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==Classification==
==Classification==
The International Classification for Intraocular Retinoblastoma, based upon the Philadelphia and Murphree systems is currently the classification being used by the Children's Oncology Group in multicenter treatment protocols.<ref name="pmid10388023">{{cite journal| author=Pratt CB, Fontanesi J, Lu X, Parham DM, Elfervig J, Meyer D| title=Proposal for a New Staging Scheme for Intraocular and Extraocular Retinoblastoma Based on an Analysis of 103 Globes. | journal=Oncologist | year= 1997 | volume= 2 | issue= 1 | pages= 1-5 | pmid=10388023 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10388023  }} </ref><ref name="pmid15136321">{{cite journal| author=Shields CL, Mashayekhi A, Demirci H, Meadows AT, Shields JA| title=Practical approach to management of retinoblastoma. | journal=Arch Ophthalmol | year= 2004 | volume= 122 | issue= 5 | pages= 729-35 | pmid=15136321 | doi=10.1001/archopht.122.5.729 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15136321  }} </ref><ref name="pmid15763190">{{cite journal| author=Linn Murphree A| title=Intraocular retinoblastoma: the case for a new group classification. | journal=Ophthalmol Clin North Am | year= 2005 | volume= 18 | issue= 1 | pages= 41-53, viii | pmid=15763190 | doi=10.1016/j.ohc.2004.11.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15763190  }} </ref><ref name="pmid16996605">{{cite journal| author=Shields CL, Mashayekhi A, Au AK, Czyz C, Leahey A, Meadows AT et al.| title=The International Classification of Retinoblastoma predicts chemoreduction success. | journal=Ophthalmology | year= 2006 | volume= 113 | issue= 12 | pages= 2276-80 | pmid=16996605 | doi=10.1016/j.ophtha.2006.06.018 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16996605  }} </ref> The goal of International Classification of Retinoblastoma (ICRB) is to reflect the likelihood of ocular survival based on modern treatment techniques such as [[chemotherapy]] and focal therapy. The International Classification of Retinoblastoma (ICRB) was developed to better predict those with intraocular retinoblastoma who are likely to be cured without the need for external-beam radiation treatment or [[enucleation]]. International retinoblastoma classification predicts the overall survival in patients with retinoblastoma.<ref name="radio">  Retinoblastoma. Radiopedia(2015) http://radiopaedia.org/articles/retinoblastoma Accessed on October 10, 2015</ref>  
The International Classification for Intraocular Retinoblastoma, based upon the Philadelphia and Murphree systems is currently the classification being used by the Children's Oncology Group in multicenter treatment protocols.<ref name="pmid10388023">{{cite journal| author=Pratt CB, Fontanesi J, Lu X, Parham DM, Elfervig J, Meyer D| title=Proposal for a New Staging Scheme for Intraocular and Extraocular Retinoblastoma Based on an Analysis of 103 Globes. | journal=Oncologist | year= 1997 | volume= 2 | issue= 1 | pages= 1-5 | pmid=10388023 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10388023  }} </ref><ref name="pmid15136321">{{cite journal| author=Shields CL, Mashayekhi A, Demirci H, Meadows AT, Shields JA| title=Practical approach to management of retinoblastoma. | journal=Arch Ophthalmol | year= 2004 | volume= 122 | issue= 5 | pages= 729-35 | pmid=15136321 | doi=10.1001/archopht.122.5.729 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15136321  }} </ref><ref name="pmid15763190">{{cite journal| author=Linn Murphree A| title=Intraocular retinoblastoma: the case for a new group classification. | journal=Ophthalmol Clin North Am | year= 2005 | volume= 18 | issue= 1 | pages= 41-53, viii | pmid=15763190 | doi=10.1016/j.ohc.2004.11.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15763190  }} </ref><ref name="pmid16996605">{{cite journal| author=Shields CL, Mashayekhi A, Au AK, Czyz C, Leahey A, Meadows AT et al.| title=The International Classification of Retinoblastoma predicts chemoreduction success. | journal=Ophthalmology | year= 2006 | volume= 113 | issue= 12 | pages= 2276-80 | pmid=16996605 | doi=10.1016/j.ophtha.2006.06.018 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16996605  }} </ref> The goal of International Classification of Retinoblastoma (ICRB) is to reflect the likelihood of ocular survival based on modern treatment techniques such as [[chemotherapy]] and focal therapy. The International Classification of Retinoblastoma (ICRB) was developed to better predict those with intraocular retinoblastoma who are likely to be cured without the need for external-beam radiation treatment or [[enucleation]]. International retinoblastoma classification predicts the overall survival in patients with retinoblastoma.<ref name="radio">  Retinoblastoma. Radiopedia(2015) http://radiopaedia.org/articles/retinoblastoma Accessed on October 10, 2015</ref>  
;The International Classification of Retinoblastoma staging system <ref name="pmid16996605">{{cite journal |vauthors=Shields CL, Mashayekhi A, Au AK, Czyz C, Leahey A, Meadows AT, Shields JA |title=The International Classification of Retinoblastoma predicts chemoreduction success |journal=Ophthalmology |volume=113 |issue=12 |pages=2276–80 |date=December 2006 |pmid=16996605 |doi=10.1016/j.ophtha.2006.06.018 |url=}}</ref><ref name="pmid17729249">{{cite journal |vauthors=Zage PE, Reitman AJ, Seshadri R, Weinstein JL, Mets MB, Zeid JL, Greenwald MJ, Strauss LC, Goldman S |title=Outcomes of a two-drug chemotherapy regimen for intraocular retinoblastoma |journal=Pediatr Blood Cancer |volume=50 |issue=3 |pages=567–72 |date=March 2008 |pmid=17729249 |doi=10.1002/pbc.21301 |url=}}</ref><ref name="pmid19172510">{{cite journal |vauthors=Novetsky DE, Abramson DH, Kim JW, Dunkel IJ |title=Published international classification of retinoblastoma (ICRB) definitions contain inconsistencies--an analysis of impact |journal=Ophthalmic Genet. |volume=30 |issue=1 |pages=40–4 |date=March 2009 |pmid=19172510 |doi=10.1080/13816810802452168 |url=}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 800px" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width: 800px" align=center
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:Group A
:Group A
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Retinoblastoma 3 mm or less in basal dimension or thickness, located at least 3 mm from the foveola and 1.5 mm from the optic nerve
*Small intraretinal tumors away from foveola and optic nerve
**3mm or smaller in the greatest dimension, confined to retina
**Located further than 3 mm from the foveola and 1.5 mm from the optic disc.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Group B
:Group B
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Retinoblastoma not in Group A with 1 or more of the following:
*Tumors confined to the retina.
**Macular location (≤3 mm to foveola)
**Not in the group A
**Juxtapapillary location (≤1.5 mm to optic nerve)
**Tumor-associated subretinal fluid less than 3 mm from the tumor with no subretinal seeding.
**Additional subretinal fluid (≤5 mm from margin)
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-All remaining discrete tumors confined to the retina.weight: bold" |
:Group C
:Group C
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Retinoblastoma tumor with 1 of the following:
*Local disease with minimal subretinal or vitreous seeding with following caracteristics:
**Focal subretinal seeds
**Discrete
**Focal vitreous seeds
**Subretinal fluid, present or past, without seeding involving up to one-fourth of the retina
**Both focal subretinal and vitreous seeds.
**Local fine vitreous seeding may be present close to the discrete tumor
**Local subretinal seeding less than 3 mm (2 DD) from the tumor
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Group D
:Group D
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Retinoblastoma tumor with 1 of the following:
*Diffuse tumor with significant vitreous or subretinal seeding
**Diffuse subretinal seeds
**May be massive or diffuse
**Diffuse vitreous seeds
**Subretinal fluid present or past without seeding, involving up to total retinal detachment
**Both diffuse subretinal and vitreous seeds
**The diffuse or massive vitreous disease may include “greasy” seeds or avascular tumor masses
**Diffuse subretinal seeding may include subretinal plaques or tumor nodules
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Group E
:Group E
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Very high-risk eyes with 1 or more of the following:
*Presence of any one or more of the following poor prognosis features
**Neovascular glaucoma
**Massive intraocular hemorrhage
**Aseptic orbital cellulitis
**Tumor anterior to the vitreous face
**Tumor touching the lens
**Tumor touching the lens
**Tumor anterior to anterior vitreous face involving the ciliary body or anterior segment
**Diffuse infiltrating retinoblastoma
**Diffuse infiltrating retinoblastoma
**Phthisis bulbi (also known as end-stage eye, this is a nonfunctioning, atrophic, scarred, and disorganized globe, frequently with dystrophic calcification).
**Neovascular glaucoma
**Opaque media from hemorrhage
**Tumor necrosis with aseptic orbital cellulitis
**Phthisis bulbi
|}
|}


Revision as of 20:40, 24 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Retinoblastoma may be classified into several subgroups based on the International Retinoblastoma Staging System (IRSS).[1] [2][3]

Classification

The International Classification for Intraocular Retinoblastoma, based upon the Philadelphia and Murphree systems is currently the classification being used by the Children's Oncology Group in multicenter treatment protocols.[1][2][3][4] The goal of International Classification of Retinoblastoma (ICRB) is to reflect the likelihood of ocular survival based on modern treatment techniques such as chemotherapy and focal therapy. The International Classification of Retinoblastoma (ICRB) was developed to better predict those with intraocular retinoblastoma who are likely to be cured without the need for external-beam radiation treatment or enucleation. International retinoblastoma classification predicts the overall survival in patients with retinoblastoma.[5]

The International Classification of Retinoblastoma staging system [4][6][7]
Groups Features
Group A
  • Small intraretinal tumors away from foveola and optic nerve
    • 3mm or smaller in the greatest dimension, confined to retina
    • Located further than 3 mm from the foveola and 1.5 mm from the optic disc.
Group B
  • Tumors confined to the retina.
    • Not in the group A
    • Tumor-associated subretinal fluid less than 3 mm from the tumor with no subretinal seeding.
Group C
  • Local disease with minimal subretinal or vitreous seeding with following caracteristics:
    • Discrete
    • Subretinal fluid, present or past, without seeding involving up to one-fourth of the retina
    • Local fine vitreous seeding may be present close to the discrete tumor
    • Local subretinal seeding less than 3 mm (2 DD) from the tumor
Group D
  • Diffuse tumor with significant vitreous or subretinal seeding
    • May be massive or diffuse
    • Subretinal fluid present or past without seeding, involving up to total retinal detachment
    • The diffuse or massive vitreous disease may include “greasy” seeds or avascular tumor masses
    • Diffuse subretinal seeding may include subretinal plaques or tumor nodules
Group E
  • Presence of any one or more of the following poor prognosis features
    • Tumor touching the lens
    • Tumor anterior to anterior vitreous face involving the ciliary body or anterior segment
    • Diffuse infiltrating retinoblastoma
    • Neovascular glaucoma
    • Opaque media from hemorrhage
    • Tumor necrosis with aseptic orbital cellulitis
    • Phthisis bulbi

References

  1. ↑ 1.0 1.1 Pratt CB, Fontanesi J, Lu X, Parham DM, Elfervig J, Meyer D (1997). "Proposal for a New Staging Scheme for Intraocular and Extraocular Retinoblastoma Based on an Analysis of 103 Globes". Oncologist. 2 (1): 1–5. PMID 10388023.
  2. ↑ 2.0 2.1 Shields CL, Mashayekhi A, Demirci H, Meadows AT, Shields JA (2004). "Practical approach to management of retinoblastoma". Arch Ophthalmol. 122 (5): 729–35. doi:10.1001/archopht.122.5.729. PMID 15136321.
  3. ↑ 3.0 3.1 Linn Murphree A (2005). "Intraocular retinoblastoma: the case for a new group classification". Ophthalmol Clin North Am. 18 (1): 41–53, viii. doi:10.1016/j.ohc.2004.11.003. PMID 15763190.
  4. ↑ 4.0 4.1 Shields CL, Mashayekhi A, Au AK, Czyz C, Leahey A, Meadows AT; et al. (2006). "The International Classification of Retinoblastoma predicts chemoreduction success". Ophthalmology. 113 (12): 2276–80. doi:10.1016/j.ophtha.2006.06.018. PMID 16996605.
  5. ↑ Retinoblastoma. Radiopedia(2015) http://radiopaedia.org/articles/retinoblastoma Accessed on October 10, 2015
  6. ↑ Zage PE, Reitman AJ, Seshadri R, Weinstein JL, Mets MB, Zeid JL, Greenwald MJ, Strauss LC, Goldman S (March 2008). "Outcomes of a two-drug chemotherapy regimen for intraocular retinoblastoma". Pediatr Blood Cancer. 50 (3): 567–72. doi:10.1002/pbc.21301. PMID 17729249.
  7. ↑ Novetsky DE, Abramson DH, Kim JW, Dunkel IJ (March 2009). "Published international classification of retinoblastoma (ICRB) definitions contain inconsistencies--an analysis of impact". Ophthalmic Genet. 30 (1): 40–4. doi:10.1080/13816810802452168. PMID 19172510.

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