Eye-Preserving Therapies for Early cT3c Retinoblastoma
Zhenyu Xu1, Yiran Yao1, Jie Yang1
1Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; State Key Laboratory of Eye Health, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
Purpose:
To evaluate the safety and effectiveness of eye-preserving therapies in patients with retinoblastoma presenting with neovascular glaucoma without buphthalmos (defined as early cT3c by the American Joint Committee on Cancer Staging Manual, eighth edition), focusing on overall survival and eye preservation.
Design:
Retrospective, single-center cohort study.
Participants:
A total of 132 patients diagnosed with early cT3c retinoblastoma from May 2014 through October 2024.
Methods:
The patients were divided into primary enucleation (50 patients) and primary eye-preserving (82 patients) groups. They were followed up for survival status and ocular outcomes.
Main Outcome Measures:
Overall survival, high-risk pathologic features, globe salvage, and vision preservation.
Results:
After a median follow-up of 52.9 months, 1 death occurred in each group, and overall survival did not differ significantly between the primary eye-preserving and primary enucleation groups (log-rank test, P = 0.775). Eye-preserving therapies were associated with a lower incidence of high-risk pathologic features (odds ratio [OR], 0.21; P = 0.003), with attenuated severity of both choroidal (OR, 0.25; P = 0.002) and optic nerve invasions (OR, 0.23; P = 0.008). The globe salvage rate was 49.4% (41 of 83) in the primary eye-preserving group. Among these preserved eyes, 46.3% (19 of 41) regained light perception or better after receiving eye-preserving therapies. Importantly, presenting intraocular pressure ≥32 mmHg (hazard ratio [HR], 2.37; P = 0.010) and corneal edema (HR, 2.86; P = 0.007) were high-risk factors for globe salvage failure. Compared with intravenous chemotherapy alone, application of intra-arterial chemotherapy (HR, 0.13; P = 0.001) alone and combined intravenous chemotherapy-intra-arterial chemotherapy regimens (HR, 0.15; P = 0.001) demonstrated a significant association with better globe salvage outcomes. Additionally, cryotherapy (HR, 0.14; P < 0.001) was identified as an independent protective factor for overall globe salvage.
Conclusions:
Primary eye-preserving therapies can secure high rates of globe salvage with partial visual function in patients with early cT3c retinoblastoma, without jeopardizing patient survival. However, eyes exhibiting corneal edema or intraocular pressure ≥32 mmHg demonstrate markedly inferior salvage outcomes; the treatment strategy for such patients must therefore be cautiously individualized.
Financial Disclosure(S):
The authors have no proprietary or commercial interest in any materials discussed in this article.
