Abstract
Purpose: :
To describe the treatment outcomes using second line chemotherapy (SLC) with intravenous vincristine, doxorubicin, and ifosfamide (IVAd) in eyes with relapsed or refractory retinoblastoma (Rb)
Methods: :
Non–comparative, consecutive, interventional series of eyes treated with IVAd following first line chemotherapy failure with vincristine, etoposide, and carboplatin. Indications and outcomes, including globe salvage (treatment success) were identified.
Results: :
21 eyes in 14 children received SLC with IVAd. Nine (43%) were Reese–Ellsworth group IVa or worse. New vitreous disease was the most common indication (n=6). Median follow up was 2 years. Twelve (57%) eyes were salvaged, nine (43%) with SLC and local therapy alone and 3 (14%) with additional external beam radiotherapy (EBRT). Eight (38%) eyes were enucleated. Relapse after SLC was correlated with treatment failure (p<0.001). Eyes needing EBRT were also likely to fail (p<0.01). Median time to failure was 282 days. No local or systemic metastases, deaths or second tumors were documented.
Conclusions: :
Second line chemotherapy with IVAd represents an option for globe sparing therapy in refractory Rb, especially with vitreous disease. This strategy allowed globe salvage in 57% of eyes. The impact of IVAd on second cancer risk in genetic Rb patients is unknown and must be considered in these patients.
Keywords: retinoblastoma • tumors