title: Multiagent chemotherapy as neoadjuvant treatment for multifocal intraocular retinoblastoma.
abstract: OBJECTIVE
  To evaluate the efficacy of multiagent chemotherapy in the neoadjuvant treatment of retinoblastoma.
  
  
  METHODS
  Noncomparative, prospective case series.
  
  
  METHODS
  Twenty consecutive patients with multifocal intraocular retinoblastoma (4 unilateral, 16 bilateral [36 eyes]).
  
  
  METHODS
  Eight cycles of chemotherapy with carboplatin and vincristine were administered at 3-week intervals over a 6-month period. Supplemental therapy was withheld until disease progression was documented.
  
  
  METHODS
  Disease progression (defined as tumor growth, vitreous or subretinal seed progression, and new tumor formation), delay of external beam radiotherapy, and ocular survival.
  
  
  RESULTS
  Thirty-six eyes were treated. Eighteen eyes had Reese-Ellsworth group I-III tumors, and 16 eyes had Reese-Ellsworth group IV-V tumors at diagnosis. Two patients, who had unilateral disease at diagnosis, subsequently had tumors develop in the contralateral eye. Nineteen of 20 patients (95%) completed eight cycles of chemotherapy without disease progression. Three eyes of three different patients were successfully treated with chemotherapy alone. Thirty-three of 36 eyes (92%) progressed after completion of chemotherapy: 15 of the 18 eyes (83.3%) with Reese-Ellsworth group I-III and 16 of 16 eyes (100%) with Reese-Ellsworth group IV-V tumors. Seventeen eyes (52%) had growth of a tumor, whereas 14 eyes (42%) had progressive vitreous seeding, and 2 eyes (6%) had new tumors develop. Fifteen eyes (42%) required external beam radiotherapy. Twenty-nine of 36 (80.5%) eyes were salvaged. The median follow-up after chemotherapy was 19 months (range, 3-42 months).
  
  
  CONCLUSIONS
  Multiagent chemotherapy alone does not ensure a cure for multifocal intraocular retinoblastoma. Supplemental focal therapy is needed to control disease progression.
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Wilson
authors.forename: C
authors.initials: C
authors.lastname: Rodriguez-Galindo
authors.forename: B G
authors.initials: BG
authors.lastname: Haik
authors.forename: D M
authors.initials: DM
authors.lastname: Moshfeghi
authors.forename: T E
authors.initials: TE
authors.lastname: Merchant
authors.forename: C B
authors.initials: CB
authors.lastname: Pratt
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012163:Retinal Detachment / Q000175:diagnosis; D019572:Retinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012175:Retinoblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D016190:Carboplatin