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G Hubbard, TM Aaberg Jr; Sequential Periocular Injections of Carboplatin for Retinoblastoma . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2595.
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Purpose:To report our experience with sequential periocular carboplatin injections for retinoblastoma. Methods:Retrospective chart review. Results:Nine eyes of 7 patients were treated with periocular carboplatin from October 2000 to December 2001. Murphree stage at the time of diagnosis ranged from group B to D. All eyes received between 2 and 7 injections combined with one or more forms of local therapy (cryo, photocoagulation, or transpupillary thermal therapy) spaced approximately 2 weeks apart. Injections consisted of carboplatin 20mg in 2cc of normal saline given in the retroseptal space. Eight eyes underwent one or more local treatments before periocular injections. Four of these eight eyes underwent systemic chemotherapy before periocular injections and 1 underwent external beam radiotherapy before periocular injections. Reasons for using periocular carboplatin in these 8 eyes were persistence of retinal tumors (3 eyes) or development of vitreous seeds (5 eyes). One eye with a 12mm tumor touching the optic nerve underwent a sequence of combined periocular injections and transpupillary thermotherapy as the initial treatment. Three of 7 patients reported one or more of the following adverse reactions to periocular carboplatin: periocular edema (2 patients), nausea with vomiting (1 patient), diarrhea (1 patient), fever (1 patient). Four patients reported no adverse reactions to the periocular injections. With median follow-up of 3.2 months since the last treatment, six eyes had regression of tumors with no additional treatment. One eye had complete regression of the treated tumors but had new tumors at the most recent follow-up visit. Two eyes in one patient required external beam radiotherapy after combined local treatment, systemic chemotherapy, and periocular injections failed to achieve regression. Conclusion:Longer follow-up is required to determine whether sequential periocular carboplatin injections are a useful adjunct in achieving regression of retinoblastoma in selected cases.
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