Al. Murphree et al., CHEMOTHERAPY PLUS LOCAL TREATMENT IN THE MANAGEMENT OF INTRAOCULAR RETINOBLASTOMA, Archives of ophthalmology, 114(11), 1996, pp. 1348-1356
Objective: To describe platinum-based chemotherapy combined with local
treatment modalities as an alternative to external beam radiotherapy
for intraocular retinoblastoma. Design: Platinum levels st ere measure
d by atomic absorption analysis in the tumors of 2 patients with retin
oblastoma given carboplatin 5 or 2.5 hours before enucleation. Platinu
m levels in heated vs nonheated Greene melanoma tumors in rabbits were
compared. A retrospective review of 172 affected eyes in 136 consecut
ive patients treated for retinoblastoma between January 1990 and Decem
ber 1945 was performed. From 1990 to 1992, all treatable eyes initiall
y received systemic carboplatin, 560 mg/m(2), followed by 15 to 30 min
utes of continuous diode laser hyperthermia (thermochemotherapy). Sinc
e 1992, larger tumors were treated initially with 3 monthly cycles of
carboplatin, etoposide, and vincristine sulfate to reduce tumor volume
(chemoreduction) followed by sequential aggressive local therapy (SAL
C) during examinations under anesthesia every 2 to 3 weeks. Outcome Me
asure: Treatment success was defined as eradication of tumor without e
nucleation or external beam radiotherapy. Results: Significant therape
utic platinum levels were measured in the human tumors 2.5 and 5 hours
after carboplatin administration. Increasing the temperature by 9 deg
rees C for 15 minutes doubled platinum levers in the rabbit model.Of t
he 38 eyes with Reese-Ellswosth group 1 through 5b rumors that were tr
eated primarily with thermochemotherapy, all 24 eyes with group 1 and
2 tumors were treated successfully and two of the 4 eyes with group 3
tumors and all 10 eyes with group 5b rumors were treated unsuccessfull
y. Chemoreduction plus SALT was the primary treatment in 35 eyes and w
as successful in all 10 eyes with group, 1 through 4 tumors and unsucc
essful in all 7 eyes with extensive subretinal seeding and all 18 eyes
with group 5b tumors with vitreous seeding. Seventy patients received
carboplatin or carboplatin, vincristine, and etoposide, with myelosup
pression, occasionally associated with bacteremia, being the main side
effect. Transfusions were required in 15% of patients. Radiation reti
nopathy occurred in all 6 eyes treated with iodine 125 plaques. Conclu
sions: Thermochemotherapy is successful primary treatment, for Reese-E
llsworth group 1 and 2 retinoblastomas. For larger tumors in the absen
ce of vitreous or Extensive subretinal seeding, 3 cycles of chemoreduc
tion followed by SALT eradicates residual viable tumor. Chemoreduction
plus SALT was not successful in eyes with diffuse vitreous or extensi
ve subretinal seeding. Prior chemotherapy increases the risk for radia
tion retinopathy following I-125 plaque therapy. External beam radioth
erapy can safely be avoided in the primary treatment of Reese-Ellswort
h groups 1 through 4 nondispersed retinoblastoma.