title: The modern role of radiation therapy in treating advanced-stage retinoblastoma: long-term outcomes and racial differences.
abstract: OBJECTIVE
  To evaluate the effects of various patient characteristics and radiation therapy treatment variables on outcomes in advanced-stage retinoblastoma.
  
  
  METHODS
  This was a retrospective review of 41 eyes of 30 patients treated with external beam radiation therapy between June 1, 1992, and March 31, 2012, with a median follow-up time of 133 months (11 years). Outcome measures included overall survival, progression-free survival, local control, eye preservation rate, and toxicity.
  
  
  RESULTS
  Over 90% of the eyes were stage V. Definitive external beam radiation therapy (EBRT) was delivered in 43.9% of eyes, adjuvant EBRT in 22% of eyes, and second-line/salvage EBRT in 34.1% of eyes. A relative lens sparing (RLS) technique was used in 68.3% of eyes and modified lens sparing (MLS) in 24.4% of eyes. Three eyes were treated with other techniques. Doses ≥45 Gy were used in 68.3% of eyes. Chemotherapy was a component of treatment in 53.7% of eyes. The 10-year overall survival was 87.7%, progression-free survival was 80.5%, and local control was 87.8%. White patients had significantly better overall survival than did African-American patients in univariate analysis (hazard ratio 0.09; 95% confidence interval 0.01-0.84; P=.035). Toxicity was seen in 68.3% of eyes, including 24.3% with isolated acute dermatitis.
  
  
  CONCLUSIONS
  External beam radiation therapy continues to be an effective treatment modality for advanced retinoblastoma, achieving excellent long-term local control and survival with low rates of treatment-related toxicity and secondary malignancy.
authors.affiliation: Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Amber
authors.initials: A
authors.lastname: Orman
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Tulay
authors.initials: T
authors.lastname: Koru-Sengul
authors.affiliation: Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Feng
authors.initials: F
authors.lastname: Miao
authors.affiliation: Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Arnold
authors.initials: A
authors.lastname: Markoe
authors.affiliation: Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: jpanoff@med.miami.edu.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Panoff
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D044383:Black People; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007908:Lens, Crystalline; D008297:Male; D009364:Neoplasm Recurrence, Local; D059351:Organ Sparing Treatments / Q000379:methods*; D011832:Radiation Injuries / Q000150:complications; D019572:Retinal Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D012175:Retinoblastoma / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome; D044465:White People; D001741:Black or African American