Treatment of Retinoblastoma Patients With Chemoreduction Plus Local Therapy: Experience of the AC Camargo Hospital, Brazil

Abstract

To evaluate the efficacy of conservative management of intraocular retinoblastoma with chemoreduction combined with local therapy with or without plaque radiation in the preservation of the eye, and avoidance of external beam radiation therapy (EBRT) (success rate). From 1995 to 2000, 84 newly diagnosed patients with intraocular retinoblastoma were admitted to the Pediatric Department of the Hospital do Cancer A.C. Camargo, São Paulo, Brazil. All children were treated with 2 to 6 cycles of chemotherapy (carboplatin, vincristine, and etoposide) plus local therapy (cryotherapy, laser photocoagulation, and thermotherapy), or plaque radiation therapy during and/or after the chemotherapy. The Mann-Whitney test was used to compare means of quantitative variables. The chi test or the Fisher exact test were employed to verify the association between the outcome and the independent variables. For all tests alpha=5% was adopted. Success rate was higher for patients with bilateral tumors (54%) than for children with unilateral tumors (19%) (P=0.003). For patients with Reese-Ellsworth stages I, II, and III, no statistically significant differences in the success rates were noted in the group of unilateral (50%) and bilateral tumors (79.1%) (P=0.179). Among children with Reese-Ellsworth stages IV and V, the success rate was significantly higher for patients with bilateral tumors (40.7%) than for those with unilateral (0%) (P=0.012). Chemoreduction combined with local therapy, with or without plaque radiotherapy, is efficacious in avoiding enucleation and the use of external beam radiation therapy for children with intraocular retinoblastoma.

Strategies to manage retinoblastoma in developing countries

“…Consequently, enucleation or EBRT are needed in up to two-thirds of the advanced cases [3,4,55]. On the basis of these results from the USA and Europe, many upper MICs have also implemented programs for chemoreduction and focal therapy with satisfactory results [56][57][58][59]. However, these programs require a large investment in personnel training and technology to procure sophisticated local treatment modalities [60] which are not always available in some developing countries or they are only available in highly specialized centers in big cities.…”

Integrin-linked kinase regulates senescence in an Rb-dependent manner in cancer cell lines

“…39 These treatments including carboplatin, etoposide, and vincristine have been shown to shrink the size of the tumor allowing focal treatments (i.e., cryotherapy, focal laser therapy, or thermotherapy). 29,40 This sequence is sometimes preferred in order to avoid enucleation. 29,40 Although many cancers have at least partially lost the ability to undergo apoptosis or senescence, these responses can still be reactivated with chemotherapy drugs.…”

“…29,40 This sequence is sometimes preferred in order to avoid enucleation. 29,40 Although many cancers have at least partially lost the ability to undergo apoptosis or senescence, these responses can still be reactivated with chemotherapy drugs. 41 Senescence inducing drugs may be a desirable outcome for those tumor cells that are resistant to apoptosis based therapies.…”

Retinoblastoma

“…Chemoreduction coupled with intensive use of sequential focal therapies (cryotherapy, laser photocoagulation, thermotherapy and brachytherapy) has resulted in an increase in the eye salvage rates and in the decrease (and delay) in the use of radiation therapy (see chapter 7). Different chemotherapy combinations are used although the best results are achieved with a combination of vincristine, carboplatin, and etoposide (or teniposide) (Shields et al 2002a;Nenadov Beck et al 2000;Murphree et al 1996;Kingston et al 1996; Chantada et al Antonelli et al 2006). An alternative chemotherapy regimen includes the addition of cyclosporine to the three-drug regimen .…”