{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T13:58:39Z","timestamp":1789826319586,"version":"4.0.1"},"reference-count":36,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"King Hussein Cancer Center, Amman, Jordan","award":["25KHCC05"],"award-info":[{"award-number":["25KHCC05"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: This study aimed to evaluate the outcomes and predictive factors of I-125 radioactive plaque therapy for recurrent and refractory retinoblastoma (Rb) cases that failed primary systemic chemotherapy and focal therapies. Methods: A retrospective study of 20 eyes with intraocular Rb treated with I-125 radioactive plaque therapy (Apex dose 45 Gy) from 2013 to 2023 was conducted. Data on tumor characteristics, treatments, and outcomes were collected over a follow-up period of at least one year. Results: There were 11 (55%) males and 8 (40%) patients who had bilateral disease. All 20 treated eyes (100%) showed initial tumor regression, while long-term tumor control and eye salvage were achieved in 14 eyes (70%). Six eyes (30%) experienced uncontrollable tumor recurrence after a mean of 6 months (range: 3\u201312 months) after plaque therapy. Recurrence included main tumor activity in six eyes and additional resistant vitreous seeds in two of them. Poor predictive factors for eye salvage included Group D at diagnosis (p = 0.044), active vitreous seeds at the time of plaque therapy ((p = 0.045), tumor thickness &gt;5.0 mm (p = 0.045), and tumor base dimension &gt;12 mm (p = 0.023). Post-plaque complications included cataracts in seven eyes (35%), tumor hemorrhage in six eyes (30%), retinal detachment in four eyes (20%), radiation retinopathy in three eyes (15%), and neovascular glaucoma in one eye (5%). Five (83%) of those with tumor hemorrhage had plaque surgery performed within less than 6 months of the last cycle of systemic chemotherapy. At a mean follow-up of 36 months (range: 12\u201396 months), five eyes (25%) were enucleated, and high-risk pathological features were identified in three eyes, including post-laminar optic nerve infiltration (one eye) and massive choroidal invasion (two eyes). All patients were alive and free of metastasis except one patient (5%) whose parents refused enucleation and came back with extra-scleral extension and bone marrow metastasis and eventually passed away. Conclusions: I-125 radioactive plaque therapy is a valuable salvage treatment for recurrent and refractory retinoblastoma, achieving tumor control and eye salvage in 70% of cases with an acceptable safety profile. However, the observed recurrence rate (30%) at an apex dose of 45 Gy suggests a need for dose optimization and individualized treatment strategies. Identifying high-risk features, such as Group D disease, active vitreous seeds, and larger tumors, is crucial for patient selection and outcome prediction. Future research should explore alternative dosing strategies, combination therapies, and improved predictive models to enhance long-term tumor control while minimizing complications.<\/jats:p>","DOI":"10.3390\/jcm14051778","type":"journal-article","created":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T09:59:17Z","timestamp":1741255157000},"page":"1778","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes and Predictive Factors of I-125 Plaque Therapy for Refractory Retinoblastoma"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7750-6454","authenticated-orcid":false,"given":"Yacoub A.","family":"Yousef","sequence":"first","affiliation":[{"name":"Department of Surgery\/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah","family":"Halawa","sequence":"additional","affiliation":[{"name":"Department of Surgery\/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8318-1171","authenticated-orcid":false,"given":"Mona","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Department of Surgery\/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lama","family":"Al-Fahoum","sequence":"additional","affiliation":[{"name":"Department of Surgery\/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rama","family":"Soudi","sequence":"additional","affiliation":[{"name":"Department of Surgery\/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Mehyar","sequence":"additional","affiliation":[{"name":"Department of Surgery\/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem","family":"AlJabari","sequence":"additional","affiliation":[{"name":"Department of Surgery\/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4803-1976","authenticated-orcid":false,"given":"Hadeel","family":"Halalsheh","sequence":"additional","affiliation":[{"name":"Department Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"AlNawaiseh","sequence":"additional","affiliation":[{"name":"Department of Surgery\/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imad","family":"Jaradat","sequence":"additional","affiliation":[{"name":"Department Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Barbosa, A.C., de Magalh\u00e3es-Barbosa, M.C., de Lima Moreira, J.P., Colombini, G.N.U.I., and Prata-Barbosa, A. 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