Elsevier

Ophthalmology

Volume 108, Issue 11, November 2001, Pages 2106-2114
Ophthalmology

Multiagent chemotherapy as neoadjuvant treatment for multifocal intraocular retinoblastoma

Presented in part at the annual meeting of the American Academy of Ophthalmology, Dallas, Texas, October 2000.
https://doi.org/10.1016/S0161-6420(01)00805-3Get rights and content

Abstract

Purpose

To evaluate the efficacy of multiagent chemotherapy in the neoadjuvant treatment of retinoblastoma.

Design

Noncomparative, prospective case series.

Participants

Twenty consecutive patients with multifocal intraocular retinoblastoma (4 unilateral, 16 bilateral [36 eyes]).

Intervention

Eight cycles of chemotherapy with carboplatin and vincristine were administered at 3-week intervals over a 6-month period. Supplemental therapy was withheld until disease progression was documented.

Main outcome measures

Disease progression (defined as tumor growth, vitreous or subretinal seed progression, and new tumor formation), delay of external beam radiotherapy, and ocular survival.

Results

Thirty-six eyes were treated. Eighteen eyes had Reese-Ellsworth group I–III tumors, and 16 eyes had Reese-Ellsworth group IV–V tumors at diagnosis. Two patients, who had unilateral disease at diagnosis, subsequently had tumors develop in the contralateral eye. Nineteen of 20 patients (95%) completed eight cycles of chemotherapy without disease progression. Three eyes of three different patients were successfully treated with chemotherapy alone. Thirty-three of 36 eyes (92%) progressed after completion of chemotherapy: 15 of the 18 eyes (83.3%) with Reese-Ellsworth group I–III and 16 of 16 eyes (100%) with Reese-Ellsworth group IV–V tumors. Seventeen eyes (52%) had growth of a tumor, whereas 14 eyes (42%) had progressive vitreous seeding, and 2 eyes (6%) had new tumors develop. Fifteen eyes (42%) required external beam radiotherapy. Twenty-nine of 36 (80.5%) eyes were salvaged. The median follow-up after chemotherapy was 19 months (range, 3–42 months).

Conclusions

Multiagent chemotherapy alone does not ensure a cure for multifocal intraocular retinoblastoma. Supplemental focal therapy is needed to control disease progression.

Section snippets

Material and methods

A single-armed prospective clinical trial was designed to test the hypothesis that multifocal intraocular retinoblastoma can be treated with primary systemic chemotherapy with carboplatin and vincristine. The Institutional Review Board at St. Jude Children’s Research Hospital approved the protocol. Before enrollment, an examination under anesthesia (EUA) was performed to confirm the diagnosis of multifocal intraocular retinoblastoma involving one or both eyes. Fundus drawings were made, and the

Results

Twenty consecutive patients with multifocal intraocular retinoblastoma were treated with primary combination chemotherapy using carboplatin and vincristine between January 1996 and December 1999 (Table 1). Fourteen patients had bilateral disease, and six patients had unilateral disease, two of which progressed to bilateral disease after completing chemotherapy. In total, 36 eyes were followed. Fifteen patients were male and five patients were female. The median age at diagnosis was 8 months

Discussion

Previous studies have investigated the use of combination chemotherapy as a primary treatment for intraocular retinoblastoma.4, 5, 6, 7, 8 Protocols using various combinations of carboplatin, vincristine, etoposide, teniposide, and cyclosporine have been intermixed with focal ophthalmic therapies, including argon laser photocoagulation, cryotherapy, diode laser hyperthermia, I125 episcleral plaque brachytherapy, and EBRT.

In a preliminary report, Shields et al4 used two cycles of carboplatin,

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Cited by (0)

Supported by Grant NCI CA23099, Cancer Center Support Grant 21765, ALSAC, Research to Prevent Blindness, Inc, New York, New York, St. Giles Foundation, New York, New York.

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