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 American Joint Committee on Cancer (AJCC) eighth edition cT3c retinoblastoma presenting with neovascular glaucoma (NVG) without buphthalmos (defined as early cT3c), focusing on overall survival and eye preservation.
Design:
Retrospective, single-center cohort study.
Participants:
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 groups (82 patients). They were followed up for survival status and ocular outcomes.
Main Outcomes Measures:
Overall survival, high-risk pathological features, globe salvage and vision preservation.
Results:
After a median follow-up of 52.9 months, one 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 pathological features (odds ratio [OR], 0.21; P = 0.003), with attenuated severity of both choroidal (OR, 0.25; P = 0.002) and optic nerve invasion (OR, 0.23; P = 0.008). The globe salvage rate was 49.4% (41/83) in the primary eye-preserving group. And among these preserved eyes, 46.3% (19/41) regained light projection or better after receiving eye-preserving therapies. Importantly, presenting intraocular pressure (IOP) ≥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 (IVC) alone, application of intra-arterial chemotherapy (IAC; HR, 0.13; P = 0.001) alone and combined IVC-IAC regimens (HR, 0.15; P = 0.001) demonstrated a significantly 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.
Conclusion:
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 IOP ≥32 mmHg demonstrate markedly inferior salvage outcomes, the treatment strategy for such patients must therefore be cautiously individualized.
