THE EFFECT OF CHEMOREDUCTION ON RETINOBLASTOMA-INDUCED RETINAL-DETACHMENT

Background: Retinoblastoma with total retinal detachment traditionally has been managed with enucleation. We employed a chemoreduction proto col in an effort to reduce the tumor size to allow for focal treatment and salvage of the eye.Methods: A prospective study was performed to assess the effects of a 5-month chemoreduction regimen of vincristine, etoposide, and carboplatin on massive retinoblastoma with total retin al detachment. Results: We treated 17 eyes with total retinal detachme nt from retinoblastoma in 13 patients over a 14-month period. At the i nitial examination, the mean tumor base was 15 mm and mean thickness w as 10 mm, The eyes were classified as Reese-Ellsworth group V in 16 ca ses (94%) and group III in one case (6%). The retina was totally detac hed with serous subretinal fluid in all cases. After 2 months of chemo reduction, all tumors showed a response, and the tumors decreased to a mean base of 10 mm and thickness of 5 mm. Overall, a mean of 33% decr ease in base and 47% decrease in thickness was noted, The subretinal f luid had resolved completely in seven eyes (41%), leaving flat retina. In three eyes (18%), partial resolution was achieved; in seven eyes ( 41%), minimal resolution of the subretinal fluid at the 5-month period was noted. By last follow up, at a mean of 10 months after initiation of chemoreduction, complete resolution of the subretinal fluid occurr ed in 13 eyes (76%) and partial resolution of subretinal fluid occurre d in four eyes (24%). Conclusion: Preliminary observations suggest tha t chemoreduction may be an important tool in the initial management of retinoblastoma, even for large tumors with total retinal detachment. Tumor shrinkage may be dramatic and subretinal fluid resolution may be complete.