Program Book

1940 RB15
PROTON THERAPY FOR RECURRENT LOCALLY
ADVANCED RETINOBLASTOMA: COMBINED RESULTS
FROM THE RETINOBLASTOMA CENTER OF HOUSTON
& INDIANA UNIVERSITY
D.S. Gombos MD FACS; A.L. Chang MD; D.L. Andolino MD; H.P. Fontanilla
MD; C. Herzog MD; M. Chintagumpala MD; P. Zage MD; R. Hurwitz MD;
P. Chevez-Barrios MD; A. Mahajan MD (dgombos@mdanderson.org)
The Retinoblastoma Center of Houston
MD Anderson Cancer Center
Indiana University
Texas Children’’s Cancer Center
The Methodist Hospital Research Insitute
Baylor College of Medicine
Purpose. Despite significant advances with systemic and local
chemotherapeutic modalities, relapsed retinoblastoma can be salvaged
with adjuvant radiotherapy. We present a cohort of patients treated with
fractionated proton beam radiotherapy for recurrent locally advanced
retinoblastoma.
Methods. A review of all patients with recurrent retinoblastoma treated
with proton beam radiotherapy at MD Anderson Cancer Center and the
Midwest Proton Radiotherapy Institute.
Results. 14 patients / 16 eyes were treated. Median treatment dose was
45 CGE with a median dose to the bony orbit of 24 CGE. Local control
was achieved in 6 of 16 eyes (38%). Median time to local failure was
eight months. Toxicity included peri-orbital erythema, cataract, retinal
vasculopathy and neovascular glaucoma.
Conclusions. Proton beam radiotherapy can be used in the salvage
setting for patients with advanced disease refractory to other treatments
with results comparable to other series.
Dosimetric planning is superior to other modalities.
Financial disclosure. Dr Gombos is a member of the Children’s Oncology Group and has received
reimbursement for travel. He has provided consultation for IMS Health.
1828 RB16
COMPARISON OF HIGH-RISK HISTOPATHOLOGY
BETWEEN UNTREATED AND TREATED EYES OF PA-
TIENTS WITH RETINOBLASTOMA
M.W. Wilson1,2,5, R. Brennan3,6, C. Rodriguez-Galindo3,6, C. Billups4,
B.G. Haik5, I. Qaddoumi3,6 (mwilson5@uthsc.edu)
Departments of 1. Surgery, 2. Pathology, 3. Oncology, and 4. Biostatics,
St Jude Children’s Research Hospital, Memphis, TN, USA
Departments of 5. Ophthalmology and 6. Pediatrics, University of
Tennessee Health Science Center, Memphis, TN, USA
Purpose. To compare high risk histology between untreated and treated
eyes of patients with retinoblastoma.
Methods. A retrospective study identified 177 eyes of 172 patients
enucleated between February 1986 and September 2010. Review of
ocular histopathology focused on high risk features: tumor invasion of
the anterior chamber, iris, ciliary body, choroid (massive), retro-laminar
optic nerve, or sclera, and/or extraocular disease.
Results. 116 eyes of 115 patients were primarily enucleated. The
untreated group had a higher proportion of Reese-Ellsworth (RE) Group
V eyes, 94% versus 59% (p0.19). Forty of the 52 patients were further
treated with adjuvant chemotherapy (n=40) and/or external beam
radiation (n=12). 3 patients died; 2 untreated from metastatic disease
despite adjuvant therapy and 1 with metastatic disease at diagnosis
from complications related to bone marrow transplant.
Conclusions. Despite more favorable Reese-Ellsworth Grouping, treated
eyes with retinoblastoma had an equal risk of harbouring HRH compared
to untreated eyes, committing patients to further adjuvant therapy.
Financial disclosure. None
2 Rb17
PATHOLOGY ASSESSMENT IN UNILATERAL RETINO-
BLASTOMA WITH & WITHOUT HISTOPATHOLOGIC
HIGH-RISK FEATURES & THE ROLE OF ADJUVANT
CHEMOTHERAPY: A COG STUDY
P. Chévez-Barrios1-3,11, R. Eagle1,4, D. Albert1,5, G. Vemuganti6, S.
Krishnakumar7, B. Langholz1, S. Honavar6, J. O’Brien1,8,9, A. Leahey1,8,
K. Matthay1,10, A. Meadows1,8, M. Chintagumpala1,3,11
(pchevez-barrios@tmhs.org)
1. Children’s Oncology Group
2. The Methodist Hospital Research Institute, Houston, TX, USA
3. Retinoblastoma Center of Houston, TX, USA
4. Will’s Eye Institute, Philadelphia, PA, USA
5. University of Wisconsin Hospital and Clinics, Madison, WI, USA
6. LV Prasad Eye Institute, India
7. Vision and Medical Research Foundation, Sankara Nethralaya, India
8. Children’s Hospital of Philadelphia , PA , USA
9. Scheie Eye Institute, Philadelphia, PA, USA
10. University of California San Francisco Medical Center-Parnassus, CA, USA
11. Baylor College of Medicine, Houston, TX, USA
Purpose. Children’’s Oncology Group (COG) finalized a prospective
multicenter international study in patients with unilateral retinoblastoma
undergoing enucleation to determine the prevalence of specific, strictly
defined histopathologic (high-risk) features (HRFs) and the role of
chemotherapy to prevent recurrences.
Methods. Eyes enucleated for unilateral retinoblastoma were submitted
for central review and three pathologists (PCB, RE, DA) independently
reviewed the slides. Additional slides were requested if material was
thought inadequate for interpretation. Central pathology consensus
stratified patients with one or more of the following: posterior uveal
invasion >3mm, any degree of concomitant optic nerve and choroid
involvement, and post-lamina optic nerve involvement. These patients
received chemotherapy; others were observed.
Results. Of 312 patients with central review, 49 patients had their risk
classification changed (13% of initial non-risk had HRFs, 24% of initial
HRFs had non-HRFs). The most important reason for discrepancy was
initial inadequate sections and sampling. 92 patients (29.48%) had HRFs
(post-laminar 16.35%, massive choroidal invasion 13.46 %, concomitant
optic nerve and choroidal invasion 10.58%, others 10.89%) requiring
adjuvant chemotherapy. Three of 312 patients developed recurrences.
Conclusions. The study highlights the importance of histopathology