MANAGEMENT OF ADVANCED RETINOBLASTOMA WITH INTRAVENOUS CHEMOTHERAPY THEN INTRA-ARTERIAL CHEMOTHERAPY AS ALTERNATIVE TO ENUCLEATION.
Shields, Carol L. MD *; Kaliki, Swathi MD *; Al-Dahmash, Saad MD *,+; Rojanaporn, Duangnate MD *,++; Leahey, Ann MD [S]; Griffin, Gregory MD [P]; Jabbour, Pascal MD **; Shields, Jerry A. MD *
33(10):2103-2109, November/December 2013.
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Purpose: To determine the efficacy of primary intravenous chemotherapy (IVC) plus secondary intraarterial chemotherapy (IAC) for patients with advanced retinoblastoma.
Methods: Retrospective, nonrandomized interventional case series of 14 patients with retinoblastoma managed with primary systemic IVC (vincristine, etoposide, and carboplatin for 6 cycles) followed by secondary IAC (melphalan for 1-6 cycles).
Results: Fourteen patients with advanced retinoblastoma classified by the International Classification of Retinoblastoma as Group D (n = 6, 43%) or Group E (n = 8, 57%) were treated with IVC as primary treatment and subsequent secondary IAC as rescue or consolidation therapy. The IAC was given for recurrent retinoblastoma and/or subretinal/vitreous seeds in 13 eyes (93%) and for persistent viable retinoblastoma in 1 eye (7%). Enucleation was the alternative option. The mean interval between IVC completion and IAC start was 40 weeks (median, 11 weeks; range, 2-170 weeks) and the mean number of IAC cycles was 3 (median, 3; range, 1-6). After primary IVC plus secondary IAC, globe salvage was achieved in 8 patients (57%) at mean 2-year follow-up. There was no evidence of retinoblastoma metastasis or death and no sign of second cancer or life-threatening complication.
Conclusion: For advanced retinoblastoma (Groups D and E) in which enucleation is the alternative option, primary systemic IVC followed by secondary focal IAC provides globe salvage in 57% of the eyes and with no metastatic event.
(C) 2013 by Ophthalmic Communications Society, Inc.