Chemotherapy, repeated diode laser effective against macular retinoblastoma

FORT LAUDERDALE, Fla. — Aggressive management with chemotherapy and repeated laser applications resulted in tumor control in a large percentage of patients with macular retinoblastoma, according to a study presented here.

“Retinoblastoma patients were treated successfully with aggressive chemotherapy and repetitive focal laser treatment applied directly to the fovea,” said Amy C. Schefler, MD, at the Association for Research in Vision and Ophthalmology meeting. A retrospective study at the Bascom Palmer Eye Institute in Miami of 45 eyes of 34 patients with macular retinoblastoma found that tumor control and avoidance of enucleation was achieved in 87% of eyes treated with the aggressive regimen.

Patients classified by the Reese-Ellsworth system as having stages 1 to 4 retinoblastoma (group 1) received four to nine cycles of systemic chemotherapy with vincristine, etoposide and carboplatin (standard treatment for cancer patients). Patients with stage 5 disease (group 2), received six to 10 cycles of the chemotherapy, with or without cyclosporine. All patients underwent focal laser treatment with a diode laser at every visit until symptoms resolved or tumors became inactive.

With a median follow-up of 42 months, Dr. Schefler said, all patients in group 1 with mild to moderate disease avoided external beam radiation or enucleation. Six patients in group 2 required enucleation, but no patient in the study needed external radiation, he said. Additionally, no patients developed metastatic retinoblastoma or a second malignancy, and none died within the study interval.

Complications included iris atrophy (64%), peripheral focal lens opacity (13%), peripheral anterior synechiae (4%) and foveal neovascular membrane (2%).