Second Primary Malignancies in Retinoblastoma Patients Treated with Intraarterial Chemotherapy: The First Ten Years.

Abstract

Purpose : Survivors of retinoblastoma carry a lifetime risk of secondary malignancies. It is well established that external beam radiation increases this risk, however, the long-term risk of intraarterial chemotherapy remains unknown.¹ We report on ten years of experience with intraarterial chemotherapy and the rate of second primary malignancy (SPM) development.

Methods : This is a retrospective review approved by the Memorial Sloan Kettering Cancer Center (MSKCC) institutional review board (IRB) of all patients who received intraarterial therapy over a ten-year period, May 2006 to November 2016. The clinical characteristics including age at first treatment, sex, laterality, genetics, family history and adjunctive therapy were collected. Second tumor free survival in bilateral and unilateral with family history or confirmed germline mutation was estimated using the Kaplan-Meier method.

Results : Twenty-nine unilateral patients with family history or confirmed germline mutation and 205 bilateral patients were analyzed. One patient was excluded as she presented with trilateral disease. Over the study period 5 patients developed a SPM. Of those, 4 were pineal tumors in patients that had not received external beam radiation (EBR) and 1 was an osteogenic sarcoma of the orbit in a patient that did receive EBR. All of the patients with SPM were bilateral patients in this cohort. Kaplan Meier analysis estimates the likelihood of developing a second cancer to be 3.7% at 5 years (95% CI 2.4 – 6.9). (Figure 1)

Conclusions : In our ten-year experience we have found that SPM development in patients treated with intraarterial chemotherapy was comparable to previously published rates for germline patients.^1,2 In the first ten years, intrarterial chemotherapy did not increase the known incidence of second malignancies and the most common second malignancy was a pineal tumor. This cohort will continue to be followed to establish the rate of development with extended follow up.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.