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P. S. Patel, G. B. Hubbard, III; Long-Term Follow-Up of Periocular Carboplatin as an Adjunct to Local Treatment of Retinoblastoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2070.
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To report our experience with sequential periocular carboplatin injections for retinoblastoma with long-term follow-up and visual acuity data.
Retrospective chart review.
Twelve eyes of 9 patients were treated with periocular carboplatin from 1999 to 2004. Murphree stage at the time of diagnosis ranged from group B to D. All cases were bilateral except for 1 unilateral case. Both eyes of 3 patients were included. All but one eye received treatment prior to the carboplatin injections including systemic chemotherapy (vincristine, etopside, and carboplatin), local therapy (cryotherapy, photocoagulation, or transpupillary thermal therapy), or a combination of systemic and local therapy. Three eyes had systemic chemptherapy alone, 3 eyes had local therapy alone, and 5 eyes had a combination of systemic chemotherapy and local treatment. No eyes had prior external beam radiation. All patients received carboplatin 20mg in 2mL of normal saline in the retroseptal space. All eyes received carboplatin in combination with one or more forms of local therapy. Periocular carboplatin was used for persistence of retinal tumors (4 eyes), development of vitreous seeds (7 eyes), or primary treatment along with local therapy (lone unilateral case). The average number of injections was 4 (range 2-7 injections). The average interval between injections was 20 days (range 14-39 days). Four of the 9 patients experienced 1 or more of the following adverse reactions: transient periocular edema (4 patients), pain (2 patients), optic atrophy (2 patients), strabismus (2 patients), nausea with vomiting (1 patient), diarrhea (1 patient), fever (1 patient). Five patients reported no adverse reactions to the periocular injections. With mean follow-up of 6.25 years (range 2.9 - 8.0 years) after the last treatment, 7 eyes had regression of tumors with no additional systemic chemotherapy or external beam radiation. Three eyes required subsequent external beam radiation (Stage D, 2eyes; Stage C , 1 eye), 2 eyes in the same patient with successful regression in both and 1 eye requiring enucleation (Stage D). Three of the 12 eyes ultimately required enucleation (Stage D, 2eyes; Stage C, 1 eye). Six of the nine non-enucleated eyes, had a final best-corrected visual acuity of 20/60 or better.
Subconjunctival carboplatin can be an effective adjunct to local therapy for regression of retinoblastoma with limited systemic side effects but concerns do exist for local adverse reactions especially optic atrophy.
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