[Results of combined chemotherapy and local ophtalmic therapy of children with intraocular retinoblastoma].
Until recently chemotherapy in retinoblastoma was used as adjuvant therapy after enucleation in cases with extraretinal spread of the disease (weal extension, orbital extension, neoplastic infiltrates of the optic nerve at resection line, intracranial metastasis and generalized disease). Recent experience has proved that use of chemotherapy for intraocular retinoblastoma before local treatment (so called "chemoreduction") has allowed not only to decrease the number of enucleations and indications for external beam irradiation or limit the extension of local therapy; but also to increase the chances for vision preservation and to decrease the risk of severe complications. Twenty children aged 0,5-96 months (with lesions in 29 eyes) in whom intraocular retinoblastoma was diagnosed between January 1996 and June 2000, were the subject of this study. Among 29 children, in 15 (52%) stage V according to Reese-Ellsworth was established. Enucleation before chemotherapy was necessary in 9 cases, and in two more children the eye had to be removed after 1-2 courses of chemotherapy. In 11 remaining children (with 18 involved eyes) VEC chemotherapy combined with delayed local therapy (cryotherapy, photocoagulation, brachytherapy) was employed. Out of 18 treated cases enucleation could be avoided in 13 (72%), including 12 qualified as Reese-Ellsworth stage II or I. No eye with stage V could be saved. First-line chemotherapy combined with local treatment should be standard treatment for intraocular retinoblastoma groups I and II. More effective therapy is required for advanced cases particularly for Reese-Ellsworth eye group V.
Balwierz
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Klinika Hematologii i Onkologii Dzieciecej, Polsko-Amerykanski Instytut Pediatrii Collegium Medicum, Uniwersytet Jagielonski, Wielicka 265, 30-663 Krakow, Poland.
Kobylarz
J
J
Starzycka
M
M
Dluzniewska
A
A
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D017679:Cryotherapy; D005047:Etoposide / Q000008:administration & dosage; D015353:Eye Enucleation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008028:Light Coagulation; D012074:Remission Induction; D019572:Retinal Neoplasms / Q000188:drug therapy / Q000628:therapy*; D012175:Retinoblastoma / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D014750:Vincristine; D005047:Etoposide; D016190:Carboplatin