title: Focal periocular carboplatin chemotherapy avoids systemic chemotherapy for unilateral, progressive retinoblastoma.
abstract: OBJECTIVE
  The purpose of this study was to report a case of a boy with unilateral, multifocal retinoblastoma who was successfully treated with periocular carboplatin injections for a tumor that progressed despite focal laser ablation.
  
  
  METHODS
  This is an interventional case report. A boy with a paternal history of retinoblastoma and in utero identification of an RB1 mutation was monitored beginning at 2 weeks of age. When the patient was 6 months old, the first tumor was detected and treatment with a direct, ablative, large spot-size diode laser was initiated. During a 38-month period of follow-up, the patient received 23 laser treatments and 3 periocular carboplatin injections (20 mg in 2 mL) to treat 3 tumors in 1 eye.
  
  
  RESULTS
  Initially, diode laser ablation of the tumors produced a favorable involutional response of the tumors, associated with a decrease in size and vascularity. Despite aggressive treatment with 12 consecutive laser treatments for 9.7 months, progressive tumor growth was observed in the superonasal tumor, whereas the other 2 tumors remained quiescent. At that time, a series of three focal periocular injections of carboplatin were administered in combination with continued laser ablation. The tumor regressed with type 4 chorioretinal scarring. No systemic chemotherapy or radiation was required.
  
  
  CONCLUSIONS
  This case of unilateral, multifocal retinoblastoma was successfully treated solely with diode laser ablation and rescue periocular injections of carboplatin after the failure of laser alone. A trial of periocular carboplatin with laser may be considered in cases of unilateral retinoblastoma that are resistant to laser ablation therapy alone.
authors.affiliation: Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Leng
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Cebulla
authors.forename: Amy C
authors.initials: AC
authors.lastname: Schefler
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Murray
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D006801:Humans; D007231:Infant, Newborn; D007267:Injections; D017075:Laser Coagulation; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D008297:Male; D009154:Mutation; D019572:Retinal Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D012175:Retinoblastoma / Q000188:drug therapy / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D016160:Retinoblastoma Protein / Q000235:genetics
chemical_list: D000970:Antineoplastic Agents; D016160:Retinoblastoma Protein; D016190:Carboplatin