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Published on: August 4, 2011
Outcomes of five cases of retinoblastoma with optic nerve invasion on imaging
Tamae Onishi1, Sachiko Nishina2, Tadashi Yokoi1
1Division of Ophthalmology, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, Japan.
Purpose:
To investigate the timing of enucleation, treatment course, and outcome for retinoblastoma (RB) with optic nerve (ON) invasion on imaging.
Study Design:
Retrospective clinical study.
Methods:
Of the 160 patients with RB who presented to the National Center for Child Health and Development in Japan between 2005 and 2022, ON invasion on imaging at the initial presentation was seen in five patients. The clinical, computed tomography (CT), and magnetic resonance imaging (MRI) findings, and treatment courses were reviewed retrospectively.
Results:
MRI showed ON invasion in all five patients (three with unilateral RB, 2 with bilateral RB); in two patients CT detected no invasion. Enucleation was performed in four patients, three of whom underwent neoadjuvant therapy and one had a positive ON resection margin following the enucleation as initial treatment. One patient did not undergo enucleation due to cerebrospinal fluid dissemination. All enucleated patients underwent adjuvant chemotherapy. Four patients underwent radiotherapy. During follow-up (mean, 89.4 months), four patients survived and one died.
Conclusion:
MRI is recommended to evaluate ON invasion and determine the timing of enucleation for RB. The appropriate choice of neoadjuvant or adjuvant therapy would be helpful to avoid radiotherapy for RB with ON invasion on imaging.
Insights
Magnetic resonance imaging (MRI) is crucial for detecting optic nerve invasion in retinoblastoma (RB), guiding timely enucleation and treatment. Optimal neoadjuvant or adjuvant therapy may help avoid radiotherapy for advanced RB.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Medical Imaging
Background:
- Retinoblastoma (RB) is the most common primary intraocular malignancy in children.
- Optic nerve (ON) invasion is a critical prognostic factor in RB, influencing treatment decisions and outcomes.
- Accurate imaging is essential for detecting ON invasion and planning management.
Purpose of the Study:
- To determine the optimal timing for enucleation in retinoblastoma (RB) patients with optic nerve (ON) invasion.
- To analyze the treatment course and outcomes for RB with ON invasion identified on imaging.
- To evaluate the role of different imaging modalities in detecting ON invasion.
Main Methods:
- Retrospective review of 160 retinoblastoma (RB) patients treated between 2005 and 2022.
- Analysis of clinical data, computed tomography (CT), and magnetic resonance imaging (MRI) findings in five patients with ON invasion.
- Review of treatment strategies including enucleation, neoadjuvant/adjuvant therapy, chemotherapy, and radiotherapy.
Main Results:
- MRI detected optic nerve (ON) invasion in all five evaluated retinoblastoma (RB) patients, while CT missed it in two.
- Four of five patients underwent enucleation; one had a positive resection margin requiring further treatment.
- All enucleated patients received adjuvant chemotherapy and four received radiotherapy; one patient with cerebrospinal fluid dissemination did not undergo enucleation.
Conclusions:
- Magnetic resonance imaging (MRI) is recommended for accurate evaluation of optic nerve (ON) invasion in retinoblastoma (RB) to guide enucleation timing.
- Strategic use of neoadjuvant or adjuvant therapy may help to avoid radiotherapy in RB cases with ON invasion.
- Early and accurate diagnosis of ON invasion is critical for optimizing treatment and improving outcomes in retinoblastoma.
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