Better retinoblastoma classification may improve treatment

NEW YORK — A modified classification system for retinoblastoma may improve treatment of the disease and allow ophthalmologists to save more eyes, according to one retina specialist.

“Our understanding of choroidal retinoblastoma continues to improve,” Carol Shields, MD, told attendees of Macula 2006 here. “But we need to improve treatment for eyes with advanced tumors.”

She described a modified classification system that has been proposed to help identify the most severe cases. The new system has five categories with increasing severity. Lesions that fall into category A are 3 mm or smaller, while those in category E cover more than 50% of the globe with opaque media.

Dr. Shields applied the system in a study of 249 cases treated with chemotherapy reduction in six cycles of vincristin, etoposide and carboplatin. Success was defined as an avoidance of radiation therapy and no enucleation.

Classifying the results using the new system, all eyes in group A were saved with chemoreduction. In group B, defined as lesions larger than 3 mm with subretinal fluid, 90% of the eyes were saved. In group D, however, which includes lesions with diffuse seeds, only 47% of eyes were saved.

This study, she said, was preliminary to a larger study called the National Retinoblastoma Study.