or brain parenchymal lesion. The right eye was enucleated and the cut end of the optic nerve was positive for tumor cells on histopathology. Bone marrow and cerebrospinal fluid analyses showed no tumor invasion. Five courses of chemotherapy were administered, including intrathecal anticancer agents, proton therapy at 45 Gy (RBE)/25 Fr. to the right optic nerve, and high-dose chemotherapy with autologous peripheral blood stem cell transplantation. Five months after treatment completion, there was no recurrence. We expect that the intensified treatment involving both local and systemic approaches is curative despite a tumor-cell-positive surgical margin of the optic nerve. All possible interventions, such as the choice of proton beams and long-term follow-up, could also reduce late complications.</p>

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