Low-Dose Chemoreduction for Infants Diagnosed with Retinoblastoma before 6 Months of Age

Abstract

Aim: The purpose of this study was to evaluate the outcomes of infants diagnosed with retinoblastoma before 6 months of age, including the need for chemoreduction (CRD). In this age group, dosage of CRD was reduced due to its potential for toxicity. Methods: This is a retrospective review from 2000 to 2009 that includes 126 eyes of 72 infants (18 unilateral, 54 bilateral). Systemic CRD was administered when local modalities failed or were considered inadequate. Primary outcome measures were the need for CRD and globe salvage. Results: Of the 72 infants diagnosed before 6 months of age, 48 (67%) ultimately required CRD for globe salvage, 40 (56%) patients before 6 months of age. Globe salvage was achieved in 62% (78/126) of eyes overall and in 93% (68/73) of eyes with Group A-C disease. No patient was hospitalized for CRD-related illness; survival was 100%. The mean follow-up was 52.9 months (range 1-148 months). Conclusion: Utilizing a combination of focal modalities and reduced-dose CRD, children diagnosed with retinoblastoma before 6 months of age attain globe salvage rates comparable to those of older age groups. Two thirds of the infants ultimately required CRD for globe salvage. Bilateral disease as well as Group D and E classification in at least one eye at presentation increased the chance of requiring CRD (p < 0.0001 and p < 0.016, respectively).

Integrated Treatment during the Intravitreal Melphalan Era: Concurrent Intravitreal Melphalan and Systemic Chemoreduction

“…The treatment protocol for retinoblastoma at CHLA has previously been published [11, 12]. The injection procedure closely adheres to the protocol outlined by Munier and colleagues [13-15] and previously published [6].…”

Long‐term outcomes of Group D retinoblastoma eyes during the intravitreal melphalan era

“…Briefly, systemic chemoreduction consists of intravenous carboplatin 390 mg/m 2 (13 mg/kg for children <36 months) each day for 2 days, etoposide 150 mg/m 2 (5 mg/kg for <36 months) each day for 2 days, and vincristine 1.5 mg/m 2 (0.05 mg/kg for <36 months) for 1 day for six cycles every 28 days (CEV). Infants less than 6 months of age at diagnosis receive a modified dosing regimen, which has been described . Local consolidation therapy includes argon or diode laser therapy (532 nm or 810 nm laser, 1.3 mm spot size) and cryotherapy (in a freeze‐thaw cycle × 2) for larger lesions anterior to the equator.…”

Optic Nerve Obscuration in Retinoblastoma: A Risk Factor for Optic Nerve Invasion

“…Globe salvaging treatment for Group E retinoblastoma is done only if the patient has bilateral disease wherein the contralateral eye will also require systemic therapy for salvage. The treatment paradigms at our center have been described previously [9,10,11]. …”