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Treatment of Intraocular Retinoblastoma With Vincristine and Carboplatin

Carlos Rodriguez-Galindo, Matthew W. Wilson, Barrett G. Haik, Thomas E. Merchant, Catherine A. Billups, Nirali Shah, Alvida Cain, James Langston, Mindy Lipson, Larry E. Kun, Charles B. Pratt

From the Departments of Hematology-Oncology, Surgery, Division of Ophthalmology, Radiation Oncology, Biostatistics, and Diagnostic Imaging, St. Jude Children’s Research Hospital; and Departments of Pediatrics, Ophthalmology, Radiation Oncology, and Radiology, University of Tennessee Health Science Center, Memphis, TN.

Address reprint requests to Carlos Rodriguez-Galindo, MD, Department of Hematology-Oncology, St. Jude Children’s Research Hospital, 332 North Lauderdale, Memphis, TN 38105; email: Carlos.Rodriguez-Galindo{at}stjude.org.

Purpose: To evaluate the efficacy of chemoreduction using vincristine and carboplatin in preventing or delaying external-beam radiotherapy (EBRT) or enucleation in patients with intraocular retinoblastoma.

Patients and Methods: Twenty-five patients (43 eyes) with newly diagnosed intraocular retinoblastoma received primary treatment with eight courses of vincristine and carboplatin. Focal treatments were delayed until documentation of disease progression. Outcome measures for each eye were length of time to disease progression, avoidance or delay of EBRT, and globe survival. Event-free survival was defined as the length of time to EBRT or enucleation.

Results: Disease in all eyes responded to chemotherapy and progressed in only two patients before completion of the eight courses of therapy. Disease in all but four eyes progressed and required focal treatments. Event-free survival estimates at 2 years were 59.2% ± 12.0% for Reese-Ellsworth group I, II, and III eyes and 26.3% ± 9.2% for group IV and V eyes. Nineteen eyes (44.2%) required EBRT and 13 eyes (30.2%) were enucleated. The ocular salvage rate was 83.3% for Reese-Ellsworth group I to III eyes and 52.6% for group IV and V eyes. For those patients receiving EBRT, the median time from enrollment to EBRT was 9.5 months (median age at EBRT, 21 months).

Conclusion: In combination with appropriate early intensive focal treatments, chemoreduction with vincristine and carboplatin, without etoposide, may be an alternative treatment for patients with early-stage intraocular retinoblastoma, although additional studies are needed. Patients with advanced intraocular disease require more aggressive treatments.

Deceased.

Supported in part by grant CA23099; Cancer Center Support CORE Grant P30 CA 21765; the American Lebanese Syrian Associated Charities (ALSAC), Memphis, TN; and unrestricted grants from Research to Prevent Blindness, Inc, New York, NY, and the St. Giles Foundation, New York, NY.

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