To the Editor.
—The recent publication in the Archives of three articles on retinoblastoma1-3 raises the problem of detecting the second nonocular tumor over a long term.Abramson et al3 state: "It appears there is a 30% chance of succumbing to a nonocular tumor within 18 years after the second dose of irradiation." They add that they expect the same in patients treated with radiation only once or not at all. Therefore, any patient with retinoblastoma with bilateral disease, regardless of treatment, runs a 30% risk of a second nonocular tumor within 18 years, most frequently osteogenic sarcoma. Unlike osteogenic sarcoma not preceded by retinoblastoma that occurs primarily in the second decade of life, these tumors apparently appear with an almost linear frequency starting four years after discovery of the retinoblastoma.To facilitate the early detection of such lesions, we now plan specificially to examine all patients with
Romano P, Gross S, Quisling RG. Retinoblastoma. Arch Ophthalmol. 1983;101(3):487. doi:10.1001/archopht.1983.01040010487039