SPECIAL DEPARTMENTS
Authors: Carol L. Shields Jerry A. Shields, Anna T. Meadows, Tero Kivelä
Journal: Journal of Clinical Oncology (2000)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2000.18.1.236 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 10623718 Carol L. Shields Jerry A. ShieldsxCarol L. Shields Jerry A. ShieldsSearch for articles by this author , Anna T. MeadowsxAnna T. MeadowsSearch for articles by this author Tero KiveläxTero KiveläSearch for articles by this author Show More Wills Eye Hospital Thomas Jefferson UniversityThe Children’s Hospital of Philadelphia University of Pennsylvania School of Medicine Philadelphia PAHelsinki University Central Hospital Helsinki Finland https://doi.org/10.1200/JCO.2000.18.1.236 First Page Full Text PDF Figures and Tables © 2000 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse01012000In Reply:Shields et al have raised a highly pertinent point regarding chemoreduction treatment in children with trilateral retinoblastoma, in part inspired by our recent meta-analysis of 106 patients with this intriguing tumor of childhood.1 None of the included children had underwent chemoreduction, an emerging mode of systemic chemotherapy given to shrink intraocular retinoblastoma in order to salvage vision and avoid external-beam radiotherapy.2-5Our meta-analysis revealed that three children with TRB had survived for more than 5 years after diagnosis, by which time all other affected children were dead.1 These three children, who likely were cured, had had an intracranial tumor 15 mm or smaller in size, and one had received systemic chemotherapy as the only treatment.6Given the above data, I am inclined to concur with Shields et al in that it is conceivable that, in selected cases and when a sufficient number of chemotherapy cycles are given, chemoreduction might cure a small TRB. In addition to their clinical impression, drugs used in chemoreduction have been considered to be potentially effective in treating TRB.7 The required number of cycles to eradicate an intracranial tumor is unknown, however, as is the frequency of complete responses, if any.Our meta-analysis revealed that 50% of the children with TRB who underwent neuroimaging at the time of diagnosis of the intraocular tumor had their intracranial tumor diagnosed at that time.1 Because baseline neuroimaging is routine in major retinoblastoma centers, it is of note that Shields et al had not observed any TRB among over 160 susceptible children treated with chemoreduction at Wills Eye Hospital; half of the expected five to 16 cases should have been found. This fact might indicate that either series may represent a biased sample as regards the chances of developing TRB. Detailed analysis of the data set might help to resolve this issue and reveal new insights into TRB.Our meta-analysis predicted that approximately one in 100 routine computed tomography and magnetic resonance imaging scans would reveal TRB if children with hereditary retinoblastoma were screened regularly.1 A prospective study was believed to be necessary to show whether this yield would translate into a clinically significant, cost-effective reduction in mortality of children with retinoblastoma. In such a study, chemoreduction would be a necessary stratification variable.Shields et al wisely caution that response to chemoreduction might not be complete. Indeed, it is considered insufficient to cure intraocular tumors, and chemoreduction must be followed by photocoagulation, cryocoagulation, or brachytherapy.2-5 Moreover, new tumors have developed during chemoreduction.8 In view of this, I believe that Shields et al would agree in that it would be ill-advised to abandon neuroimaging solely because of chemoreduction, if such imaging is otherwise believed to be rational in managing retinoblastoma.5. Kivelä T: Trilateral retinoblastoma: A meta-analysis of hereditary retinoblastoma associated with primary ectopic intracranial retinoblastoma. J Clin Oncol 17::1829,1999-1837, Link, Google Scholar5. Gallie BL, Budning A, DeBoer G, et al: Chemotherapy with focal therapy can cure intraocular retinoblastoma without radiotherapy. Arch Ophthalmol 114::1321,1996-1328, Crossref, Medline, Google Scholar5. Murphree AL, Villablanca JG, Deegan WF III, et al: Chemotherapy plus local treatment in the management of intraocular retinoblastoma. Arch Ophthalmol 114::1348,1996-1356, Crossref, Medline, Google Scholar5. Shields CL, Shields JA, Needle M, et al: Combined chemoreduction and adjuvant treatment for intraocular retinoblastoma. Ophthalmology 104::2101,1997-2111, Crossref, Medline, Google Scholar5. Bechrakis NE, Bornfeld N, Schueler A, et al: Clinicopathologic features of retinoblastoma after primary chemoreduction. Arch Ophthalmol 116::887,1998-893, Crossref, Medline, Google Scholar5. De Potter P, Shields CL, Shields JA: Clinical variations of trilateral retinoblastoma: A report of 13 cases. J Pediatr Ophthalmol Strab 31::26,1994-31, Medline, Google Scholar5. Marcus DM, Brooks SE, Leff G, et al: Trilateral retinoblastoma: Insights into histogenesis and management. Surv Ophthalmol 43::59,1998-70, Crossref, Medline, Google Scholar5. Scott IU, Murray TG, Toledano S, et al: New retinoblastoma tumors in children undergoing systemic chemotherapy. Arch Ophthalmol 116::1685,1998-1686, Medline, Google Scholar