Targeted chemotherapy in retinoblastoma: A step forward from patient survival to globe survival
Ahad Sedaghat1 , Masood Naseripour 1 *, Reza Mirshahi 2
- Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Abstract: Despite being the most common intraocular malignancy in childhood, there is a substantial disparity in terms of patient and globe survival in retinoblastoma (Rb) between developing and developed countries. The current study intends to determine the patient and globe survival before and after the introduction of the new treatment modalities in a developing country.
Methods: Medical records of 350 patients (516 eyes) with retinoblastoma referred to a tertiary referral center for Rb in Tehran, Iran were reviewed. In order to compare patient and globe survival before and after the availability of the new treatment modalities including intra-arterial and intravitreal chemotherapy, the patients were divided into group 1 (2001-2007) and group 2 (2008-2018) based on the calendar period of diagnosis.
Results: Two-hundred-twenty-three eyes of 149 patients and 293 eyes of 201 patients were categorized into groups 1 and 2, respectively. Kaplan–Meier estimates for 5-year patient survival were 98.8% across the current survey and the overall survival rate was 92.7% (SE:0.03) in group 1 and 95.4% (SE:0.03) in group 2 (P=0.848). Overall, 49.6% of eyes with retinoblastoma underwent enucleation which was the primary in 63% (116/184) of unilateral and 29.8% (99/322) of bilateral cases. Primary enucleation was significantly lower in group 2 (34.8%) in contrast to group 1 (50.74%) (P < 0.001). In addition, globe survival improved significantly in Group D (16.7% in group 1 vs. 66.1% in group 2 P<0.001) and E (1.3% in group 1 vs. 23.3% in group 2 P<0.001) according to International Classification of Retinoblastoma (ICRB) during the two timelines. In enucleated eyes, despite the increased rate of prelaminar involvement in group 2 (13.1% vs. 2.2% in group 1, P=0.003), the rate of high-risk histopathologic findings was similar between the two groups.
Conclusion: Similar to developed countries, the application of new targeted treatment modalities, including intra-arterial and intravitreal chemotherapy has been associated with significantly improved globe survival in Rb patients. However, it should be noted that with the availability of these novel treatment options, the decision for on-time enucleation should not be deferred.
