Eye on the prize.

A multi-institutional Latin American observational study reports excellent outcomes with a risk-based chemo approach for unilateral retinoblastoma: [1] observation for stage 0 (intraocular confinement), [2] enucleation alone for “low-risk” stage 1 (microscopic spread to orbital nerves without retrolaminar or scleral invasion), [3] adjuvant chemo for “high-risk” stage 1 (retrolaminar and/or scleral invasion), and [4] neoadjuvant and adjuvant chemo for any buphthalmia (enlargement of globe). The predefined benchmarks to meet for event-free survival were 95% for low-risk disease and 90% for high-risk disease. Actual events at 3 years occurred in 0/42 patients with stage 0 disease, 1/84 patients with low-risk stage 1 disease (1 recurrence), 2/42 patients with high-risk stage I disease (1 recurrence and 1 death), and 1/7 patients with buphthalmia. TBL: Lots of children with localized unilateral retinoblastoma may be able to safely skip the chemo. | Pérez, JAMA Oncol 2018