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P. Mruthyunjaya, J.E. Kingston, J.L. Hungerford; Treatment Outcomes and Globe Salvage Using Second Line Chemotherapy in Advanced Retinoblastoma . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2291.
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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)
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.
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.
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.
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