Carboplatin and Vincristine as Primary Systemic Chemotherapy for Intraocular Retinoblastoma: A Review of 82 Consecutively Treated Eyes.

Abstract

Abstract: : Purpose: To report 82 consecutive eyes with intraocular retinoblastoma treated with primary systemic chemotherapy using carboplatin and vincristine. Methods: The charts of 46 patients (36 bilateral/10 unilateral) diagnosed with intraocular retinoblastoma between February 1996 and October 2002 were retrospectively reviewed. Forty–one of the 46 patients were treated with carboplatin and vincristine every 3 weeks for 8 cycles. Four patients with either advanced disease at diagnosis (n=3) or disease progression while on chemotherapy (n=1) also received etoposide. One patient with an X;13 translocation and developmental delay was treated with carboplatin alone. For 25 patients (21 bilateral/4 unilateral), focal consolidation was withheld until disease progression was documented. In the remaining 21 patients, focal treatment was initiated upon completion of the second cycle of chemotherapy. Main outcomes measured were avoidance of external beam radiotherapy (EBRT) and ocular survival. Results: Among the 82 eyes treated, 45 (55%) were Reese–Ellsworth Groups IV–V and 37 (45%) were Groups I–III. Median follow–up from the start of chemotherapy was 36.4 months (range, 9.5 to 90 months). At 2 years, the estimated event–free survival (EFS), defined as the avoidance of EBRT or enucleation, was 42.7 +/– 6.0%. The estimated ocular survival at 3 years was 68.2 +/– 7.0%. The estimated cumulative incidence (CIN) of EBRT at 2 years was 46.2 +/– 5.7%. Timing of focal treatment did not significantly affect either EFS or ocular survival (p= 0.87 and p= 0.72, respectively). Patients who received focal treatment after the first 2 courses of chemotherapy had a significantly lower CIN of EBRT (p= 0.035). Conclusions: Primary systemic chemotherapy with carboplatin and vincristine combined with focal consolidation is an effective regimen in the treatment of intraocular retinoblastoma. The earlier incorporation of focal therapies in treatment may reduce the subsequent need for EBRT.

Keywords: retinoblastoma • tumors • retina