Evaluación de secuelas visuales y cosméticas del tratamiento conservador con terapia radiante externa en pacientes con retinoblastoma bilateral en el Hospital de Pediatría Garrahan / Assessment of visual and cosmetic sequelae of conservative treatment of external beam radiation of patients with bilateral retinoblastoma at the Pediatric Hospital Garrahan

El Retinoblastoma es la neoplasia ocular más frecuente en pediatría. La Terapia radiante externa fue hasta hace una década el tratamiento conservador de elección. Luego se incluyó la quimio reducción; en un intento de evitar la radioterapia externa y sus complicaciones. En este estudio retrospectivo evaluamos los resultados del tratamiento conservador con terapia radiante externa o con quimio reducción en el servicio de oftalmología del Hospital Nacional de Pediatría Juan P. Garrahan, desde 1987 a 2009. De un total de 571 pacientes con diagnóstico de Retinoblastoma, 341 fueron unilaterales y 217 bilaterales. De estos últimos se analizaron 166 pacientes cuya edad media al diagnostico fue de 12 meses. Se trataron 332 ojos de 166 pacientes con Retinoblastoma bilateral, 157 ojos (47,3%) recibieron quimioreducción como tratamiento inicial, 115 ojos (34,6%) fueron enucleados al inicio, 45 ojos (13,6%) recibieron radioterapia externa como único tratamiento y 15 ojos (4,5%) recibieron tratamiento local solo (laser o crioterapia) como primera elección. Se analizaron los datos con el programa estadístico STATA 12.0 stataCorp Texas.USA. La agudeza visual final fue superior a 20/70 en el 51,5% de los pacientes e inferior en el 48,5%. Se encontró una relación significativa (p=0,005) entre el estadio al diagnóstico y la agudeza visual final; los pacientes con discapacidad visual se presentaron con estadios avanzados. Se evaluaron todas las orbitas enucleadas (157); de ellas el 74,5% recibieron radioterapia externa antes o después de la enucleación. El 24,8% de las orbitas irradiadas presentaron deformidad de la cavidad, con mala adaptación de prótesis y retracción orbitaria, el 70,1% presentaron cambios que permitían una adaptación de prótesis aceptable con alguna limitación de movilidad y solo 6 orbitas (5,12%) presentaban una muy buena cavidad para adaptación cosmética. Cuarenta de 157 orbitas enucleadas no recibieron radioterapia en ningún momento (25,5%), el 92,5% de ellas presentaron buena adaptación y solo el 7,5% tuvieron problemas de adaptación debido a complicaciones postoperatorias. El diagnóstico precoz, el tratamiento oportuno, y el uso de quimio reducción como terapia inicial en Retinoblastoma intraocular, permiten aumentar la tasa de preservación del globo ocular y reducen o eliminan la necesidad de recibir Terapia radiante externa, evitando sus secuelas (AU)

Retinoblastoma is the most common ocular neoplasia in childhood. External beam radiation therapy was the conservative treatment of choice until a decade ago. Subsequently, chemoreduction was added trying to avoid external beam radiation therapy and its complications. In this retrospective study we assess the results of conservative therapy with external beam radiation therapy or with chemoreduction at the Department of Ophthalmology at the Pediatric Hospital Juan P. Garrahan between 1987 and 2009. Of a total of 571 patients with a diagnosis of retinoblastoma, 341 had unilateral and 217 bilateral retinoblastoma. Of the latter patients, 166 patients were analyzed with a mean age at diagnosis of 12 months. Overall, 332 eyes of 166 patients with bilateral retinoblastoma were treated; at initial treatment 157 eyes (47.3%) underwent chemoreduction, 115 eyes (34.6%) were enucleated, 45 eyes (13.6%) underwent external beam radiation therapy as the only treatment, and 15 eyes (4.5%) only received local treatment (laser or cryotherapy) as a first choice. Data were analyzed using STATA 12.0 stataCorp Texas.USA. Final visual acuity was more than 20/70 in 51.5% and less in 48.5% of the patients. A significant relationship (p=0.005) between stage at diagnosis and final visual acuity was found; patients with visual impairment presented with advanced stages. All enucleated orbits were assessed (157); 74.5% underwent external beam therapy before or after enucleation. Of all irradiated orbits, 24.8% presented with cavity deformity, poor prosthesis fit, or contraction of the socket. Of all patients, 70.1% presented with changes that allowed acceptable fitting of the prosthesis with slight movement limitation and only 6 orbits (5.12%) had a good cavity for cosmetic appearance. Forty of 157 enucleated orbits did not receive radiation therapy at any moment (25.5%); 92.5% of them had a good fitting and in only 7.5% fitting problems due to postoperative complications were found. Early diagnosis, adequate treatment, and use of chemoreduction as initial therapy of intraocular retinoblastoma allow for an increased rate of preservation of the eye and reduce or eliminate the need for external beam therapy and its sequelae (AU)

Supervivencia libre de enucleación de pacientes con diagnóstico de retinoblastoma tratados con quimioterapia intraarterial en el Hospital Universitario de San Vicente Fundación / Enucleation free survival of patients with retinoblastoma diagnosis treated with intraarterial chemotherapy at University-Based San Vicente Fundacion Hospital

Objetivo: describir la supervivencia libre de enucleación, respuesta al tratamiento y complicaciones de los pacientes sometidos a tratamiento con quimioterapia intraarterial (QIA) para el control del retinoblastoma en el Hospital Universitario de San Vicente Fundación (HUSVF). Tipo de estudio: estudio de cohortes. Materiales y Métodos: se incluyeron todos los pacientes con diagnóstico de retinoblastoma tratados en el husvf con qia supraselectiva de la arteria oftálmica entre agosto del 2011 y agosto de 2013. Resultados: se realizó tratamiento a 21 pacientes, 24 ojos, en un periodo de 23.5 meses. La edad media al momento de inicio de la QIA fué 19 meses (rango 5-60 meses) con un seguimiento promedio de 9.3 meses (rango 3 semanas a 23.5 meses). Se realizaron 78 cateterizaciones, siendo 9 de ellas bilaterales. El salvamento ocular se alcanzó en el 100% de los Grupo A (n1), 100% B (n=2), 100% C (n=5) y 87.5% D (n=16), según la Clasificación Internacional para Retinoblastoma (CIRB). Sólo se reportaron dos eventos adversos importantes, una hemiparesia transitoria y una reacción alérgica severa. Ninguno de los pacientes ha fallecido, ha tenido compromiso metastásico o necesidad de radioterapia externa. Sólo se realizaron dos enucleaciones. La media de supervivencia de los 24 globos oculares tratados es de 10.4 meses ± 1.6. La media de supervivencia de los 21 pacientes tratados es de 10.4 meses ±1.7. Conclusiones: los resultados muestran una respuesta satisfactoria, constituyéndose la QIA como procedimiento seguro y con baja tasa de complicaciones en el tratamiento del retinoblastoma.

Purpose: to describe globe salvage, treatment response and complications of patients following intra-arterial chemotherapy (IAC) for retinoblastoma at Hospital Universitario de San Vicente Fundacion (HUSVF). Type of study: Cohort Study. Materials and methods: We included all patients diagnosed with retinoblastoma and treated with IAC between from August 2011 to August 2013. Results: A total of 21 patients, with a total of 24 eyes, were treated with IAC over a period of 23.5 months. The mean age of patients at time of treatment was 19 months (range 5-60 months) with a mean follow-up time of 9.3 months (range 3 weeks to 23.5 months). 78 catheterizations were performed, nine of them being bilateral. Ocular salvage rate was achieved in 100% of the Group A (n1), 100% in group B (n = 2), 100% in group C (n = 5) and 87.5% in group D (n = 16), according to the International Classification for Retinoblastoma. Only two major adverse events were reported, a transient hemiparesis and a severe allergic reaction. No deaths, metastatic involvement or need for external beam radiotherapy were reported. Two eyes, from group D, required enucleation. The mean survival rate of 24 eyes treated was 10.4 months ± 1.6. The mean survival rate of the 21 patients treated was 10.4 ± 1.7 months. Conclusions: The results show a satisfactory response, becoming the IAC a safe procedure with a low complication rate in retinoblastoma treatment.

Consideraciones clínicas, diagnósticas y de tratamiento en retinoblastoma / Clinical, diagnostic and therapeutic considerations in retinoblastoma

El retinoblastoma es el tumor intraocular primari o más frecuente en l a infancia. Su detección temprana y el inici o del tratamiento adecuado permi te mejorar dramáticamente l a sobrevida en estos niños. En este artícul o se hace una revisión general de l a enfermedad. Se empleó PubMed y se revisaron artículos representativos del tema, que permi tieran dar una idea general de los di ferentes avances alcanzados. Dada su cl ínica característica, el médico de atención primaria, es pieza fundamental en l a captación inicial del paciente. [Vi l lami l JF , Quintero LM, Serrano RA, Moreno IA. Consideraciones cl ínicas, diagnósticas y de tratamiento en retinoblastoma. MedUNAB 201 1; 14:180-187].

Retinoblastoma is the most common primary intraocular tumor in childhood. Its early detection and initiation of appropriate therapy , can dramatically improve the life expectancy in these children. This article is a general review of the disease. PubMed was employed and representative articles about the topic were selected in order to given us a general idea about the advances achieved. Due to clinical features, primary care physician is a fundamental part in the initial catchment of patient. [Villamil JF , Quintero LM, Serrano RA, Moreno IA. Clinical, diagnostic and therapeutic considerations in retinoblastoma. MedUNAB 2011; 14:180-187].

Severe aseptic orbital cellulitis with subtenon carboplatin for intraocular retinoblastoma.

Retinoblastoma is a rare intraocular tumor of childhood. Chemoreduction followed by laser or cryotherapy is the treatment of choice. Subtenon carboplatin injection is also an accepted treatment modality for vitreous seeds, along with systemic chemotherapy. Transient periocular edema, optic neuropathy and fibrosis of orbital tissues are the known side effects of subteneon carboplatin injection. We report a case of severe aseptic orbital cellulitis with necrosis and prolapse of the conjunctiva 48 h after the injection, which resolved well on only conservative management.

The Clinical Outcomes of Proton Beam Radiation Therapy for Retinoblastomas That Were Resistant to Chemotherapy and Focal Treatment

PURPOSE: To evaluate the clinical results of proton beam radiation therapy (PBRT) for treatment of retinoblastoma. METHODS: Children with retinoblastoma who were treated with chemotherapy and focal treatment such as brachytherapy and thermotherapy but showed no response or developed recurrences later received PBRT. The PBRT strategy was designed to concentrate the radiation energy to the retinoblastoma and spare the surrounding healthy tissue or organs. RESULTS: There were three patients who received PBRT. The first patient received PBRT because of an initial lack of tumor regression with chemotherapy and brachytherapy. This patient showed regression after PBRT. The second patient who developed recurrence of retinoblastoma as diffuse infiltrating subretinal seeding was taken PBRT. After complete regression, there was recurrence of tumor and the eye was enucleated. The third patient had unilateral extensively advanced retinoblastoma. Initial chemotherapy failed and tumor recurred. The tumor responded to PBRT and regressed significantly. However, the eye developed sudden multiple recurrences, so we had to perform enucleation. CONCLUSIONS: PBRT for retinoblastoma was effective in cases of showing no response to other treatment modalities. However, it should be carefully applied when there was recurrence of diffuse infiltrating subretinal seeding or extensively advanced retinoblastoma initially.

Le traitement du rétinoblastome au CHU de Brazzaville

La pathologie cancéreuse de l'enfant représente 7%, d'après les données du registre des cancers de Brazzaville(RCB). Une étude rétrospective a été menée, allant du 1er Janvier 2000 au 31 Décembre 2008. Nous avons ainsi rassemblé 292 cas des cancers observés chez l'enfant de 0 à 14 ans, dont 74 cas de rétinoblastome soit une fréquence 25,3%. Cette localisation occupe ainsi la première place des cancers solides de l'enfant. Nous n'avons pas observé de différences dans les deux sexes. L'âge moyen au moment du diagnostic était de 4,29 ans. Le diagnostic était clinique dans 58,5% (43 cas), à l'examen du fond d'œil 21,6% (16 cas),à l'échographie 16,2%(12 cas), et la confirmation anatomie pathologie 4 % (3 cas). La localisation était unilatérale 83,7% (62 cas), bilatérale dans 8,1% (6 cas) non précisée dans 9,5 % (7 cas). La chimiothérapie était utilisée dans 61,8% (45 cas), l'énucléation dans 13,5% (10 cas), chimiothérapie associée à l'énucléation 10,8% (8 cas), et non précisée 14,9% (11 cas). La moyenne de survie était de 4,65 mois avec des extrêmes de 1 à 9 mois en raison du retard de diagnostic et des difficultés d'accès au traitement

Visual Prognosis of Retinoblastoma in the Posterior Pole Treated with Primary Chemotherapy Plus Local Treatments

PURPOSE: To evaluate the visual outcomes of retinoblastoma in the posterior pole (RBPP) treated with chemotherapy plus local treatments and to address the prognostic factors that influence such outcomes. METHODS: The medical records of patients with RBPP diagnosed at the Department of Pediatric Ophthalmology, Seoul National University Children's Hospital between August 1987 and September 2007 were reviewed retrospectively. Only those patients treated via primary chemotherapy plus local treatments were included. The presence of foveal involvement and tumors in the posterior pole before and after treatment, the type of regression pattern and the best corrected visual acuity (BCVA) of each patient were evaluated. RESULTS: A total of 13 eyes in 12 patients were included. The mean final BCVA for treated RBPP was 20/210 (range, hand motion to 20/16). However, eight eyes (61.5%) had an acuity of 20/200 or better and seven eyes (53.8%) had an acuity of 20/50 or better. The mean final BCVA was significantly better in cases with negative foveal involvement; however, four eyes (37.5%) with positive foveal involvement had an acuity of 20/200 or better. Tumors area in the posterior pole and the type of regression pattern were not significantly related to final BCVA. CONCLUSIONS: Over one half of the studied RBPP patients had working vision. Although the eyes had RBPP with positive foveal involvement, about one-third of the patients had working vision. Vision preservation should be considered when deciding on RBPP treatment.

Leiomyosarcoma of the bladder in a 16-year-old girl with a history of cyclophosphamide therapy for bilateral retinoblastoma during infancy

A 16-year-old female with bladder leiomyosarcoma had a history of bilateral retinoblastoma at 6 months of life. She received cyclophosphamide chemotherapy after surgical enucleation. In this report, we discussed the possible role of retinoblastoma or cyclophosphamide as a target for the development of bladder leiomyosarcoma

Comportamiento del retinoblastoma en el Centro Nacional de Oftalmología del 2002 al 2005 / Behavior of the retinoblastoma in the National Center of Ophthalmology of the 2002 at the 2005

Se realizo un estidio en el Centro Nacional de Oftalmología, con el objetivo de analizar el comportamiento del retinoblastoma, a la vez determinar el abordaje terapeútico, que reciben las pacientes con diagnóstico de retinoblastoma en nuestro centro. El estudio es descriptivo, transversal, su universo estuvo constituido por 22 niños que fueron ingresados al Centro Nacional de Oftalmología en el período comprendido de mayo del 2002 a mayo del 2005, se hizo un estudio de tres años. La muestra fue igual al universo siendo de 22 expedientes de niños diagnosticados de retinoblastoma y que fueron ingresados en el período en estudio. Entre mayo dle 2003 y mayo 2004 se presentó más retinoblastoma, la mayoría del área rural, no hubo predilección por sexo, la edad más frecuente fue entre los 12 a 24 meses 54.4 porciento y más frecuente la forma unilateral. Del total de pacientes se confirmó el diagnóstico en 19 casos 86.4 porciento se encontró diagnóstico diferente en tres casos 13.6 porciento. El signo mas precoz fue la leucocoria con un 68 porciento y el estrabismo con 13 porciento el 63.6 porciento se presentaron en estadio V de Reese. Dentro de los estudios de imagenología fueron los más frecuentes el ultrasonido 54 porciento, en los cuales se encontraron datos de calcificación en un 86.4 porciento. La enucleación y la exanteración en la forma más frecuente de tratamiento. Orienta que deben de realizarse campañas de educación a la población sobre el primer signo clínico de presentación de Retinoblastoma (leucocoria) para lograr que lleguen a estadios mas tempranos y no se tengan que recurrir a procedimientos cruentos, así como capacitar al personal médico y de enfermería de la atención primaria para la detección precoz de los signos mas frecuentes

Clinical Result of Prolonged Primary Chemotherapy in Retinoblastoma Patients

This study evaluated the effects of prolonged primary chemotherapy in retinoblastoma. The data for 27 eyes in 22 children who were treated for retinoblastoma with up to 13 cycles of primary chemotherapy was reviewed. The chemotherapy consisted of etoposide, vincristine, and either carboplatin or ifosfamide. In bilateral retinoblastoma, 1 eye was in each Ia, Ib, and Va, according to the Reese-Ellsworth classification, 2 in each IIa, IIIa, and IIIb, 4 in IIb, and 5 in IVa. Enucleation was performed in 1 in IIa and 1 in Va. In unilateral, 1 was in each IIa, IIIa, IVa, IVb, and Vb, and 4 in Va. Enucleation was performed in 8 with the exception of 1 in IIa. Complete regression was observed in 17 eyes (12 patients). There was no toxicity severe enough to delay treatment. Prolonged primary chemotherapy can be considered as an alternative treatment for retinoblastoma in III or less.

Chemoreduction Followed by Local Therapy and Adjuvant Chemotherapy for Advanced Intraocular Retinoblastoma: A Pilot Study in a Single Center

Intraocular (IO) retinoblastoma (RB) has traditionally been treated with enucleation (ENU) or external beam radiotherapy (EBRT). Recently, clinical trials are in progress to cure RB without ENU or EBRT in order to salvage the globe and to avoid unacceptable side effects of EBRT. We performed a pilot study to treat patients with advanced Reese-Ellsworth (RE) stage IO RB with initial chemotherapy (CRx) followed by local therapy (LT) and adjuvant CRx. Ten eyes (8 RE group V, 2 RE group IV) from 9 patients were enrolled from March 2001 to November 2001. All tumors responded to CRx. In 5 of 10 eyes, the RB was enough to be treated with LT after chemoreduction. One patient who underwent LT is waiting for ENU due to post-cryotherapy complication. For a median follow-up of 13 months (8-16 mo), 4 eyes that received LT and adjuvant CRx were relapse-free. A patient with bilateral RB who failed to be a candidate for LT was rescued with high-dose CRx and hematopoietic stem cell transplantation. Consequently, by treating patients according to our strategy, we were able to salvage 6 out of 10 eyes without ENU or EBRT. These results suggest that chemoreduction followed by LT and adjuvant CRx might offer the opportunity to salvage the globe and vision even in patients with advanced stage IO RB.

Osteosarcoma como segunda neoplasia de retinoblastoma / Osteosarcoma as a second neoplasm in a children with retinoblastoma

Introducción. Es bien conocido que el osteosarcoma se presenta frecuentemente como segunda neoplasia del retinoblastoma congénito, así como otro tipo de carcinomas, melanomas y tumores neuroepiteliales. Todos los pacientes con retinoblastoma bilateral congéntio presentan una alteración del gen RB1 localizado en el cromosoma 13q14. Caso clínico. Se presenta el caso de una paciente con retinoblastoma bilateral congénito diagnosticado a la edad de 1 año 11 meses, quien recibió tratamiento con ciclofosfamida, epirrubicina y VP 16, entre otros agentes; y que desarrolló osteosarcoma peroneo con metástasis pulmonares tras una latencia de 10 años 6 meses. En esta paciente es conocido el uso de alquilantes, antracíclicos y etopósido, así como los antecedentes familiares de cáncer por ambas ramas. Conclusión. El retinoblastoma bilateral conlleva factores de riesgo para el desarrollo de segundas neoplasias. Los antecedentes familiares constituyen razones suficientes para catalogarlo como un síndrome de cáncer familiar, el uso de agentes alquilantes, antraciclicos y etopósidos, aumentan este riesgo acortando el período de latencia

Ciclofosfamida a dosis escaladas en tumores sólidos malignos en población pediátrica: Experiencia en el Hospital Infantil de México Federico Gómez / Cyclophosphamide dose escalation in solid tumors in children

Introducción. La ciclofosfamida a dosis escaladas incrementó su citotoxicidad en tumores sensibles a ésta, sin aumento de sus efectos tóxicos. Material y métodos. Se evaluaron 50 pacientes con tumores sólidos, en los que se utilizó ciclofosfamida en dosis escaladas de 2.5 g hasta 4.5 g/m² de superficie corporal como esquema de primera línea o de rescate, con uroprotector y factor estimulante de colonia en cada ciclo. La toxicidad y la respuesta fueron basadas en criterios de la Organización Mundial de la Salud. Resultados. Los diagnósticos más frecuentes fueron tumores del sistema nervioso central y retinoblastoma con 18 y 9 pacientes respectivamente. Cuarenta y cinco pacientes (90 por ciento) presentaron respuesta a quimioterapia, ya sea completa (72 por ciento) o parcial. Sólo en 5 pacientes no hubo respuesta. Se presentaron 3 episodios de cistitis hemorrágica. Conclusiones. Se comprobó que la ciclofosfamida a dosis escalada es activa en un grupo heterogéneo de pacientes con tumores sólidos y que esta modalidad terapéutica no incrementa el riesgo de toxicidad

O câncer infantil: caracterizaçäo da populaçäo atendida em um hospital-escola como subsídio para a assistência de enfermagem / Cancer in children: characterization of an university-hospital population as an AID to the nursing care

O presente estudo tem por objetivo descrever algumas características biológicas e clínicas de uma determinada populaçäo infantil afetada por neoplasias, a fim de subsidiar a assistência de enfermagem. Através da coleta de dados empíricos, realizada em um hospital-escola do município de Ribeiräo Preto-SP, evidenciamos que o câncer acomete mais frequentemente crianças menores de 10 anos de idade (84,5 por cento); a maioria (71,3 por cento) so sexo masculino; o diagnóstico mais frequente (56,3 por cento) foi leucemia; a terapêutica mais utilizada foi a quimioterapia , em associaçäo ou näo e os diagnósticos secundários foram os infecciosos, destacando-se a pneumonia, infecçäo de vias aéreas superiores, otite média aguda, amidalite e septicemia

Chemotherapy in patients with retinoblastoma.

Chemotherapy composed of vincristine, cyclophosphamide, procarbazine and intrathecal thiotepa/methotrexate (in the indicated ones) were given for 1.5 years in the doubtful and very unfavorable (Reese-Ellsworth classification) cases of retinoblastoma. There were 58 new cases treated at the Department of Ophthalmology and the Department of Pediatrics, Ramathibodi Hospital from October 1, 1985 to December 31, 1991. Eight cases had refused the surgery prior to admission. Nine cases were not given chemotherapy due to the very advanced cases and refusal. Forty-nine cases received chemotherapy. Eighteen cases were not followed. Among 31 evaluable cases, three cases had progression of the disease. Twenty-eight cases (90%) were clinically well 2 months-6 years after discontinuation of chemotherapy. The good result could be attributable to spontaneous regression (minimal percentage), surgery, radiation therapy or chemotherapy. However, obvious chemotherapeutic effects were seen in some cases. Even though 28 cases seemed to have good result including three of the 8 cases who had refused surgery before admission, we should stress that retinoblastoma is a curable disease provided that early diagnosis and treatment are rendered. Ophthalmologic examination in first degree relatives should be done in the bilaterally involved cases.

Chemosensitization to adriamycin by cyclosporin A and verapamil in human retinoblastoma cell lines

The chemosensitizing effects of cyclosporin A and verapamil on the cytotoxicity of adriamycin were investigated using MTT assay against two human retinoblastoma cell lines, Y79 and WERI-Rb-1. Y79 and WERI-Rb-1 were totally resistant to doses up to 5.0 micrograms/ml of verapamil. Cyclosporin A inhibited the survival of Y79 and WERI-Rb-1 dose-dependently, however, the maximum inhibition at the highest concentration tested (5.0 micrograms/ml) was less than 50% (% survival at 5.0 micrograms/ml of cyclosporin A: 65.6% and 66.9% in Y79 and WERI-Rb-1, respectively). Combination of cyclosporin A and verapamil did not further inhibit the survival of Y79 and WERI-Rb-1 compared with cyclosporin A alone. Adramycin inhibited the survival of Y79 and WERI-Rb-1 dose-dependently. The chemosensitizing effects of cyclosporin A and verapamil on the cytotoxicity of adriamycin were evaluated in terms of sensitizing index (SI: the ratio of IC50 to adriamycin alone to IC50 to adriamycin in the presence of cyclosporin A and/or verapamil). Cyclosporin A significantly enhanced SI and the addition of verapamil enhanced SI further: SI values at 5.0 micrograms/ml of cyclosporin A, 5.0 micrograms/ml of cyclosporin A plus 1.5 micrograms/ml of cyclosporin A plus 1.5 micrograms/ml of verapamil, 5.0 micrograms/ml of cyclosporin A plus 3.0 micrograms/ml of verapamil were 2.0, 2.6 and 2.8 in Y79 and 2.6, 5.8 and 9.7 in WERI-Rb-1, respectively. These results suggest that cyclosporin A and verapamil are promising chemosensitizers to adriamycin in the treatment of retinoblastoma.