Christina Scelfo1, Jasmine H Francis1,2, Vikas Khetan3, Thomas Jenkins4, Brian Marr1,2, David H Abramson1,2, Carol L Shields4, Jacob Pe'er5, Francis Munier6, Jesse Berry7, J William Harbour8, Andrey Yarovoy9, Evandro Lucena10, Timothy G Murray11, Pooja Bhagia12, Evelyn Paysse13, Samuray Tuncer14, Guillermo L Chantada15, Annette C Moll16, Tatiana Ushakova17, David A Plager18, Islamov Ziyovuddin19, Carlos A Leal20, Miguel A Materin21, Xun-Da Ji22, Jose W Cursino23, Rodrigo Polania24, Hayyam Kiratli25, Charlotta All-Ericsson26, Rejin Kebudi27, Santosh G Honavar28, Vicktoria Vishnevskia-Dai29, Sidnel Epelman30, Anthony B Daniels31, Jeanie D Ling31, Fousseyni Traore32, Marco A Ramirez-Ortiz33. 1. Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York 10065, USA. 2. Department of Ophthalmology, Weill-Cornell Medical Center, New York 10065, USA. 3. Department of Vitreoretinal and Ocular Oncology, Sankara Nathralaya, Chennai 600066, India. 4. Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Pennsylvania 19107, USA. 5. Hadassah - Hebrew University Medical Center, Jerusalem 91120, Israel. 6. Jules-Gonin Eye Hospital, Lausanne 1004, Switzerland. 7. USC Roski Eye Institute, Children's Hospital of Los Angeles, California 90033, USA. 8. Ocular Oncology Service, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Florida 33136, USA. 9. Ocular Oncology Department, S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow 127486, Russia. 10. Department of Ocular Oncology, Instituto Nacional de Cancer, Rio de Janeiro 1122, Brazil. 11. Murray Ocular Oncology and Retina, Miami Children's Hospital, Florida 33143, USA. 12. St. Joseph's Children's Hospital, New Jersey 07504, USA. 13. Department of Ophthalmology, Baylor College of Medicine, Texas 77030, USA. 14. Department of Ophthalmology, Ocular Oncology, Istanbul Medical Faculty, Istanbul University, Istanbul 34452, Turkey. 15. Oncology Department, Hospital JP Garrahan, Buenos Aires 1245, Argentina. 16. Department of Ophthalmology, VU University Medical Center, Amsterdam 1081, the Netherlands. 17. Department of Head and Neck Tumors, Science Research Institute of Pediatric Oncology and Hematology, N.N. Blokhin Russian Cancer Research Center, Moscow 115478, Russia. 18. Pediatric Ophthalmology and Adult Strabismus, Riley Hospital for Children, Indiana University Medical Center, Indiana 46202, USA. 19. National Oncology Center of Uzbekistan, Tashkent 110508, Uzbekistan. 20. Instituto Nacional de Pediatria, Coyoacan 04530, Mexico. 21. Department of Ophthalmology and Visual Science, Smilow Cancer Hospital at Yale New Haven, CT 06520, USA. 22. Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China. 23. Department of Ophthalmology, Santa Casa Misericordia S. Paulo, Sao Paulo 01221-020, Brazil. 24. Fundacion Clinica Valle del Lili, Cali, Columbia. 25. Ocular Oncology Service, Hacettepe University School of Medicine, Ankara 06100, Turkey. 26. Ocular Oncology Service, St. Erik Eye Hospital, Stockholm 11282, Sweden. 27. Istanbul University, Cerrahpasa Medical Faculty & Oncology Institute, Istanbul 34303, Turkey. 28. Ophthalmic and Facial Plastic Surgery and Ocular Oncology, Centre for Sight Eye Hospital, Hyderabad 500034, India. 29. The Ocular Oncology and Autoimmune Center, Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer 52621, Israel. 30. Santa Marcelina Hospital, Sao Paulo 08452-590, Brazil. 31. Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Tennessee 37232, USA. 32. Hospital Gabriel Toure, Bamako, Mali. 33. Ophthalmology Service, Hospital Infantil de Mexico Federico Gomez, Mexico City 01020, Mexico.
Abstract
AIM: To determine which IIRC scheme was used by retinoblastoma centers worldwide and the percentage of D eyes treated primarily with enucleation versus globe salvaging therapies as well as to correlate trends in treatment choice to IIRC version used and geographic region. METHODS: An anonymized electronic survey was offered to 115 physicians at 39 retinoblastoma centers worldwide asking about IIRC classification schemes and treatment patterns used between 2008 and 2012. Participants were asked to record which version of the IIRC was used for classification, how many group D eyes were diagnosed, and how many eyes were treated with enucleation versus globe salvaging therapies. Averages of eyes per treatment modality were calculated and stratified by both IIRC version and geographic region. Statistical significance was determined by Chi-square, ANOVA and Kruskal-Wallis tests using Prism. RESULTS: The survey was completed by 29% of physicians invited to participate. Totally 1807 D eyes were diagnosed. Regarding IIRC system, 27% of centers used the Children's Hospital of Los Angeles (CHLA) version, 33% used the Children's Oncology Group (COG) version, 23% used the Philadelphia version, and 17% were unsure. The rate for primary enucleation varied between 0 and 100% and the mean was 29%. By IIRC version, primary enucleation rates were: Philadelphia, 8%; COG, 34%; and CHLA, 37%. By geographic region, primary enucleation rates were: Latin America, 57%; Asia, 40%; Europe, 36%; Africa, 10%, US, 8%; and Middle East, 8%. However, systemic chemoreduction was used more often than enucleation in all regions except Latin America with a mean of 57% per center (P<0.0001). CONCLUSION: Worldwide there is no consensus on which IIRC version is used, systemic chemoreduction was the most frequently used initial treatment during the study period followed by enucleation and primary treatment modality, especially enucleation, varied greatly with regards to IIRC version used and geographic region.
AIM: To determine which IIRC scheme was used by retinoblastoma centers worldwide and the percentage of D eyes treated primarily with enucleation versus globe salvaging therapies as well as to correlate trends in treatment choice to IIRC version used and geographic region. METHODS: An anonymized electronic survey was offered to 115 physicians at 39 retinoblastoma centers worldwide asking about IIRC classification schemes and treatment patterns used between 2008 and 2012. Participants were asked to record which version of the IIRC was used for classification, how many group D eyes were diagnosed, and how many eyes were treated with enucleation versus globe salvaging therapies. Averages of eyes per treatment modality were calculated and stratified by both IIRC version and geographic region. Statistical significance was determined by Chi-square, ANOVA and Kruskal-Wallis tests using Prism. RESULTS: The survey was completed by 29% of physicians invited to participate. Totally 1807 D eyes were diagnosed. Regarding IIRC system, 27% of centers used the Children's Hospital of Los Angeles (CHLA) version, 33% used the Children's Oncology Group (COG) version, 23% used the Philadelphia version, and 17% were unsure. The rate for primary enucleation varied between 0 and 100% and the mean was 29%. By IIRC version, primary enucleation rates were: Philadelphia, 8%; COG, 34%; and CHLA, 37%. By geographic region, primary enucleation rates were: Latin America, 57%; Asia, 40%; Europe, 36%; Africa, 10%, US, 8%; and Middle East, 8%. However, systemic chemoreduction was used more often than enucleation in all regions except Latin America with a mean of 57% per center (P<0.0001). CONCLUSION: Worldwide there is no consensus on which IIRC version is used, systemic chemoreduction was the most frequently used initial treatment during the study period followed by enucleation and primary treatment modality, especially enucleation, varied greatly with regards to IIRC version used and geographic region.
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