Elsevier

Ophthalmology

Volume 115, Issue 8, August 2008, Pages 1405-1410.e2
Ophthalmology

Original article
Conservative Treatments of Intraocular Retinoblastoma

https://doi.org/10.1016/j.ophtha.2007.11.009Get rights and content

Objective

To describe the efficacy of conservative management of retinoblastoma by an association of conservative ocular therapies and chemothermotherapy.

Design

Phase II prospective nonrandomized trial.

Participants

Eighty-three children were included (115 eyes).

Methods

Conservative ocular therapies and chemothermotherapy (intravenous carboplatin followed by transpupillary thermotherapy to the tumor) after chemoreduction by 2 cycles of carboplatin and etoposide.

Main Outcome Measures

Use of external beam therapy and ocular tumor control.

Results

One hundred fifteen of the 147 affected eyes were eligible for conservative management. Nineteen children had unilateral lesions (22.8%), and 64 (77.1%) had bilateral lesions. Sixty-six children received neoadjuvant chemotherapy before ocular therapy, which consisted of one or a combination of several techniques: chemothermotherapy (65 children [86 eyes]) with a mean of 3 cycles per child, thermotherapy alone (22 children [24 eyes]), cryoapplication (49 children [58 eyes]), and iodine 125 brachytherapy (26 children [29 eyes]). Tumor control was achieved for 97 eyes (84%). At the end of the study, external beam radiotherapy (EBR) was necessary for a total of 9 children (11%) and 13 eyes (12%). Enucleation was necessary for a total of 23 eyes (20%), because of complications in 5 cases.

Conclusions

Neoadjuvant chemotherapy with 2 cycles of carboplatin and etoposide followed by ocular therapy and chemothermotherapy achieves satisfactory tumor control and permits a low need for EBR.

Section snippets

Patients and Methods

This was a single-center study designed as a phase II, prospective, nonrandomized evaluation of a conservative treatment strategy for the management of retinoblastoma.

This therapeutic approach comprises the use of different treatment modalities such as chemothermotherapy, thermotherapy, cryoapplication, and plaque brachytherapy, preceded by neoadjuvant chemotherapy when the tumor volume at diagnosis is important.

The primary objective was to allow conservative management of the eye by decreasing

Results

From December 1998 to March 2002, 83 children were included in this study. During this same period, 195 children were treated for retinoblastoma in our institute. Thirty-eight children were not included for the following reasons: follow-up could not be ensured (14); already treated elsewhere (17, 15 of whom were also likely to present a problem of follow-up); concomitant disease (homozygous sickle-cell anemia, suprasellar primitive neuroectodermal tumor, severe hematologic and hepatic

Discussion

This study reports the results in terms of tumor control of a therapeutic strategy comprising a phase of chemoreduction for a majority of children (2 cycles of a combination of etoposide and carboplatin), followed by local therapies or chemothermotherapy. The results are very positive, confirming the efficacy of this strategy for tumor control, with the exception of initially very advanced forms. Tumor control was obtained in the great majority of cases (84%), with the need for EBR in only 9

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    Manuscript no. 2007-687.

    The study received a grant from the Programme Hospitalier de Recherche Clinique and funding from the Association pour la Recherche sur le Cancer, Villejuif, France, and Retinostop, Paris, France, for the purchase of the Retcam equipment.

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