Abstract
Purpose :
While combining surgery with chemotherapy is common practice in many forms of cancer, it has not been forthcoming in retinoblastoma. Tylectomy (“tylos”, “lump” in Ancient Greek) refers to surgical resection of retinoblastoma via pars plana vitrectomy with intra-operative chemotherapy infusion. Our previous study of 960 children showed managing of children with tylectomy did not compromise overall survival compared to without tylectomy. This study compared eye salvage rates when standard therapies included tylectomy (Group I) versus no tylectomy (Group II).
Methods :
Retrospective review of consecutive eyes with IIRC Group D or E retinoblastoma treated with eye salvage therapy diagnosed between 2012–2017 in 29 Chinese centers. Absolute contraindications for tylectomy were evidence of optic nerve or extra-scleral invasion on imaging. Relative contraindications were eyes with obscuration of the optic nerve or poor visual prognosis.
Results :
Studied were 1322 eyes of 1016 children, 470 (36%) Group I and 852 (64%) Group II. Primary treatment was systemic chemotherapy (990, 75%) or intra-arterial chemotherapy (332, 25%). 5-year ocular survival was higher for Group I than Group II (80% v 47%; P<0.001), for both Group D (81% v 62%; P<0.001) and Group E (77% v 20%; P<0.001) eyes. Group I had higher 5-year ocular survival than Group II with either primary systemic chemotherapy (80% v 40%; P<0.001) or intra-arterial chemotherapy (80% v 67%; P<0.001). The number of cycles of pre-tylectomy systemic chemotherapy (mean 3.1 v 2.5; P<0.001) was higher in Group I than Group II eyes; number of intra-arterial chemotherapy cycles (mean 1.4 v 1.6; P=0.072) did not differ between Groups. Adjuvant intravitreal or systemic chemotherapy after tylectomy (Group I) did not affect 5-year eye salvage (80% v 81%; P=0.433). 5-year overall survival rate was not significantly different between Group I and Group II children (95% v 92%; P=0.065).
Conclusions :
In retinoblastoma management, treatment goal is to cure cancer while preserving eye, vision and patient’s quality of life. Tylectomy may both physically remove chemotherapy-resistant tumor and address complications of previous therapies, thereby sparing eyes previously deemed unsalvagable. Overall, tylectomy as part of multimodal therapy improved eye salvage, with no impact on survival.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.