To estimate the risk of disease recurrence and metastasis, doctors examine the surgically removed eye under a microscope and classify the tumor as either low-, intermediate-, or high-risk. All patients whose tumors are considered high-risk receive intensive postoperative chemotherapy and radiation therapy. There is no general consensus, however, on the need for adjuvant therapy and the optimal treatment approach for patients in the other two risk categories. Therefore, protocols for adjuvant chemotherapy use in these patient groups have varied widely.
"Our study confirms that it is not necessary to give adjuvant treatment to many children with unilateral retinoblastoma," said lead study author Isabelle Aerts, MD, a pediatric oncologist at Institut Curie in Paris, France. "I think that our results will help establish the standard of care for such patients, reducing variations in postoperative chemotherapy protocols."
In the present study, 123 patients with unilateral, non-hereditary retinoblastoma were assigned to one of three risk groups according to previously established criteria. The median age at the time of eye removal surgery was 23 months. The 70 patients with low-risk disease received no postoperative chemotherapy; the 52 patients with intermediate-risk disease received four courses of adjuvant chemotherapy (etoposide, carboplatin, vincristine, cyclophosphamide), and the only patient with high-risk disease received six courses of high-dose adjuvant therapy (etoposide, carboplatin, thiotepa, vincristine, and cyclophosphamide).
At a median follow-up period of 71 months, all patients were alive. None of the patients experienced disease worsening, relapse, distant metastasis or secondary cancers. The adjuvant chemotherapy was safe overall. These data confirm that the specific regimens administered in this study, which are already being used
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American Society of Clinical Oncology