title: Survival in extra-orbital metastatic retinoblastoma:treatment results.
abstract: BACKGROUND
  Retinoblastoma (RB) is the most frequent malignant eye tumor in childhood. In developing countries advanced stages are common. The purpose of this paper is to present our 21-year clinical experience with metastatic extra ocular RB patients treated with 5 different chemotherapy schemas at a single Mexican Pediatric referral center.
  
  
  METHODS
  A retrospective analysis was carried out reviewing the clinical characteristics of patients with metastatic RB. The information analyzed included the delay in diagnosis after first symptoms, age, sex, ocular staging, and anatomic site of metastases, treatment scheme, initial response and status at the last contact or date of death.
  
  
  RESULTS
  Eighty-one patients were included; age range was from 3 to 80 months. The most common site of metastasis was central nervous system (83.9%). From those patients treated with chemotherapy (n = 74), 89.2% presented a complete initial response (n = 66). Early mortality occurred in 7 cases before any treatment. Fifty-six received treatment and died with progressive disease. All patients without radiotherapy died with tumor activity (n = 15). The use of cisplatin was related with longer disease free intervals; no other variable was related with survival. Four patients were alive and disease free at 33 to 144.3 months of follow up from diagnosis. The prevalent cause of death was tumor progression.
  
  
  CONCLUSIONS
  In our experience, metastatic RB has a very high mortality rate in spite of the use of different chemotherapy regimens.
authors.affiliation: Department of Oncology, Instituto Nacional de Pediatría, Mexico DF, Mexico. drcarlosaleal@msn.com
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Leal-Leal
authors.forename: Roberto
authors.initials: R
authors.lastname: Rivera-Luna
authors.forename: Martha
authors.initials: M
authors.lastname: Flores-Rojo
authors.forename: Juan C
authors.initials: JC
authors.lastname: Juárez-Echenique
authors.forename: Juan C
authors.initials: JC
authors.lastname: Ordaz
authors.forename: Jorge
authors.initials: J
authors.lastname: Amador-Zarco
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D018450:Disease Progression; D018572:Disease-Free Survival; D005134:Eye Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015993:Life Tables; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D008297:Male; D008800:Mexico / Q000453:epidemiology; D020360:Neoadjuvant Therapy; D016016:Proportional Hazards Models; D012074:Remission Induction; D012175:Retinoblastoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D003037:Cobalt Radioisotopes; D002945:Cisplatin