Pre-enucleation chemotherapy for eyes severely affected by XXXX masks risk of tumor extension and increases death from @entity3 .

@entity1 @entity3 @entity995
PURPOSE: Initial response of intraocular @entity995 to chemotherapy has encouraged primary chemotherapy instead of primary enucleation for eyes with clinical features suggesting high risk of extraocular extension or @entity3 . Upfront enucleation of such high-risk eyes allows pathologic evaluation of extraocular extension, key to management with appropriate surveillance and adjuvant therapy. Does chemotherapy before enucleation mask histologic features of extraocular extension, potentially endangering the @entity1 's life by subsequent undertreatment? METHODS: We performed retrospective analysis of 100 eyes with advanced @entity995 enucleated with, or without, primary chemotherapy, in Beijing Tongren Hospital, retrospectively, from October 31, 2008. The extent of @entity995 invasion into optic nerve, uvea, and anterior chamber on histopathology was staged by pTNM classification. The treatment groups were compared for pathologic stage (Cochran-Armitage trend test) and disease-specific mortality (competing risks methods). RESULTS: @entity1 who received chemotherapy before enucleation had lower pTNM stage than primarily enucleated @entity1 (P = .01). Five @entity1 who received pre-enucleation chemotherapy died as a result of extension into brain or @entity3 . No @entity1 who had primary enucleation died. For @entity1 with group E eyes, disease-specific survival (DSS) was lower with pre-enucleation chemotherapy (n = 45) than with primary enucleation (n = 37; P = .01). Enucleation longer than 3 months after diagnosis was also associated with lower DSS (P < .001). CONCLUSION: Chemotherapy before enucleation of group E eyes with advanced @entity995 downstaged pathologic evidence of extraocular extension, and increased the risk of metastatic death from reduced surveillance and inappropriate management of high-risk disease, if enucleation was performed longer than 3 months after diagnosis.
