Intense Protocol With High-Dose Chemotherapy Saves Eyes

Fran Lowry

October 27, 2011

October 27, 2011 (Orlando, Florida) — A protocol of intensive management with high-dose chemotherapy and periocular carboplatin produced a "gratifying" outcome in children with advanced retinoblastoma with vitreous seeds, according to a new study presented here in an original paper session at the American Academy of Ophthalmology (AAO) 2011 Annual Meeting.

Dr. P.M. Fairooz

"Retinoblastoma with vitreous seeds is a challenge to treat," lead author P.M. Fairooz, MD, from the LV Prasad Eye Institute in Hyderabad, India, told Medscape Medical News. "It belongs to the classification of Reese-Ellsworth Vb and International Classification of Retinoblastoma D and E, so these are very difficult cases to manage, especially in terms of vision salvage and eye salvage."

The prognosis for patients with retinoblastoma in developed countries is excellent. Early diagnosis and improved methods of treatment have resulted in a success story, going from 95% mortality 50 years ago to 95% survival now.

However, in developing countries, as a result of delayed detection and a preponderance of high-risk cases, the prognosis of retinoblastoma is poor, with greater than 50% mortality, Dr. Fairooz said.

In her talk, Dr. Fairooz presented results that were obtained in 137 consecutive eyes (101 children; 60 boys and 41 girls) with advanced retinoblastoma with vitreous seeds that were treated at her institution during a 10-year period between July 2000 and December 2010.

The median age of the children was 25 months (range, 3.3 - 192.8 months). All patients underwent high-dose chemotherapy for an average of 6 cycles, combined with periocular carboplatin in a protocol that was devised by senior author Santosh G. Honavar, MD, also from the LV Prasad Eye Institute.

The regimen consisted of carboplatin, 840 mg/m2 (or 28 mg/kg if the child was younger than 36 months) divided on day 1 and day 2; etoposide, 360 mg/m22 (or 12 mg/kg if the child was younger than 36 months) divided on day 1 and day 2; and vincristine, 0.75 mg/m2 (or 0.025 mg/kg if the child was younger than 36 months) given on day 1.

In addition, 63 eyes with diffuse vitreous seeds received an average of 6 injections of 15 mg subtenon periocular carboplatin. There were no major complications except local inflammation and scar associated with these injections, Dr. Fairooz reported.

The children were followed-up for an average of 45 months after they completed treatment.

Vision salvage was achieved in 83% of children, and 77% of them had a regression of the tumor and vitreous seeds.

"That is a remarkable result," Dr. Fairooz said.

"We would like to apply this protocol in most patients," she added. "Especially in developing countries, 75% come with a late diagnosis with advanced retinoblastoma. We think this treatment achieved a great result."

Dr. J. Fernando Arevalo

Medscape Medical News asked J. Fernando Arevalo, MD, professor of ophthalmology at the Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, for his opinion of this review.

"This is a very important study because retinoblastoma with vitreous seeds represents one of the most difficult stages of retinoblastoma to treat. Dr. Fairooz demonstrated a large study with many unilateral and bilateral cases of these children with advanced disease that they have been treating now for 10 years, and they have done a wonderful job," Dr. Arevalo said.

"In a developing country like India, I think it's an amazing achievement. The senior author is a fantastic ocular oncologist specialist, and definitely one of the treasures they have in India. I'm very proud of what they have done," he said.

Dr. Fairooz and Dr. Arevalo have disclosed no relevant financial relationships.

American Academy of Ophthalmology (AAO) 2011 Annual Meeting: Abstract PA029. Presented October 24, 2011.

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