title: Experience with chemoreduction and focal therapy for intraocular retinoblastoma in a developing country.
abstract: BACKGROUND
  Chemoreduction is used for the treatment of retinoblastoma in industrialized nations; however, there are fewer data from developing countries. Before the implementation of this program, radiotherapy was used in almost all preserved eyes.
  
  
  METHODS
  Retrospective evaluation from 1995 to 2001 at the Hospital Garrahan (Argentina). Carboplatin 18.7 mg/kg/day 1 and vincristine (0.05 mg/kg/day 1) were offered to patients with Reese-Ellsworth (RE) groups I-III and all unilateral cases. Etoposide (3.3 mg/kg/day 1 and 2) was added for groups IV and V. The number of cycles was tailored according to response.
  
  
  RESULTS
  Fifty-eight patients (78 eyes) were evaluated (39 bilateral, 19 unilateral). With a median follow-up of 47 months, 40 patients had unilateral enucleation, 14 were not enucleated, and 4 had bilateral enucleation. Nineteen patients had unilateral initial enucleation. Eye preservation at 5 years was: RE groups I-III (n = 24 eyes), 0.9 (SE: 0.095) IV-V (n = 54), 0.45 (SE 0.07). Patients received a median of four cycles of chemotherapy. Acute toxicity was mild. External beam radiotherapy was avoided in 41% of eyes with groups I-III. Etoposide was avoided in 24 patients. Two patients died of metastasis. No secondary malignancy occurred.
  
  
  CONCLUSIONS
  Compared to our previous experience, eye preservation was better and even though less radiotherapy was used, it was prescribed more often than currently recommended in eyes with less advanced disease because of limited availability of sophisticated local therapy.
authors.affiliation: Department of Hematology/Oncology, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina. gchantada@garrahan.gov.ar
authors.forename: Guillermo L
authors.initials: GL
authors.lastname: Chantada
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Fandiño
authors.forename: Elsa C
authors.initials: EC
authors.lastname: Raslawski
authors.forename: Julio
authors.initials: J
authors.lastname: Manzitti
authors.forename: Maria T G
authors.initials: MT
authors.lastname: de Dávila
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Casak
authors.forename: Marcelo J
authors.initials: MJ
authors.lastname: Scopinaro
authors.forename: Enrique
authors.initials: E
authors.lastname: Schvartzman
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003906:Developing Countries; D005047:Etoposide / Q000008:administration & dosage; D015353:Eye Enucleation; D006801:Humans; D011878:Radiotherapy; D012175:Retinoblastoma / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D005047:Etoposide; D016190:Carboplatin