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The Outcome of Chemoreduction Treatment in Patients With Reese-Ellsworth Group V Retinoblastoma
Kaan Gündüz, MD;
Carol L. Shields, MD;
Jerry A. Shields, MD;
Anna T. Meadows, MD;
Nicole Gross, MD;
Jacqueline Cater, PhD;
Michael Needle, MD
Arch Ophthalmol. 1998;116:1613-1617.
Objective To determine the outcome of chemoreduction treatment in patients with Reese-Ellsworth group V retinoblastoma.
Methods Prospective analysis of 27 eyes in 22 patients with group V retinoblastoma treated with either 2- or 6-cycle chemoreduction and focal treatment methods (argon laser photocoagulation, transpupillary thermotherapy, cryotherapy, and plaque radiotherapy). The need for external beam irradiation and the eventual globe salvage rate were assessed. Median follow-up was 28 months.
Results There were 16 eyes in the 2-cycle chemoreduction treatment group and 11 eyes in the 6-cycle chemoreduction treatment group. No significant difference was noted between the 2 groups with respect to baseline patient and eye findings. After chemoreduction treatment, external beam irradiation was necessary in 12 (75%) of 16 eyes in the 2-cycle chemoreduction treatment group and in 4 (36%) of 11 eyes in the 6-cycle chemoreduction treatment group. There was no statistical difference between the 2- and 6-cycle chemoreduction treatment groups with respect to necessity for external beam irradiation (logistic regression analysis). All 4 eyes in the 2-cycle chemoreduction treatment group and 3 of 12 eyes in the 2-cycle chemoreduction treatment and irradiation group were eventually enucleated, the globe salvage rates being 0% and 75%, respectively. Two of 7 eyes in the 6-cycle chemoreduction treatment group and 1 of 4 eyes in the 6-cycle chemoreduction treatment and irradiation group were enucleated, the globe salvage rates being 71% and 75%, respectively. Except for the 2-cycle chemoreduction treatment group, in which the globe salvage rate was significantly lower (P=.03), there was no difference among the other 3 groups (2-cycle chemoreduction treatment and irradiation, 6-cycle chemoreduction treatment, and 6-cycle chemoreduction treatment and irradiation) with respect to globe salvage (logistic regression analysis).
Conclusions Local tumor control of group V retinoblastoma is possible with 6-cycle chemoreduction and focal therapy when external beam irradiation is not used. A larger sample size is necessary to determine how often external beam irradiation can be avoided.
From the Oncology Service, Wills Eye Hospital, Thomas Jefferson University (Drs Gündüz, C. L. Shields, J. A. Shields, Gross, and Cater), and the Children's Hospital of Philadelphia (Drs Meadows and Needle), Philadelphia, Pa.
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