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Carol L. Shields, MD; Melis Palamar, MD; Pooja Sharma, BS; Aparna Ramasubramanian, MD; Ann Leahey, MD; Anna T. Meadows, MD; Jerry A. Shields, MD

Arch Ophthalmol. 2009;127(3):282-290.

Objective  To evaluate retinoblastoma regression patterns following chemoreduction and adjuvant therapy.

Participants  A total of 557 retinoblastomas.

Methods  A retrospective medical record review following 6 cycles of chemoreduction and tumor consolidation (thermotherapy or cryotherapy). Regression patterns included type 0 (no remnant), type 1 (calcified remnant), type 2 (noncalcified remnant), type 3 (partially calcified remnant), and type 4 (flat scar).

Main Outcome Measures  Regression pattern.

Results  Retinoblastoma regressions were type 0 (n = 10), type 1 (n = 75), type 2 (n = 28), type 3 (n = 127), and type 4 (n = 317). Tumors with an initial thickness of 3 mm or less regressed most often to type 4 (92%), those 3 to 8 mm regressed to type 3 (34%) or type 4 (40%), and those thicker than 8 mm regressed to type 1 (40%) or type 3 (49%). Factors predictive of type 1 regression included larger tumor base and closer foveolar proximity. Factors predictive of type 3 included older age, larger tumor base, macular location, closer foveolar proximity, and lack of consolidation. Factors predictive of type 4 included familial hereditary pattern, smaller tumor base, greater foveolar distance, and tumor consolidation.

Conclusions  Following chemoreduction, most small retinoblastomas result in a flat scar, intermediate tumors in a flat or partially calcified remnant, and large tumors in a more completely calcified remnant.

Author Affiliations: The Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University (Drs C. L. Shields, Palamar, Ramasubramanian, and J. A. Shields and Ms Sharma); and the Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Drs Leahey and Meadows).

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