Cancer Res Treat.  2008 Dec;40(4):164-171.

Clinical Results of Chemotherapy based Treatment in Retinoblastoma Patients: A Single Center Experience

• Kim H
• Lee JW
• Kang HJ
• Park HJ
• Kim YY
• Shin HY
• Yu YS
• Kim IH
• Ahn HS

Abstract

PURPOSE: Retinoblastoma is the most common intraocular malignancy in children. Since the 1990s, chemotherapy was indicated for intraocluar disease to reduce the frequency of enucleation and spare the complications associated with external beam radiation. In this study, we analyzed treatment results of retinoblastoma in our institute.
MATERIALS AND METHODS
Datas from children diagnosed with retinoblastoma and treated at Seoul National University Children's Hospital between 1986 and 2008 were analyzed retrospectively. We utilized cyclophosphamide, vincristine, adriamycin, and methotrexate (CVAM) for OPD-based adjuvant chemotherapy. From 1990, primary chemotherapy was administered to patients with intraocular disease for eyeball-saving and patients received a combination of etoposide, vincristine, cisplatin (or ifosfamide) as a moderately intensive regimen, or a combination of cisplatin, doxorubicin, etoposide, and cycophosphamide (CDEC) as a highly intensive regimen.
RESULTS
One hundred eighteen children were analyzed. There were 68 unilateral and 50 bilateral diseases. The median age at diagnosis was 1 year and ReeseEllsworth stage V was the most common stage at the time of diagnosis. All patients were treated by chemotherapy-based multimodality methods, and primary chemotherapy was administered to 80 patients. The 10-year overall and event-free survival rate of all patients were 93.9% and 91.6%, respectively. Two patients who died were in the CDEC regimen group, but there was no significant statistical difference in survival rates by chemotherapy regimens. Fifty-six of 114 eyeballs were saved after primary chemotherapy-based treatment, and the eyeball-saving rate was 49.1%. Six patients relapsed after enucleation and 2 patients were treated successfully after autologous PBSCT. Osteosarcoma occurred in 2 patients as a secondary malignancy, and facial asymmetry after radiotherapy was the most common long-term sequelae.
CONCLUSIONS
In this study, the overall and event-free survival rates of retinoblastoma were satisfactory and eye-saving was possible with primary chemotherapy. Development of new chemotherapeutic regimens and a team approach are necessary to improve the eyeball-saving rate.

Keyword

Retinoblastoma; Chemotherapy; Radiotherapy; Enucleation; Survival rate; Eyeball-saving

MeSH Terms

Chemotherapy, Adjuvant
Child
Cisplatin
Cyclophosphamide
Disease-Free Survival
Ditiocarb
Doxorubicin
Etoposide
Facial Asymmetry
Humans
Methotrexate
Osteosarcoma
Retinoblastoma
Retrospective Studies
Survival Rate
Vincristine
Cisplatin
Cyclophosphamide
Ditiocarb
Doxorubicin
Etoposide
Methotrexate
Vincristine

Figure

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  Fig. 1 Kaplan-Meier analysis of total patients. (A) Ten-year overall survival rate; (B) Ten-year event-free survival rate of total patients.

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  Fig. 2 Treatment flow by laterality and the numbers of patients whose eyes saved. CTx: chemotherapy, En: enucleation, *One of them died due to cytomegalovirus or P.jirovceci pneumonia. †One of them died due to septic shock during chemotherapy to secondary malignancy.

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  Fig. 3 Kaplan-Meier analysis of enucleation free survival rate in total patients with primary chemotherapy.

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