Looking at Chemo for Kids

Retinoblastoma patients with lower risk tumors do not need adjuvant chemotherapy

(RxWiki News) A few hundred children in this country are diagnosed with a cancer of the eye. The disease is called retinoblastoma and it starts in the retina of the eye. Fortunately, cure rates are very high.

A recent study looked at the extent of therapy that kids need to beat retinoblastoma, which has a cure rate of about 95 percent.

The results of this study suggested that children with retinoblastoma may not need chemotherapy following surgery. The researchers found that the tumors were unlikely to return or spread, so these young patients could safely forego chemotherapy after surgery.  

"Visit a pediatrician if you notice changes to your child’s pupil."

Researchers in France tested the impact of eliminating or reducing chemotherapy following surgery to treat retinoblastoma. Isabelle Aerts, MD, a pediatric oncologist at Institut Curie in Paris, France, was the lead author.

About 300 children usually under the age of 5 are diagnosed with retinoblastoma every year. Most children are diagnosed around age 2.

In retinoblastoma, a tumor forms on the retina – a nerve center at the back of the eye. The disease most often appears in only one eye (unilateral).

Treatment involves surgically removing the entire eyeball, with the child’s sight in the other eye preserved.  

After the surgery, the tumor is analyzed under a microscope to determine the likelihood of the disease returning or spreading.

Children with high-risk tumors are treated with high doses of chemotherapy and radiation.

Researchers wanted to know if children with lower risk tumors needed chemotherapy. There is no consensus on chemotherapy regimens for young patients with tumors that are not likely to cause problems after treatment.

For the study, 123 patients with retinoblastoma in a single eye were assigned to a disease risk group: low-, intermediate- or high-risk.   

The 70 kids in the low-risk group received no adjuvant chemotherapy. The 52 children in the intermediate-risk group were given four rounds of postoperative chemotherapy. Only one child in the high-risk group had six courses of chemotherapy that involved five different agents.

All of the children were alive after about six years of follow-up. No child experienced worsening disease, return (relapse), or spreading to other sites (metastasis). Furthermore, no secondary cancers developed.

“Our study confirms that it is not necessary to give adjuvant treatment to many children with unilateral retinoblastoma,” Dr. Aerts said in a press release. “I think that our results will help establish the standard of care for such patients, reducing variations in postoperative chemotherapy protocols.”

More research is needed to confirm these results, according to the authors. Dr. Aerts and colleagues are currently testing to see if children with intermediate-risk tumors can be treated with two instead of four rounds of adjuvant chemotherapy.

Pediatric cancers expert, ZoAnn Eckert Dreyer, MD, of the Texas Children's Cancer Center and Hematology Service Clinic, said,“While this study does not include a novel therapy, it demonstrates that with improved, refined risk stratification, it may be possible to reduce chemotherapy in some patient groups – particularly those with intermediate-risk disease. Physicians and parents can be reassured that many children can go without aggressive chemotherapy and be spared from its long- and short-term effects. This will potentially result in a change in the standard of care for these patients.”

This study was published March 4 in the the Journal of Clinical Oncology. Funding information was not provided. The authors declared no potential conflicts of interest.

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Review Date: 
March 7, 2013