title: Risk factors for extraocular relapse following enucleation after failure of chemoreduction in retinoblastoma.
abstract: OBJECTIVE
  To assess the outcome and determine risk factors for extraocular relapse in patients with retinoblastoma who had been enucleated after failure of chemoreduction.
  
  
  METHODS
  Retrospective study (1995-2002) at three institutions. Pathological risk factors (PRF) were defined as invasion of the anterior segment, choroid, post-laminar optic nerve, subarachnoid space, or sclera according to the local pathology report. Extraocular relapse was defined as an event.
  
  
  RESULTS
  One hundred twenty-two patients were included (17 had bilateral enucleation). Chemoreduction included vincristine, carboplatin, and etoposide (n=80, 65.6%), vincristine, and carboplatin (n=17, 13.9%), or carboplatin (n=25, 20.5%). Thirty-five also received external beam radiotherapy (28.7%). PRF included: 39 with choroidal involvement, 9 with anterior segment, 9 with scleral, and 2 with post-laminar optic nerve with subarachnoid invasion. Adjuvant chemotherapy was given to eight patients (6.5%) because of scleral invasion. Four patients had an extraocular relapse after enucleation, two of whom survive after intensive treatment including stem cell rescue. Five-year probability of event-free survival is 0.96. Only scleral invasion and bilateral enucleation were significantly associated with extraocular relapse.
  
  
  CONCLUSIONS
  The risk of extraocular relapse is low after enucleation following failure of chemoreduction. Patients who underwent bilateral enucleation and those with scleral invasion are at higher risk of extraocular relapse.
authors.affiliation: Department of Hemato-oncology, Hospital JP Garrahan, Buenos Aires, Argentina, and Department of Pathology, University of Sao Paulo, Brazil. gchantada@yahoo.com
authors.forename: Guillermo L
authors.initials: GL
authors.lastname: Chantada
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Dunkel
authors.forename: Celia B G
authors.initials: CB
authors.lastname: Antoneli
authors.forename: María T G
authors.initials: MT
authors.lastname: de Dávila
authors.forename: Victor
authors.initials: V
authors.lastname: Arias
authors.forename: Katherine
authors.initials: K
authors.lastname: Beaverson
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Fandiño
authors.forename: Martha
authors.initials: M
authors.lastname: Chojniak
authors.forename: David H
authors.initials: DH
authors.lastname: Abramson
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009361:Neoplasm Invasiveness; D019572:Retinal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D012175:Retinoblastoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin