Survival and ocular preservation in a long-term cohort of Japanese patients with retinoblastoma

Tamaki Ueda, Yuhki Koga, Hiroshi Yoshikawa, Mika Tanabe, Kanako Yamana, Utako Oba, Kentaro Nakashima, Hiroaki Ono, Takuya Ichimura, Shunji Hasegawa, Wakako Kato, Tetsuko Kobayashi, Hideki Nakayama, Yasunari Sakai, Tadamasa Yoshitake, Ohga Saiji, Yoshinao Oda, Shigenobu Suzuki, Koh Hei Sonoda, Shouichi Ohga

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Abstract

Background: Retinoblastoma is an ocular tumor in infants with cancer predisposition. Treatment of the rare tumor needs to be optimized for ocular preserved survival without second primary malignancy (SPM). Methods: We studied the outcomes of all patients with retinoblastoma at a tertiary center in 1984-2016, when preservation method changed from radiotherapy (1984-2001) to systemic chemotherapy (2002-2016). Results: One-hundred sixteen infants developed unilateral- (n = 77), bilateral- (n = 38), or trilateral-onset (n = 1) tumor. Ten (8.6%) had a positive family history, despite a few studies on RB1 gene. Contralateral disease occurred in one unilateral-onset case. One-hundred eight of 155 eyes (70%) were enucleated. Nine binocular survivors were from 5 bilateral- and 4 unilateral-onset cases. Two survivors received bilateral enucleation. Six deaths occurred; brain involvement (including 3 trilateral diseases) in 4 bilateral-onset, systemic invasion in a unilateral-onset, and SPM (osteosarcoma) in a bilateral-onset case(s). Two others survived SPM of osteosarcoma or lymphoma. The 10-year overall survival (OS: 98.5% vs. 91.3%, p = 0.068) and binocular survivors (13.2% vs. 5.2%, p = 0.154) between bilateral- and unilateral-onsets did not differ statistically. The 10-year OS and cancer (retinoblastoma/SPM)-free survival (CFS) rates of all patients were 94.9 and 88.5%, respectively. The proportion of preserved eyes did not differ between radiotherapy and chemotherapy eras. The CFS rate of bilateral-onset cases in systemic chemotherapy era was higher than that in radiotherapy era (p = 0.042). The CFS rates of bilateral-onset patients with neoadjuvant chemotherapy (upfront systemic therapy for preservation) was higher than those without it (p = 0.030). Conclusions: Systemic chemotherapy and local therapy raised OS and binocular survival rates of bilateral-onset patients similarly to those of unilateral-onset patients. All but one death was associated with a probable germline defect of the RB1 gene. Neoadjuvant stratified chemotherapy may support the long-term binocular life with minimized risk of SPM.

Original languageEnglish
Article number37
JournalBMC Pediatrics
Volume20
Issue number1
DOIs
Publication statusPublished - Jan 28 2020

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

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    Ueda, T., Koga, Y., Yoshikawa, H., Tanabe, M., Yamana, K., Oba, U., Nakashima, K., Ono, H., Ichimura, T., Hasegawa, S., Kato, W., Kobayashi, T., Nakayama, H., Sakai, Y., Yoshitake, T., Saiji, O., Oda, Y., Suzuki, S., Sonoda, K. H., & Ohga, S. (2020). Survival and ocular preservation in a long-term cohort of Japanese patients with retinoblastoma. BMC Pediatrics, 20(1), [37]. https://doi.org/10.1186/s12887-020-1923-7