Journal of Clinical Oncology, Vol 15, 1183-1189, Copyright © 1997 by American Society of Clinical Oncology
Orbital development in long-term survivors of retinoblastoma
SC Kaste, G Chen, J Fontanesi, DB Crom and CB Pratt
Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. sue.kaste@stjude.org
PURPOSE: To determine the effects of enucleation, irradiation, and age at
diagnosis on bony orbital growth in long-term survivors of retinoblastoma
using measurements based on computed tomographic (CT) imaging. PATIENTS AND
METHODS: We used CT obtained at a median age of 13 years to measure orbital
volume and configuration in 54 patients who had been treated for
retinoblastoma a minimum of 5 years previously. RESULTS: Enucleation and
high-dose orbital irradiation (> 35 Gy) both independently adversely
affected orbital development (P = .014 and P = .022, respectively). Orbital
volume differences for children treated when < or = 1 year old were no
greater than those for children treated when older than 1 year of age. In
children treated for bilateral retinoblastoma, the impact of enucleation on
orbital development was not statistically different from that of
irradiation (P = .13). Small implants (12 to 14 mm in diameter) were more
commonly associated with smaller orbital volumes. Migration of orbital
implants was associated with the smaller orbital sphere size in children
< or = 1 year of age (P < .035). CONCLUSION: Treatment for
retinoblastoma compromises orbital development. Resulting orbital asymmetry
seems to be at least partially related to the size of the implant. Detailed
imaging-based measurements of orbital volume and configuration may aid the
planning for cosmetic and reconstructive surgery in those who develop
orbital asymmetry.
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