title: Advanced Unilateral Retinoblastoma: The Impact of Ophthalmic Artery Chemosurgery on Enucleation Rate and Patient Survival at MSKCC.
abstract: OBJECTIVE
  To report on the influence of ophthalmic artery chemosurgery (OAC) on enucleation rates, ocular and patient survival from metastasis and impact on practice patterns at Memorial Sloan Kettering for children with advanced intraocular unilateral retinoblastoma.
  
  
  METHODS
  Single-center retrospective review of all unilateral retinoblastoma patients with advanced intraocular retinoblastoma treated at MSKCC between our introduction of OAC (May 2006) and December 2014. End points were ocular survival, patient survival from metastases and enucleation rates.
  
  
  RESULTS
  156 eyes of 156 retinoblastoma patients were included. Primary enucleation rates have progressively decreased from a rate of >95% before OAC to 66.7% in the first year of OAC use to the present rate of 7.4%. The percent of patients receiving OAC has progressively increased from 33.3% in 2006 to 92.6% in 2014. Overall, ocular survival was significantly better in eyes treated with OAC in the years 2010-2014 compared to 2006-2009 (p = 0.023, 92.7% vs 68.0% ocular survival at 48 months). There have been no metastatic deaths in the OAC group but two patients treated with primary enucleation have died of metastatic disease.
  
  
  CONCLUSIONS
  OAC was introduced in 2006 and its impact on patient management is profound. Enucleation rates have decreased from over 95% to less than 10%. Our ocular survival rate has also significantly and progressively improved since May 2006. Despite treating more advanced eyes rather then enucleating them patient survival has not been compromised (there have been no metastatic deaths in the OAC group). In our institution, enucleation is no longer the most common treatment for advanced unilateral retinoblastoma.
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, NewYork, New York, United States of America.|Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, United States of America.
authors.forename: David H
authors.initials: DH
authors.lastname: Abramson
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, NewYork, New York, United States of America.
authors.forename: Armida W M
authors.initials: AW
authors.lastname: Fabius
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, NewYork, New York, United States of America.
authors.forename: Reda
authors.initials: R
authors.lastname: Issa
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, NewYork, New York, United States of America.|Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, United States of America.
authors.forename: Jasmine H
authors.initials: JH
authors.lastname: Francis
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, NewYork, New York, United States of America.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.affiliation: Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America.|Department of Pediatrics, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, United States of America.
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Dunkel
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, NewYork, New York, United States of America.|Interventional Neuroradiology, Departments of Radiology, Neurosurgery and Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, United States of America.
authors.forename: Y Pierre
authors.initials: YP
authors.lastname: Gobin
mesh_terms: D002648:Child; D002675:Child, Preschool; D015353:Eye Enucleation; D006801:Humans; D007223:Infant; D009362:Neoplasm Metastasis; D009880:Ophthalmic Artery / Q000601:surgery*; D019572:Retinal Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery*; D012175:Retinoblastoma / Q000098:blood supply / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis