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Retinoblastoma case - Brazil

Retinoblastoma case - Brazil. National Cancer Institute – (INCA) Rio de Janeiro – Brazil Evandro Lucena, MD Sima Ferman, MD. Retinoblastoma case - Brazil. Age: 10 month-old girl.

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Retinoblastoma case - Brazil

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  1. Retinoblastoma case - Brazil National Cancer Institute – (INCA) Rio de Janeiro – Brazil Evandro Lucena, MD Sima Ferman, MD

  2. Retinoblastoma case - Brazil • Age: 10 month-old girl. • Diagnosed bilateral retinoblastoma at age of 3 mos (July 2006) when parents noticed deviation in the OS and also noticed leukocoria OU on pictures previously taken.

  3. Retinoblastoma case - Brazil • Underwent EUA on late July, 2006 – Bilateral retinoblastoma B. • OD – Lesion on the macula with 6 mm base and 2 mm height (Ultrasound) and a second lesion with 2 mm base and almost no elevation. Periphery OK. ON OK. • OS – Lesion on the macula compromising the foveal area with 8 mm base and 3 mm height. Periphery and ON normal.

  4. Retinoblastoma case - Brazil • Systemic workup was OK and she started chemo (2 drugs - Vincristine and Carboplatin) on July 26th – 6 cycles and 4 local treatments after the second cycle (TTT X4 in the whole lesion). • The tumors regressed nicely in both eyes. • Last chemo on Nov 13th.

  5. Retinoblastoma case - Brazil • She was followed with monthly EUAs. • In Dec 2006 – OD tumor completely regressed with calcification of the whole lesion. The other lesion (smaller) was flat with a circunjacent pigmented scar. • OS exam showed a completely regressed lesion in the fish-flesh pattern with cincunjacent pigmented scar. The macula is compromised but no active lesion or area was noticed.

  6. Retinoblastoma case - Brazil • Jan 29th - EUA OD - Small lesion (Less than 1 DD) just ½ disc from the pigmentary boundary of the bigger lesion OD was noticed. • The dilated OS exam was unchanged.

  7. Retinoblastoma case - Brazil • March 2nd, 2007 - EUA OD - Showed multiple snowball lesions OD with different sizes (1 to 3 DD) some close to the posterior pole and some to the inferior periphery. Superior hemisphere was OK. • No vitreous seeding weas noticed. • The neovascularization to the lesions is very important and we could see new tumors close to the periphery. • Stage D (good D). OS is OK. NO tumor growth or seeding to the vitreous or to the retina.

  8. Retinoblastoma case - Brazil • Questions: • 10 month old D with no hope for chemo plus local treatment OD. Next step? • EBRT with that little age? • Start chemo and wait for at least 15 months for EBRT? • Local carboplatin (Subtenon)? • Enucleation? • We were thinking about 4+ more cicles of Vincristine, carboplatin and VP16, close follow up for the OS and EBRT OD as soon as the age allows us. Any place for subtenon carboplatin? • Any insights?

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