Postenucleation Adjuvant Chemotherapy With Vincristine, Etoposide, and Carboplatin for the Treatment of High-Risk Retinoblastoma

Abstract

Background: Analysis of 52 eyes with high-risk retinoblastoma managed with postenucleation adjuvant chemotherapy using vincristine sulfate, etoposide phosphate, and carboplatin showed no evidence of systemic metastasis in any case during a mean (range) follow-up of 66 (12-202) months.Purpose: To determine the efficacy of postenucleation adjuvant chemotherapy with vincristine, etoposide, and carboplatin in the prevention of metastasis for patients with high-risk retinoblastoma.Methods: Retrospective, nonrandomized, interventional case series of 52 eyes in 51 patients with high-risk retinoblastoma consisting of tumor invasion into the anterior segment, posterior uvea 3 mm or greater, postlaminar optic nerve, or any combination of posterior uvea and optic nerve involvement.Results: Of 51 consecutive patients with high-risk retinoblastoma, there were 30 males (59%) and 21 females (41%), with a median age of 28 months at diagnosis. All 52 eyes were classified as group E. The main histopathologic risk factors included anterior segment invasion ( 7[13%]), isolated massive posterior uveal invasion of 3 mm or greater (6 [12%]), isolated postlaminar optic nerve invasion (15 [29%]), or any posterior uveal invasion with any optic nerve involvement (24 [46%]). There was additional invasion into the sclera (3 [6%]) and extrascleral structures, including the orbit (1 [2%]). A single histopathologic high-risk factor was present in 32 eyes (62%), whereas 20 eyes (38%) manifested 2 or more highrisk characteristics. Based on previously published series, untreated high-risk retinoblastoma carries at least a 24% risk for metastatic disease. In the present series, using vincristine, etoposide, and carboplatin in all cases, there was no metastasis during a mean follow-up of 66 months (median [range], 55 months).Conclusions: Retinoblastoma with invasion into the postlaminar optic nerve and/or posterior uvea is at high risk for metastasis and death. In this study, postenucleation chemotherapy using vincristine, etoposide, and carboplatin was effective in preventing metastasis in every case (100%).

Clinical Features Predictive of High-Risk Retinoblastoma in 403 Asian Indian Patients

“…14,15 In our study, 7 cases (5%) with high-risk retinoblastoma developed systemic metastasis during a mean follow-up of 37 months. Of these 7 cases, 5 (3%) developed systemic metastasis despite receiving adjuvant treatment.…”

Effect of Intraarterial Chemotherapy on Retinoblastoma-Induced Retinal Detachment

“…In such cases, systemic intravenous chemotherapy (chemoreduction) might be preferable. 18 In summary, our analysis has shown that eyes with retinoblastoma and partial or total retinal detachment can be successfully treated with IAC in many cases, and most eyes can be salvaged, avoiding enucleation. Some of these eyes can regain visual acuity.…”

Retinoblastoma frontiers with intravenous, intra-arterial, periocular, and intravitreal chemotherapy

“…The chemotherapy protocol for IVC is similar to that used for prevention of metastasis in high-risk retinoblastoma. 38 Unfortunately, IVC alone might not completely control advanced retinoblastoma because group D eyes show 53% local intraocular recurrence and group E eyes show 75% local recurrence, necessitating EBRT, IAC, or enucleation. 26,32 In one analysis, globe salvage was achieved using IVC followed by IAC in 67% of group D eyes and 63% of group E eyes 33 (Figures 2 and 3).…”