title: Practical approach to management of retinoblastoma.
abstract: OBJECTIVE
  To present a simplified approach to management of retinoblastoma using basic clinical features.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Ocular Oncology Service, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107, USA. carol.shields@shieldsoncology.com
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Arman
authors.initials: A
authors.lastname: Mashayekhi
authors.forename: Hakan
authors.initials: H
authors.lastname: Demirci
authors.forename: Anna T
authors.initials: AT
authors.lastname: Meadows
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D005047:Etoposide / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D019572:Retinal Neoplasms / Q000145:classification / Q000188:drug therapy* / Q000473:pathology; D012175:Retinoblastoma / Q000145:classification / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014750:Vincristine; D005047:Etoposide; D016190:Carboplatin