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Jasmine H. Francis, Y P. Gobin, Scott E. Brodie, Brian Marr, Ira Dunkel, David H. Abramson; Single-agent Intraarterial Carboplatin For The Treatment Of Retinoblastoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1882.
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Carboplatin has been used as a single-agent in the treatment of retinoblastoma. This includes systemic chemotherapy for chemoreduction and local, periorbital administration for intraocular disease. However, there have been no reports on the use of single-agent carboplatin with the intra-arterial (IA) delivery method. We report our initial experience with single-agent carboplatin via IA administration for retinoblastoma.
Retrospective chart review, employing electroretinogram (ERG) responses as a measure of retinal function and drug toxicity.
Three eyes of three patients with bilateral retinoblastoma and an average age of 6.33 mos (+/- 4.5 mos) received single-agent intraarterial carboplatin (2 eyes each received three cycles; one eye received one cycle). One eye was classified as Reese-Ellsworth (RE) IIB, one as RE IVA and one as RE VA (two eyes International Classification (IC) C and one eye IC B). The maximum dose of carboplatin ranged from 25 to 40mg, while the cumulative dose ranged from 25 to 100mg. One patient was 2 months old at the time of diagnosis and received two cycles of systemic carboplatin (18.7mg/kg every 3-4 weeks) prior to IA carboplatin at 4 mos of age. Two eyes were treated with local therapy including laser and cryotherapy. All patients had a dramatic response to therapy, demonstrating a type III regression pattern with no tumor reccurence over the mean follow up of 3.33 mos. One patient had a retinal detachment which improved with treatment. All patients had a meaningful (defined by a change of 25mV or more) increases in their ERG responses with a mean improvement of 77.8mV (+/- 28.9 mV and range of 56.1 to 110.6 mV).
Single-agent intraarterial carboplatin proves effective against intraocular retinoblastoma in our initial cohort of 3 patients. These eyes demonstrated dramatic tumor regression, even after a single cycle of IA carboplatin or following systemic intravenous carboplatin. ERG responses were increased in all eyes following treatment, suggesting retinal function was not only preserved, but improved (most likely from subretinal fluid resolution). Carboplatin at these doses via IA administration does not appear to pose a toxic effect to the retina.
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