Elsevier

Ophthalmology

Volume 113, Issue 12, December 2006, Pages 2276-2280
Ophthalmology

Original Article
The International Classification of Retinoblastoma Predicts Chemoreduction Success

https://doi.org/10.1016/j.ophtha.2006.06.018Get rights and content

Purpose

To evaluate the reliability of the International Classification of Retinoblastoma (ICRB) for predicting treatment success with chemoreduction (CRD).

Design

Noncomparative interventional case series.

Participants

Two hundred forty-nine consecutive eyes.

Methods

All eyes were treated with CRD and were classified according to the ICRB: group A included those eyes with retinoblastoma ≤3 mm; group B included those eyes with retinoblastoma >3 mm, macular location, or minor subretinal fluid; group C included those eyes with retinoblastoma with localized seeds; group D included those eyes with retinoblastoma with diffuse seeds; group E included those eyes with massive retinoblastoma necessitating enucleation. The CRD regimen included vincristine, etoposide, and carboplatin for 6 cycles plus local consolidation with thermotherapy or cryotherapy.

Main Outcome Measure

Chemoreduction success, defined as avoidance of external beam radiotherapy or enucleation.

Results

Of the 249 eyes, 23 (9%) were in group A, 96 (39%) were in group B, 21 (8%) were in group C, and 109 (44%) were in group D. In this series, group E eyes were managed with enucleation. Treatment success was achieved in 100% of group A, 93% of group B, 90% of group C, and 47% of group D eyes.

Conclusions

The ICRB can be of assistance in predicting CRD success for retinoblastoma. Additional treatment methods are necessary to salvage more group D eyes.

Section snippets

Patients and Methods

All new patients with retinoblastoma who were treated with initial CRD (Institutional Review Board approved CHP no. 582) on the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, in conjunction with the Division of Oncology at The Children’s Hospital of Philadelphia, were identified. The eligibility criteria for treatment with CRD5 were children with retinoblastoma in whom either eye ordinarily would require enucleation or EBRT for cure of the disease based on published

Results

Between July, 1994, and June, 2004, 249 eyes of 163 patients were treated with the CRD protocol5, 10 and were included in this study. The percent success for each group and subgroup of the Reese–Ellsworth (Table 1) and ICRB (Table 2) classifications are listed in Table 3, Table 4, respectively (Figure 1, Figure 2). The mean patient follow-up was 6.2 years (median, 6.2; range, 1–10.6).

When assessing the eyes using the 5 major Reese–Ellsworth groups, success was achieved in 93% of group I, 88% of

Discussion

The ICRB was designed to simplify retinoblastoma classification and to predict treatment success with current methods, specifically CRD.12, 13, 16 This classification was not intended to predict life prognosis or visual outcome. It was intended to predict globe outcome, specifically, avoidance probability of enucleation and EBRT after CRD. In this study, we have shown that the ICRB is predictive of globe outcome after CRD. Patients within groups A, B, and C had a considerable chance for globe

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Cited by (0)

Manuscript no. 2005-1095.

Supported by a donation from Michael, Bruce, and Ellen Ratner, New York, New York (JAS, CLS); the Paul Kayser International Award of Merit in Retina Research, Houston, Texas (JAS); the National Institutes of Health, Bethesda, Maryland (NIH R25 training grant [AKA]); Mellon Charitable Giving from the Martha W. Rogers Charitable Trust, Philadelphia, Pennsylvania (CLS); the Macula Foundation, New York, New York (CLS); and the Eye Tumor Research Foundation, Philadelphia, Pennsylvania (CLS, JAS).

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