Sights Set on Success

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Eye-preserving surgery may be an effective treatment for retinoblastoma.
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Retinoblastoma predominantly affects young children, typically before the age of four. It is the most common type of childhood eye cancer.

Researchers at the Donald K. Johnson Eye Institute have revealed that an eye-preserving surgical procedure is a safe and effective approach to treating retinoblastoma.

Retinoblastoma is a rare and aggressive cancer that forms in the retina—the light-sensitive tissue at the back of the eye. Standard treatments include chemotherapy, laser therapy and radiation. If these treatments fail, the eye is often removed to prevent the cancer from spreading.

Organ-preserving surgery, in which the tumor and a small portion of surrounding tissue are removed, is not used to treat retinoblastoma for fear that portions of the cancer will remain and spread.

“Recent technical advances have greatly improved the safety of eye surgery for retinoblastoma,” explains Dr. Brenda Gallie, the senior author of the study and an Affiliate Scientist at the Donald K. Johnson Eye Institute. “Given these advances, our research team performed eye-preserving surgery, called tylectomy, as a secondary treatment to save vision in children for whom standard chemotherapy was not effective.”

To determine the safety and effectiveness of the surgery, Dr. Gallie’s team examined data from 919 children (1171 eyes) who received standard treatments alone, standard treatments plus tylectomy or eye removal. All children were treated by a single team in China, which included retinoblastoma specialist, Dr. Junyang Zhao, and vitreoretinal surgeon, Dr. Qiyan Li, co-first authors of the study.

The researchers found that the percentage of children who eventually needed eye-removal surgery was reduced from 47% with standard treatments alone to 20% with standard treatments plus tylectomy.

Furthermore, the five-year overall survival rate for children who underwent tylectomy was nearly 94%. This survival rate is significantly higher than that of children who received standard treatments alone (89%) and similar to that of children who had immediate eye removal (95%).

Children who received tylectomy were no more likely to experience lethal cancer spread than those who had immediate eye removal, and they were nearly three times less likely to die of cancer spread than those who received standard treatments alone.

These findings suggest that tylectomy is a safe and effective treatment for retinoblastoma, and that it should be made available to more patients in combination with standard therapies.

“The children that we treat are unbelievably resilient and they motivate us to keep working to improve therapies,” says Dr. Gallie. “Our findings reveal that we can safely remove tumours surgically without sacrificing the entire eye—an insight that has the potential to help children with retinoblastoma around the world.”

This work was supported by the UHN Foundation.

Zhao J, Li Q, Feng ZX, Zhang J, Wu S, Jin L, Gallie BL. Tylectomy Safety in Salvage of Eyes with Retinoblastoma. Cancers (Basel). 2021 Nov 22. doi: 10.3390/cancers13225862.

 

Dr. Brenda Gallie is an Affiliate Scientist at UHN’s Donald K. Johnson Eye Institute and Techna Institute; Professor in the departments of Medical Biophysics, Molecular Genetics, and Ophthalmology and Vision Science at the University of Toronto; and Head of the Retinoblastoma Program at The Hospital for Sick Children.