Primary enucleation rather than chemotherapy?
In a departure from the usual, a paper, which featured in the recent issue of British journal
of ophthalmology, mentioned the preference towards primary enucleation to chemotherapy in group D retinoblastoma. This was done purely on the basis of cost analysis which showed that in cases where a globe saving treatment such as chemotherapy was used, multiple examination under anesthesia were needed during the follow up. They analysed 92 group D patients of which 40 (37 unilateral) underwent primary enucleation and 52 (17 unilateral) were treated with intravenous chemotherapy. Over a median follow up of 5 years, it was noted that primary enucleated patients had on average 7 EUAs and chemotherapy-treated patients 21 EUAs (p<0.001). The authors suggested that Group D patients’ families should be counselled regarding the significant difference in number of EUAs following primary enucleation versus chemotherapy when deciding on a treatment strategy and hence with respect to this primary enucleation would be most beneficial for older patients with unilateral disease.
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Fabian ID, Stacey AW, Johnson KC, Chowdhury T, Duncan C, Reddy MA, Sagoo MS. Primary enucleation for group D retinoblastoma in the era of systemic and targeted chemotherapy: the price of retaining an eye. Br J Ophthalmol. 2017 Jun 28.