Third (fourth and fifth) nonocular tumors in survivors of retinoblastoma

Ophthalmology. 2001 Oct;108(10):1868-76. doi: 10.1016/s0161-6420(01)00713-8.


Objective: This study aimed to investigate the incidence, timing, pattern, and distribution of, as well as survival as a result of, third, fourth, and fifth primary tumors in survivors of retinoblastoma.

Design: This study was a retrospective case series of patients diagnosed with retinoblastoma and a second malignant neoplasm. Records were examined for demographic, prior treatment, and second tumor information, as well as any evidence of the development of a third, fourth, or fifth nonocular tumor. When possible, telephone inquiries were conducted for follow-up.

Participants: The study included 1506 patients followed in the Ophthalmic Oncology Center at New York-Presbyterian Hospital, New York Weill Cornell Medical Center, 211 of whom developed a second tumor and had sufficient treatment data to be useful for analysis.

Main outcome measures: The development of third and additional nonocular tumors and survival from these tumors were the primary outcome measures.

Results: Of 211 second-tumor patients, 142 died before an additional malignancy developed (median survival time, 1.8 +/- 0.3 years) and in 28, third tumors developed (5-year incidence rate, 11%; 10-year incidence rate, 22%; median time to third tumor development, 5.8 +/- 8.3 years). The 5- and 10-year survival rates for this group were 41% and 30%, respectively (median survival time, 4.1 +/- 1.0 years). Of 28 patients in whom third tumors developed, 27 (96%) had received radiation therapy for their retinoblastoma. The most common sites for third tumors were soft tissues of the head (36% of all third tumors) and skin (36% of all third tumors). In six patients, a fourth tumor developed, and in two patients a fifth tumor developed. All fourth and fifth tumors were found in the soft tissues of the head, the skin, or the bones.

Conclusions: Survivors of retinoblastoma in whom second malignant neoplasms develop are at a higher risk for the development of additional tumors than they were for the development of a second tumor. The locations and expected ages at which additional tumors develop are consistent with the patterns we have seen in second tumors.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Incidence
  • Infant
  • Male
  • Middle Aged
  • Neoplasms, Radiation-Induced / etiology*
  • Neoplasms, Radiation-Induced / mortality
  • Neoplasms, Second Primary / etiology*
  • Neoplasms, Second Primary / mortality
  • Neoplasms, Second Primary / pathology
  • Retinal Neoplasms / mortality
  • Retinal Neoplasms / radiotherapy*
  • Retinoblastoma / mortality
  • Retinoblastoma / radiotherapy*
  • Retrospective Studies
  • Soft Tissue Neoplasms / etiology*
  • Soft Tissue Neoplasms / mortality
  • Soft Tissue Neoplasms / pathology
  • Survival Rate
  • Survivors
  • Time Factors