Clinical and histopathological correlation of outcomes in advanced retinoblastoma with neoadjuvant chemotherapy

Session Details

Session Title: Inflammation and Pathology

Session Date/Time: Sunday 11/09/2016 | 14:30-16:00

Paper Time: 15:54

Venue: Hall C2

First Author: : U.Singh INDIA

Co Author(s): :    D. Bansal   M. Dogra   S. Singh   A. Bal           

Abstract Details

Purpose:

Advanced retinoblastoma forms a major proportion of the children presenting with retinoblastoma in the developing countries owing to the delays in detection and referral. Despite the recent advances in the treatment of patients with retinoblastoma, the prognosis of patients with advanced retinoblastoma remains dismal and currently there is no consensus on the management options for this particular subgroup of patients. We aimed to study the correlation of clinical and histopathological features with the outcome in advanced retinoblastoma treated with neoadjuvant chemotherapy and enucleation.

Setting:

Retinoblastoma clinic of a tertiary care referral institute in Northern India

Methods:

Retrospective chart review was done of all patients with advanced retinoblastoma presenting to the Retinoblastoma clinic between January 1996 and December 2010. Treatment naïve patients recieveing neoadjuvant chemotherapy followed by secondary enucleation were included. Patients with less than 1 year of follow up were excluded. Demographic data and details of examination under anaesthesia at presentation were recorded along with a histopathological review of all enucleated eyes. Outcome measures such as response to chemotherapy, recurrence, survival and other treatment related complications were noted. Statistical analysis was done for the correlation of clinical and histopathological features with the final outcome.

Results:

Seventy five eyes of 72 patients were included in the study with a mean age of 34.75±25.97 months. There were 59 eyes in the intraocular group while 16 eyes had extraocular disease. Overall ratio of unilateral to bilateral disease was 2.1:1. Fifty percent of the eyes in the intraocular group and 60% in the extraocular group showed favourable response to neoadjuvant chemotherapy. Histopathological risk factors were present in 22.67% eyes with retro-laminar optic nerve involvement being the commonest in 10. Default/delay in definitive therapy was the most common cause of poor outcome in patients with advanced retinoblastoma.

Conclusions:

Neoadjuvant chemotherapy with secondary enucleation appears to be an effective modality of treatment in cases with advanced retinoblastoma. However delayed presentation, treatment default due to neglect, poor socio-economic status and high risk features on histopathology worsens outcomes in these patients. In context to our developing country, which has majority of patients presenting with advanced disease, there is a need for exploring effective, safe and conservative therapies, which are cost effective in order to salvage globe and vision.

Financial Disclosure:

NONE