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Factors Predictive of Recurrence of Retinal Tumors, Vitreous Seeds, and Subretinal Seeds Following Chemoreduction for Retinoblastoma
Carol L. Shields, MD;
Santosh G. Honavar, MD;
Jerry A. Shields, MD;
Hakan Demirci, MD;
Anna T. Meadows, MD;
Thomas John Naduvilath, MSc
Arch Ophthalmol. 2002;120:460-464.
Objective To identify the clinical features of eyes with retinoblastomas that
predict the recurrence of retinal tumors, vitreous seeds, and subretinal seeds
following treatment with chemoreduction.
Design Prospective nonrandomized single-center clinical trial.
Setting Ocular oncology service at Wills Eye Hospital of Thomas Jefferson University
(Philadelphia, Pa) in conjunction with the division of oncology at Children's
Hospital of Philadelphia.
Participants There were 158 eyes with 364 tumors in 103 consecutive patients with
retinoblastoma managed with chemoreduction between June 1994 and August 1999.
Intervention All patients received treatment for retinoblastoma with 6 cycles of
chemoreduction using vincristine, etoposide, and carboplatin combined with
focal treatment (cryotherapy, thermotherapy, or plaque radiotherapy) for each
retinal tumor.
Main Outcome Measures The 3 main outcome measures included recurrence of retinal tumors, recurrence
of vitreous seeds, and recurrence of subretinal seeds. The clinical features
at the initial examination were analyzed for their association with the main
outcome measures using a series of Cox proportional hazards regressions.
Results All retinal tumors, vitreous seeds, and subretinal seeds showed an initial
favorable response of regression during this treatment regimen. Using Kaplan-Meier
estimates, at least 1 retinal tumor recurrence per eye was found in 37% of
eyes at 1 year, 51% at 3 years, and no further increase at 5 years. By multivariate
analysis, the only factor predictive of retinal tumor recurrence was the presence
of tumor-associated subretinal seeds at the initial examination. Of the 54
eyes that had vitreous seeds at the initial examination, vitreous seed recurrence
was found in 26% of eyes at 1 year, 46% at 3 years, and 50% at 5 years. By
univariate analysis, the only factor predictive of vitreous seed recurrence
was the presence of tumor-associated subretinal seeds at the initial examination.
Of the 71 eyes that had subretinal seeds at the initial examination, subretinal
seed recurrence was detected in 53% of eyes at 1 year, 62% at 3 years, and
no further increase at 5 years. By multivariate analysis, factors predictive
of subretinal seed recurrence included a tumor base greater than 15 mm and
a patient age of 12 months or younger at diagnosis. There were no patients
who developed retinoblastoma metastasis, pinealoblastoma, or second malignant
neoplasms.
Conclusions Chemoreduction combined with focal therapy is effective for selected
eyes with retinoblastomas. Eyes with subretinal seeds at initial examination
are at particular risk for recurrence of retinal tumor and vitreous seeds.
Younger patients with large tumors are at risk for recurrence of subretinal
seeds. Retinal tumor and subretinal seed recurrence seems to manifest within
3 years of follow-up. Close follow-up of all patients treated with chemoreduction
is warranted.
From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson
University, (Drs C. L. Shields, Honavar, J. A. Shields, and Demirci); the
Division of Oncology, The Children's Hospital of Philadelphia, (Dr Meadows),
Philadelphia, Pa; and the Ocular Oncology Service, LV Prasad Eye Institute,
Hyderabad, India (Dr Honavar and Mr Naduvilath).
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