Orbital recurrence of retinoblastoma following enucleation

Kim, Jonathan Wano; Kathpalia, Vinnie; Dunkel, Ira J.; Wong, Ryan; Riedel, Elyn; Abramson, David H.

doi:10.1136/bjo.2008.138453

Cited by 49 publications

(30 citation statements)

References 22 publications

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“…11 However, it is notable that these historical estimates were based on enucleated eyes of multiple stages, not just those that were classified as RE stage V, or ICRB stage D, or E. Since prior estimates of orbital disease might be diluted by a lower rate of orbital recurrence within eyes that were not as advanced as the cohort in this study, our overall recurrence rate of 4.2% may in fact represent a decrease in the total number of orbital recurrences in advanced eyes driven by a lower incidence within the OAC group.…”

Section: Discussionmentioning

confidence: 99%

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Enucleation vs Ophthalmic Artery Chemosurgery for Advanced Intraocular Retinoblastoma

et al. 2015

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IMPORTANCE 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. DESIGN, SETTING, AND PARTICIPANTSSingle-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.MAIN OUTCOMES AND MEASURES 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 AND RELEVANCEIn 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.

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Section: Discussionmentioning

confidence: 99%

“…The one study that was limited to patients who presented with intraocular disease only revealed an incidence of 4.2% over the course of almost 100 years and ranged between 3.7% and 5.1% when calculated using twenty year periods. 11 …”

Section: Introductionmentioning

confidence: 99%

Enucleation vs Ophthalmic Artery Chemosurgery for Advanced Intraocular Retinoblastoma

et al. 2015

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“…After enucleation, it is crucial for providers to follow all patients for two years to monitor for orbital relapse. A retrospective study showed a 4.2% incidence of recurrence that occurred from one month to two years after enucleation, and 85% of those patients developed metastatic disease . A combination of intra‐arterial and intravitreal chemotherapy may increase the effectiveness of treatment with vitreous seeds.…”

Section: Retinoblastoma Treatmentmentioning

confidence: 99%

An Overview of Retinoblastoma and Enucleation in Pediatric Patients

Leclerc¹,

Olin²

2019

AORN Journal

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Retinoblastoma is a rare malignancy of the eye affecting children, most commonly four years old and younger. Although chemotherapy and radiation treatment aim to spare the eye, in some cases, enucleation (ie, removal of the eye) is required to prevent cancer metastases or recurrence. Enucleation procedures are primarily performed at specialty institutions and may involve the surgical placement of an implant in the orbit of the eye. Unique perioperative considerations are required because of the age of the child at the time of the diagnosis and procedure and the involvement of a parent or caregiver who will be caring for the child postoperatively. This article presents an overview of retinoblastoma and enucleation and discusses the care and management of the unique patient population undergoing enucleation.

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“…In our case, we postulate that repeated, aggressive laser treatment caused a focal thinning of the sclera within the atrophic scar, allowing a portal of entry for active tumor cells to seed the orbit. Another possibility is that the orbital recurrence was related to metastatic disease caused by hematogenous dissemination to the orbit [8]. We consider this mechanism less likely given the original diagnosis of group C retinoblastoma and the location of the single extraocular lesion directly posterior to the sclera with no other evidence of metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

Orbital Recurrence following Aggressive Laser Treatment for Recurrent Retinoblastoma

et al. 2015

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Purpose: To report a case of a 29-month-old male with familial, bilateral retinoblastoma with orbital recurrence following aggressive laser treatment. Methods: This is a retrospective case report of a single patient. Results: A 3-week-old male was diagnosed with familial, bilateral retinoblastoma (group D OD, group A OS), and treated with 6 cycles of systemic chemotherapy and laser treatment. The patient exhibited full regression of tumors in both eyes. Two years after diagnosis, a small tumor recurrence within the macular laser scar of the right eye was discovered. The tumor recurrence was treated with argon and diode laser over 6 months. The tumor recurrence completely resolved following the laser treatments. Ten weeks after the last laser treatment, MRI revealed a large intraconal orbital mass, contiguous with the sclera of the right eye. Orbital biopsy and systemic work-up confirmed the diagnosis of retinoblastoma with no other metastatic foci. B-scan ultrasonography showed thinning of the sclera at the site of recurrence. Conclusion: This is an unusual orbital recurrence after successful treatment of intraocular disease with aggressive laser therapy. Clinicians should be aware of the rare possibility of orbital recurrence following chemoreduction with local consolidation even when fundus examinations are normal.

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Orbital recurrence of retinoblastoma following enucleation

Cited by 49 publications

References 22 publications

Enucleation vs Ophthalmic Artery Chemosurgery for Advanced Intraocular Retinoblastoma

Enucleation vs Ophthalmic Artery Chemosurgery for Advanced Intraocular Retinoblastoma

An Overview of Retinoblastoma and Enucleation in Pediatric Patients

Orbital Recurrence following Aggressive Laser Treatment for Recurrent Retinoblastoma

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