Visual fields in retinoblastoma survivors

OBJECTIVE

To describe the visual field defects in retinoblastoma survivors and relate those defects to characteristics such as tumor size, tumor location, and treatment modality.

METHODS

Thirty-one patients treated for retinoblastoma were included in this study. Humphrey visual fields were determined in 33 eyes.

RESULTS

Twenty-seven patients (29 eyes, 68 tumors) had sufficient diagnosis and treatment data available for further analysis. Twenty-six of the 27 patients had both absolute and relative visual field defects. Four types of visual field defects were observed and correlated with location of the tumor and therapy to the individual tumors: (1) no residual defect, (2) absolute scotoma, (3) arcuate and sector scotoma, and (4) "pseudo"-visual field defects caused by relative enophthalmos resulting from radiation.

CONCLUSIONS

Patients with retinoblastoma demonstrate a variety of long-term visual field defects after treatment for their intraocular disease. Characteristics that determine the size and type of defects are tumor size, tumor location, and treatment method.

Nonocular Second Primary Tumors After Retinoblastoma

The objective of this study was to assess the role of various clinical and treatment factors involved in the long-term incidence of nonocular second primary tumors following retinoblastoma. The study was based on 111 patients treated between 1963 and 1977 according to the same radiotherapy protocol (electron beam radiotherapy) alone or in combination with triethylene melamine (TEM). Various statistical methods were used to obtain the actuarial survival curve, the cumulative incidence of second primary tumors, and comparisons of patient groups and subgroups. The 5-, 10-, 20-, and 30-year survival rates were 75%, 70%, 63%, and 55% with a follow-up of 23 to 35 years. The study reports the various parameters concerning 111 children and 17 second primary tumors: sex, age at treatment, histology of the retinoblastoma and second primary tumors, site of second tumors (anatomic and compared with irradiation field), radiation dose, time to onset, and chemotherapy with or without TEM. The results are discussed and compared with the data reported in the literature. Electron beam radiotherapy at a dose of 45 Gy does not eliminate the risk of nonocular second primary tumors. TEM also does not modify survival or the overall incidence of second primary tumors, but significantly increases the risk of second primary tumors outside the irradiation field.

[Apropos of a case of renal oncocytoma with hepatic localization]

A renal oncocytoma was treated by radical nephrectomy. Although it was considered benign, hepatic localizations were discovered seven years later. The authors discuss the problems of whether these were secondary metastatic lesions or a new development in the evolution of the disease.

Mesothelioma following Wilms' tumor in childhood

A high percentage of children with Wilms' tumor are cured with multimodal treatment. A small percentage of these children will develop second tumors, perhaps related to a genetic predisposition to neoplasia or possibly secondary to the treatment utilized for Wilms' tumor. Malignant mesothelioma has been associated with contact with asbestos but has also been reported after radiation exposure. Two patients are reported who developed malignant mesothelioma of the pleura after treatment for Wilms' tumor in childhood. Both received orthovoltage radiation; one patient also received triethylenemelamine (TEM), an alkylating agent closely related to nitrogen mustard, for 5 years. Factors in the development of second tumors are discussed.

[Results of treatment in cases with bilateral retinoblastoma (author's transl)]

Immediate and late results of treatment in 132 cases with bilateral retinoblastoma (the children were aged between two months and six years) were analyzed. Combined treatment comprised enucleation of the more affected eye, further chemotherapy, X-ray treatment and photocoagulation. Cytostatic compounds used were "TET" (analogous to "TEM") and "Prospidin". Of the treated children, 44.8% are alive; the period of observation ranged from seven to 16 years.

Retinoblastoma. A survivor 12 years after treatment for metastatic disease

A 21-year-old man currently is well 12 years after his last treatment for metastatic retinoblastoma.

Chemotherapy of childhood medulloblastoma

A number of chemotherapeutic agents have been shown to have anti-tumor activity against childhood medulloblastoma. Ten-year survival with optimal surgery and radiation therapy ranges from 5% to 25%. Carefully controlled clinical trials utilizing a combination of surgery, radiation therapy, and chemotherapy should be employed in the early stages of the disease in an attempt to define which drugs are most effective, and to improve the survival rate.

Non-Hodgkin's malignant lymphomata in adults: chemo-radiotherapy in stages III and IV

Patients presenting with Stage III or IV non-Hodgkin's malignant lymphoma were given chemotherapy; about 20% complete remission was obtained for both stages. The addition of radiotherapy increased the incidence to 70% in Stage III patients. The duration of first complete remission was longer for Stage III (25% of the patients are still in first remission at 7 years) than for Stage IV (0%). The survival was longer for nodular lymphosarcoma patients (25% are alive at 7 years for Stages III and IV) than for diffuse lymphosarcomata and reticulosarcomata (10%). Among the new drugs, VM 26 is able to produce a good frequency of remission in patients in relapse.

Chemotherapy in polycythemia vera

210 cases of polycythemia vera were observed over a period of 15 years. The majority of them received P32; treatment with Myleran instead of with radioactive phosphorus was instituted only recently. To a small number of patients chemotherapy was given alternately with P32. The differing response pattern to either kind of treatment and the possible interference of therapy with the natural development of the disease process are demonstrated in a few selected cases.