Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatments.
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.
Balaguer
Julia
J
Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
Wilson
Matthew W
MW
Billups
Catherine A
CA
Mancini
John
J
Haik
Barrett G
BG
Qaddoumi
Ibrahim
I
Khoury
Joseph D
JD
Rodriguez-Galindo
Carlos
C
D002675:Child, Preschool; D015353:Eye Enucleation; D006801:Humans; D007223:Infant; D009361:Neoplasm Invasiveness / Q000473:pathology; D012175:Retinoblastoma / Q000473:pathology* / Q000601:surgery; D016879:Salvage Therapy