Effect on ocular survival of adding early intensive focal treatments to a two-drug chemotherapy regimen in patients with retinoblastoma.

PURPOSE: To evaluate vincristine and carboplatin with intensive focal treatments in the management of intraocular retinoblastoma. DESIGN: Noncomparative, retrospective interventional case series. SETTING: Institutional. PATIENT POPULATION: Sixteen patients (11 bilateral, 5 unilateral) with intraocular retinoblastoma. Interventional procedures: Patients were treated with eight courses of vincristine and carboplatin. Intensive focal treatments were administered after two courses of chemotherapy. MAIN OUTCOME MEASURES: Avoidance of external beam radiotherapy (EBRT) and eye survival. RESULTS: Twenty eyes (74.1%) were classified as Reese-Ellsworth Group V. All eyes responded to chemotherapy. With a median follow-up of 23 months (range 10 to 33 months) and a median of 5.5 focal treatments per eye (range 0 to 19 treatments), ocular survival was 81%. Eight eyes (30%) in five patients received EBRT. CONCLUSIONS: Vincristine and carboplatin combined with intensive focal treatments is an effective regimen for patients with intraocular retinoblastoma. This treatment regimen has outcomes comparable to those of more toxic regimens and merits further evaluation.