Study finds tylectomy, paired with normal therapy, shows positive impact on eye survival in retinoblastoma patients

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The treatment of many cancers generally includes a combination of surgery and chemotherapy. However, because this approach has not achieved the desired results in patients with retinoblastoma, the authors of a recent study reported that using “tylectomy” and standard therapy, they salvaged more eyes treated with standard therapy alone, without harming the overall survival.

First author Zhao Xun Feng, MD, from the Department of Ophthalmology, The Ottawa Hospital Foundation, Ottawa, Ontario, Canada, presented his team’s results at the Association for Research in Vision and Ophthalmology in Seattle.

He explained that tylectomy (from “tylos”, “lump” in ancient Greek) indicates surgical resection of retinoblastomas via pars plana vitrectomy with intraoperative chemotherapy infusion.

Their previous retrospective review¹ published in 2021 showed that managing 960 children with tylectomy did not compromise the overall survival compared to those managed without tylectomy. The current study under discussion compared eye salvage rates when standard therapies included tylectomy (group I) versus no tylectomy (group II).

This retrospective study reviewed consecutive eyes with the International Intraocular Retinoblastoma Classification (IIRC) of Group D or E retinoblastoma that were treated with eye salvage therapy and diagnosed between 2012 and 2017 in 29 Chinese centers. The absolute contraindications for tylectomy were evidence of optic nerve or extra-scleral invasion on imaging; the relative contraindications were eyes with obscuration of the optic nerve or poor visual prognosis, Feng explained.

Analysis results

The 2 study groups included 1,322 eyes (1,016 children) divided into group I with 470 (36%) patients and group II with 852 (64%) patients. The primary treatment was either systemic chemotherapy (990, 75%) or intra-arterial chemotherapy (332, 25%).

The authors reported that the 5-year ocular survival rate was higher in group I with tylectomy than group II without tylectomy (80% and 47%, respectively; P<0.001), for both patients with the IIRC of Group D retinoblastoma (81% and 62%, respectively; P<0.001) and Group E retinoblastoma (77% and 20%, respectively; P<0.001).

Patients in group I with tylectomy had a higher 5-year ocular survival rate than those in group II without tylectomy who underwent either primary systemic chemotherapy (80% and 40%, respectively; P<0.001) or intra-arterial chemotherapy (80% and 67%, respectively; P<0.001).

The authors also found that the number of cycles of systemic chemotherapy administered before tylectomy in groups I and II (mean, 3.1 and 2.5, respectively; P<0.001) was higher in group I than group II; the number of intra-arterial chemotherapy cycles (mean, 1.4 and 1.6, respectively; P=0.072) did not differ between the groups.

Adjuvant intravitreal or systemic chemotherapy after tylectomy (group I) did not affect the 5-year eye salvage (80% and 81%, respectively; P=0.433). The 5-year overall survival rates did not differ significantly different between groups I and II (95% and 92%, respectively; P=0.065).

In commenting on their results, the authors said, “In retinoblastoma management, the treatment goal is to cure cancer while preserving the eye, vision, and patient quality of life. Tylectomy may both physically remove chemotherapy-resistant tumor and address complications of previous therapies, thereby sparing eyes previously deemed unsalvageable. Overall, tylectomy as part of the multimodal therapy improved eye salvage and did not impact survival.”

Reference

Feng ZX, Zhao J, Li Q, et al. Tylectomy for salvage of eyes with retinoblastoma. Paper presented at: Association for Research in Vision and Ophthalmology annual meeting; May 5-9, 2024, Seattle, WA. Abstract number: 3273