Retinoblastoma in older patients: A retrospective comparative analysis of 100 consecutive patients based on age

Intra-Arterial Chemotherapy: New Hope for Adult Retinoblastoma Treatment-A Case Report and Brief Review

Background

Adult retinoblastoma (RB) is a rare intraocular tumor, leading to delayed diagnosis and, eventually, enucleation of the involved eyes. Therefore, this diagnosis should be considered if attributable signs and symptoms occurred. Here, the authors report a case of an adult group D RB, treated successfully with intra-arterial chemotherapy (IAC) as primary treatment followed by cryotherapy. The authors briefly review the literature on the prognosis and management of adult RB. Case Presentation. A 22-year-old man has noticed floaters in his right eye for 2 months. Right eye examination revealed diffuse white spherical calcified vitreous seeds in all quadrants and a large white endophytic mass in the superonasal quadrant with engorged feeding vessels. Based on clinical data, the group D RB tumor was classified and the IAC was started with 2 medications, melphalan (5 mg) and topotecan (1 mg), for 3 cycles. Trans-scleral triple freeze-thaw cryotherapy was used as an adjunctive treatment at the latest hospital visit. Thirteen months after the last treatment, the RB tumor showed type 4 regression (flat chorioretinal scar) and no evidence of recurrence was identified.

Conclusion

It seems that IAC, as the first line of treatment, either alone or in conjunction with adjuvant therapies may allow us to salvage the globe of adult patients involved with RB.

Retinocytoma/retinoma: comparative analysis of clinical features in 78 tumors and rate of transformation into retinoblastoma over 20 years

PURPOSE

To explore clinical features and long-term outcomes in patients with retinocytoma/retinoma.

METHODS

The medical records of patients with retinocytoma/retinoma over a 20-year period were reviewed retrospectively to compare patient age at presentation (<4 vs ≥4 years), tumor type, and tumor focality (unifocal vs multifocal).

RESULTS

Of 2,021 patients with retinoblastoma, 62 (3%; median age, 5 years; 85% white; 58% male) had 78 tumors: 54 retinocytoma (69%) and 24 retinoma (31%). Median basal tumor diameter was 6.0 mm; mean thickness, 2.3 mm. Younger patients (<4 years) were more likely Hispanic (19% vs 2%; P = 0.04), with leukocoria (24% vs 0%; P = 0.003), and with calcification in ≤50% of the tumor (96% vs 70%; P = 0.007). Compared with retinoma, retinocytoma was more prevalent in older patients (median age, 9 vs 2 years; P < 0.001), with fewer symptoms (38% vs 69%; P = 0.04), larger median basal diameter (7.0 vs 3.0 mm; P < 0.001), greater thickness (2.5 vs 1.6 mm; P = 0.02), and less frequently with additional retinoblastoma in either eye (9% vs 71%; P < 0.0001). Compared with multifocal tumors, unifocal tumors occurred more frequently with lack of symptoms (62% vs 25%; P = 0.03), greater median basal diameter (6.0 vs 3.3; P = 0.003), and greater thickness (2.5 vs 1.5 mm; P = 0.006). Tumor transformation into retinoblastoma was found in 2.7% by 2 years, 9.2% by 5 years, 15.3% by 10-20 years. The only factor predictive of transformation was increasing thickness (P = 0.003; hazard ratio of 2.83 per 1 mm increase).

CONCLUSIONS

In our study cohort, the rate of retinocytoma/retinoma transformation into retinoblastoma increased from 2 to 10-20 years of age. The only factor predictive of transformation was increasing tumor thickness.