title: Enucleation vs Ophthalmic Artery Chemosurgery for Advanced Intraocular Retinoblastoma: A Retrospective Analysis.
abstract: OBJECTIVE
  Ophthalmic artery chemosurgery (OAC) has emerged as a primary treatment for advanced-stage retinoblastoma. To our knowledge, the incidence of orbital recurrence in eyes treated with OAC has not been described.
  
  
  OBJECTIVE
  To determine the incidence of orbital recurrence following enucleation or OAC as primary treatments for advanced-stage retinoblastoma.
  
  
  METHODS
  Single-institution cohort study with retrospective record review at an academic ophthalmic oncology practice. A total of 140 eyes in 135 patients who presented between February 14, 2006, and March 4, 2014, and were classified as having Reese-Ellsworth group 5 or International Classification of Retinoblastoma (Children's Oncology Group) group D or E retinoblastoma were included; 63 patients (63 eyes) were primarily treated with enucleation and 72 patients (77 eyes) were primarily treated with OAC. This analysis was conducted between August 1, 2014, and March 1, 2015.
  
  
  METHODS
  Incidence of and time to orbital recurrence, metastasis, and death.
  
  
  RESULTS
  There were 5 orbital recurrences (incidence, 7.9%) in the primary enucleation group and 1 orbital recurrence (incidence, 1.3%) in the primary OAC group during median follow-up times of 42.6 months (range, 6.2-97.1 months) and 38.7 months (range, 9.0-104.3 months), respectively. The 24-month Kaplan-Meier estimate for orbital recurrence-free survival was worse for the enucleation group (92.1%; 95% CI, 82.0-96.7) than for the OAC group (100%) (log-rank test, P = .049). The enucleation group had 5 cases of metastatic disease (7.9%) and 2 deaths (3.2%). In the OAC group, there were 3 cases of metastatic disease (4.2%) and no deaths. Kaplan-Meier analysis of metastasis-free survival and overall survival yielded no differences between the 2 treatment groups. Analysis of a number of features of the 2 groups revealed more eyes with iris neovascularization in the enucleation group (25.4%) than in the OAC group (5.2%) and more eyes with group E retinoblastoma in the enucleation group (87.3%) than in the OAC group (29.9%), although neither of these factors was an independent predictor of orbital relapse in a Cox proportional hazards model.
  
  
  CONCLUSIONS
  In this single-institution retrospective study of advanced intraocular retinoblastoma, there were more orbital recurrences in the group primarily treated with enucleation. Ophthalmic artery chemosurgery for advanced intraocular retinoblastoma was not found to increase the chance of orbital recurrence, metastatic disease, or death compared with primary enucleation.
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Nicolas Alessandro
authors.initials: NA
authors.lastname: Yannuzzi
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York2Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
authors.forename: Jasmine H
authors.initials: JH
authors.lastname: Francis
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York2Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Irina
authors.initials: I
authors.lastname: Belinsky
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York, New York4Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Dunkel
authors.affiliation: Service of Interventional Neuroradiology, Department of Neurology and Radiology, Weill Cornell Medical College, New York, New York.
authors.forename: Yves Pierre
authors.initials: YP
authors.lastname: Gobin
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York2Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
authors.forename: David Harold
authors.initials: DH
authors.lastname: Abramson
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D002675:Child, Preschool; D018572:Disease-Free Survival; D015353:Eye Enucleation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009880:Ophthalmic Artery / Q000187:drug effects*; D019572:Retinal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012175:Retinoblastoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents