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M. W. Wilson, J. Balaguer, C. Billups, B. G. Haik, C. Rodriguez-Galindo; Prognostic Factors for High Risk Histology Following Chemoreduction for Retinoblastoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2014.
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To study the impact of focal therapies, external beam radiotherapy (EBRT) and co-existing ocular morbidities on histologic findings in eyes with retinoblastoma enucleated following chemoreduction.
Eyes with retinoblastoma enucleated after failing chemoreduction were retrieved from the pathology archives and reviewed for ciliary body, choroidal, optic nerve and scleral invasion. The following data were recorded from the patients’ medical record: age at diagnosis, gender, laterality of disease, Reese-Ellsworth Classification of each eye, chemotherapy received, focal treatments administered to the eye, prior EBRT, reason for and time to enucleation, as well as the presence of neovascular glaucoma, cataract, vitreous hemorrhage and retinal detachment.
25 eyes from 23 patients (18 with bilateral disease) treated for intraocular retinoblastoma, were enucleated between May 1997 and November 2003. Median age at diagnosis was 14 months. 15 patients were female. 20 eyes were classified as Reese-Ellsworth Group IV-V. In addition to chemotherapy, 10 eyes were treated with focal therapies, 9 with focal therapies plus EBRT, and 3 with EBRT. 24 of the 25 eyes had recurrent disease at enucleation; one eye was enucleated for neovascular glaucoma and dense vitreous hemorrhage. Co-existing ocular morbidities included vitreous hemorrhage (n=6), retinal detachment (n=9), neovascular glaucoma (n=9) and cataracts (n=3). Histologic findings included massive deep choroidal (n=7), ciliary body (n=4), post-laminar optic nerve (n=6) and scleral invasion (n=3). Median time to enucleation was 11 months from diagnosis. No treatment rendered significantly increased the likelihood of invasive disease. However, co-existing retinal detachments (p=0.014) and vitreous hemorrhages (p-0.011) both significantly increased the likelihood of optic nerve invasion. Cataracts were associated with a greater risk for scleral invasion (p=0.034). Prolonged time to enucleation significantly increased the likelihood of choroidal (p= 0.010) and ciliary body (p=0.021) invasion as well as the likelihood of multiple sites of invasion (3 sites at median of 25 months).
In eyes with retinoblastoma enucleated after chemoreduction, co-existing ocular morbidities and the time to enucleation were more predictive of choroidal, ciliary body, optic nerve and scleral invasion, rather than the focal and radiation treatments administered.
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