Practical approach to management of retinoblastoma.

Abstract

OBJECTIVE:

To present a simplified approach to management of retinoblastoma using basic clinical features.

DESIGN:

In a prospective, nonrandomized, single-center clinical trial, 158 eyes of 103 patients with retinoblastoma were managed with 6 cycles of chemoreduction (vincristine sulfate, etoposide, and carboplatin). The eyes were classified according to the Reese-Ellsworth classification and were also grouped on the basis of clinical features as follows: group 1, tumor only; group 2, tumor plus subretinal fluid; group 3, tumor plus focal seeds (3a, focal subretinal seeds; 3b, focal vitreous seeds); group 4, tumor plus diffuse seeds (4a, diffuse subretinal seeds; 4b, diffuse vitreous seeds); and group 5, neovascular glaucoma or invasive retinoblastoma.

MAIN OUTCOME MEASURE:

Treatment success (avoidance of enucleation and external beam radiotherapy).

RESULTS:

According to the Reese-Ellsworth classification, chemoreduction was successful in 100% of group Ia, 100% of group Ib, 86% of group IIa, 100% of group IIb, 91% of group IIIa, 100% of group IIIb, 50% of group IVa, 77% of group IVb, 50% of group Va, and 27% of group Vb. There was erratic correlation of the Reese-Ellsworth classification with treatment success. In contrast, the simplified grouping system displayed a smooth, nonerratic correlation for treatment success, with 100% success for group 1, 91% for group 2, 59% for group 3, and 12% for group 4 (group 5 always managed by primary enucleation). When all 6 subcategory groups were analyzed, there was consistent correlation for treatment success of 100% for group 1, 91% for group 2, 68% for group 3a, 54% for group 3b, 17% for group 4a, and 11% for group 4b.

CONCLUSION:

This practical approach to retinoblastoma using basic clinical features is predictive of treatment success for eyes in which modern conservative therapy for retinoblastoma is used.

• Authors: Carol L Shields, Arman Mashayekhi, Hakan Demirci, Anna T Meadows, Jerry A Shields
• Journal: Archives of ophthalmology (Chicago, Ill. : 1960) (Arch Ophthalmol) Vol. 122 Issue 5 Pg. 729-35 (May 2004) ISSN: 0003-9950 [Print] United States
• PMID: 15136321 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Vincristine
• Etoposide
• Carboplatin

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carboplatin (administration & dosage, therapeutic use)
• Child, Preschool
• Etoposide (administration & dosage, therapeutic use)
• Humans
• Infant
• Prospective Studies
• Retinal Neoplasms (classification, drug therapy, pathology)
• Retinoblastoma (classification, drug therapy, pathology)
• Treatment Outcome
• Vincristine (administration & dosage, therapeutic use)