Abstract
Purpose :
Primary intravenous chemotherapy (chemoreduction) is an effective treatment for retinoblastoma, but recurrence is not uncommon. We performed a retrospective, observational study to identify risk factors for retinoblastoma recurrence following chemoreduction.
Methods :
Retrospective review of retinoblastoma managed from 1994-2019 with Kaplan-Meier, Cox regression, and logistic regression analysis.
Results :
There were 869 eyes of 551 patients with retinoblastoma managed with chemoreduction. Follow up in 556 eyes revealed new tumor (n=118, 21%), main tumor recurrence (n=355, 64%), subretinal seed recurrence (n=244, 44%), and/or vitreous seed recurrence (n=162, 29%), requiring management with focal therapy (transpupillary thermotherapy, cryotherapy) (n=294, 53%), intra-arterial chemotherapy (n=125, 22%), intravitreal chemotherapy (n=36, 6%), plaque radiotherapy (n=120, 22%), external beam radiotherapy (n=57, 10%), and/or enucleation (n=49, 9%). Of all recurrences, 62% were detected by 1 year, 86% by 2 years, 94% by 3 years, 98% by 5 years, 99% by 10 years, and 100% by 15 years. Risk factors for recurrence on univariate analysis (odds ratio (OR) [95% confidence interval]) included younger age at diagnosis (OR 1.02 [1.01-1.03] per 1 month of age, p=0.003), more advanced International Classification of Retinoblastoma (ICRB) group (OR 1.27 [1.13-1.43], p<0.001), greater number of tumors on presentation (OR 1.12 [1.02-1.24], p=0.01), greater tumor basal diameter (OR 1.05 [1.03-1.08] per 1 mm increase, p<0.001) and thickness (OR 1.08 [1.04-1.12] per 1 mm increase, p<0.001), shorter tumor distance to foveola (OR 1.13 [1.08-1.18] per 1 mm decrease, p<0.001) and optic disc (OR 1.18 [1.12-1.24] per 1 mm decrease, p<0.001), and initial presentation with subretinal seeds (OR 2.27 [1.64-3.15], p<0.001), subretinal fluid (OR 1.68 [1.25-2.25], p=0.001), and anterior chamber seeds (OR 5.22 [1.08-25.33], p=0.04). Factors significant on multivariate analysis included age, ICRB group, distance to optic disc, and subretinal seeds.
Conclusions :
Retinoblastoma recurrence after chemoreduction is usually detected within the first 3 years of treatment. Younger patients with more advanced, posteriorly located tumor, and subretinal seeds at presentation are at increased risk, but recurrence can often be managed with globe-sparing therapy.
This is a 2020 ARVO Annual Meeting abstract.