title: Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatments.
abstract: BACKGROUND
  The impact of chemotherapy, focal therapies, radiation and co-existing ocular morbidities on histology of eyes with retinoblastoma enucleated following chemoreduction is not well known.
  
  
  METHODS
  Twenty-five eyes (23 patients) with retinoblastoma enucleated after failing eye-salvage therapy were evaluated. Reasons for enucleation (tumor progression, subretinal or vitreous seeds) and co-morbid conditions (neovascular glaucoma, cataract, vitreous hemorrhage and retinal detachment) were documented. All specimens were reviewed for evidence of ciliary body, choroidal, optic nerve, and scleral invasion.
  
  
  RESULTS
  The median age at diagnosis was 14 months (range, 1-37 months). Twenty eyes were classified as Reese-Ellsworth Group IV-V at diagnosis. Twenty-four eyes had recurrent disease at enucleation; one eye was enucleated for neovascular glaucoma and vitreous hemorrhage. Co-existing ocular morbidities at enucleation included vitreous hemorrhage (n = 6), retinal detachment (n = 9), neovascular glaucoma (n = 9) and cataracts (n = 3). Histologic findings included choroidal invasion (n = 7), ciliary body invasion (n = 4), optic nerve invasion (n = 6) and scleral invasion (n = 3). The median time from diagnosis to enucleation was 11 months. Co-existing retinal detachment and vitreous hemorrhage significantly increased the likelihood of optic nerve invasion (P = 0.014 and P = 0.011, respectively). Prolonged time to enucleation was significantly associated with the likelihood of choroidal (P = 0.010) and ciliary body (P = 0.021) invasion as well as invasion of multiple sites.
  
  
  CONCLUSIONS
  In eyes with retinoblastoma enucleated after chemoreduction, co-existing ocular morbidities and time to enucleation are predictive of extra-retinal extension.
authors.affiliation: Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Balaguer
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Wilson
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Billups
authors.forename: John
authors.initials: J
authors.lastname: Mancini
authors.forename: Barrett G
authors.initials: BG
authors.lastname: Haik
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Qaddoumi
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Khoury
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez-Galindo
mesh_terms: D002675:Child, Preschool; D015353:Eye Enucleation; D006801:Humans; D007223:Infant; D009361:Neoplasm Invasiveness / Q000473:pathology; D012175:Retinoblastoma / Q000473:pathology* / Q000601:surgery; D016879:Salvage Therapy