The Outcome of Chemoreduction Treatment in Patients With Reese-Ellsworth Group V Retinoblastoma

Abstract

To determine the outcome of chemoreduction treatment in patients with Reese-Ellsworth group V retinoblastoma. Methods: Prospective analysis of 27 eyes in 22 patients with group V retinoblastoma treated with either 2-or 6-cycle chemoreduction and focal treatment methods (argon laser photocoagulation, transpupillary thermotherapy, cryotherapy, and plaque radiotherapy). The need for external beam irradiation and the eventual globe salvage rate were assessed. Median follow-up was 28 months. Results: There were 16 eyes in the 2-cycle chemoreduction treatment group and 11 eyes in the 6-cycle chemoreduction treatment group. No significant difference was noted between the 2 groups with respect to baseline patient and eye findings. After chemoreduction treatment, external beam irradiation was necessary in 12 (75%) of 16 eyes in the 2-cycle chemoreduction treatment group and in 4 (36%) of 11 eyes in the 6-cycle chemoreduction treatment group. There was no statistical difference between the 2-and 6-cycle chemoreduction treatment groups with respect to necessity for external beam

Combined chemotherapy and local treatment in the management of intraocular retinoblastoma

“…In the past, standard treatments for retinoblastoma consisted of enucleation and EBRT; systemic chemotherapy in retinoblastoma was generally reserved for patients with invasion into the optic nerve, choroid, orbit or with metastatic disease. More recently, many studies showed the interest of chemotherapy in the management of intraocular disease with the aim to avoid EBRT [5][6][7][8][9][10][11][12][13]. Reported studies are very promising but the number of patients are small and there are some variations in chemotherapeutic regimen used.…”

“…Gallie et al, reported an 83% globe salvage rate in group V retinoblastoma eyes after chemoreduction in combination with cyclosporine and focal treatment [18]. Gündüz et al found that group V retinoblastoma was potentially treatable with chemoreduction and focal treatment with 59% of eyes requiring EBRT and an overall globe salvage rate of 63% with a median follow-up of 25 months [7]. In a recent report, Friedman et al [3] showed that 33% of group IV and 53% of group V, respectively, required EBRT and/or enucleation and concluded that if, in patients with groups I, II, III, chemoreduction and local ophtalmic therapy were effective with little morbidity, other treatment options needed to be developed in group IV, V as addition of subconjonctival chemotherapy [19], cyclosporine, and plaque or adjuvant low-dose radiation therapy.…”

The Clinical Outcomes of Proton Beam Radiation Therapy for Retinoblastomas That Were Resistant to Chemotherapy and Focal Treatment

“…Since the time when Kingston et al [9] established the current regimen of chemotherapy, it has been used to reduce tumor volume and make additional focal therapy possible. Using these treatment modalities have not only much improved the ocular salvage rates [10,20] but also have reduced the occurrence of secondary malignant tumors and intracranial neuroblastic tumors, such as pinealoblastoma [21]. …”

Retinoblastoma

“…Although randomized studies have not been performed, when compared to radiation and focal treatments alone, chemoreduction does not seem to improve overall ocular salvage significantly for patients with very advanced intraocular disease (Scott et al 1999;Hungerford et al 1995;Toma et al 1995). Chemotherapy intensification appears to correlate with outcome, and better results are obtained with protocols that include at least 6 courses of vincristine, etoposide, and carboplatin (Shields et al 2002a;Gündüz et al 1998;Shields et al 1997). Central retinal tumors usually respond better to chemotherapy than do tumors in the peripheral retina , but large central tumors may be associated with subretinal seeds, which ultimately may cause treatment failure (Shields et al 2002b).…”