PURPOSE: To report the results of conservation of the ocular globe after treatment with carboplatin and laser; with or without the use of other forms of local treatment or radiotherapy, if necessary. METHODS: All eyes, initially untreated, were evaluated using indirect ophthalmology under inhalation anesthesia in an outpatient clinic treatment setting. They were categorized according to the Reese-Ellsworth system; thereafter, the patients were evaluated clinically by a pediatric oncologist. The patients received the first cycle of chemotherapy consisting of intravenous carboplatin 200 mg/m², vincristine 1.5 mg/m² and etoposide 150 mg/m², for three days. This was followed by other cycles with intervals of between 21 and 28 days. From 7 to 15 days after the end of the chemotherapy cycle, another indirect ophthalmoscopy under inhalation anesthesia was performed, with documentation of the findings and laser hyperthermia application, using a Diode laser, 810 nm, continuous pulse with a large spot size. The procedure (chemotherapy and laser) was repeated until complete cicatrization of all lesions was observed, or until the need for another treatment modality such as radiotherapy or enucleation became apparent. Follow-up examinations every two months during the first year and three months thereafter were done for review and for treatment of recurrent or new lesions. Pediatric oncology follow-up was also done throughout the entire initial assessment and follow-up period. RESULTS: We treated a total of 62 patients with retinoblastoma, of whom 32 were male and 30 female. Fifteen were unilateral and 47 were bilateral with a total of 107 eyes. The mean age was 16.9 months (2.6 - 71.4). In 5 patients we administered 4 cycles of chemotherapy; but in most cases we found it necessary to use between 4 - 8 chemotherapy cycles. In 34 eyes we could not avoid the use of radiotherapy. The mean follow-up time was 26.8 months (5 - 60). In the bilateral cases, we were able to conserve the globe as follows (Reese & Ellsworth): I 10/11 (90.9%); II 8/9 (88.8%); III 10/10 (100.0%); IV 3/8 (37.5%); V 14/54 (25.9%). Considering all those bilateral cases we reached conservation of 48.9% of the treated eyes. In the unilateral group, we were able to conserve the globe as follows: I 0/0 (0%); II 2/2 (100%); III 1/3 (33.3%); IV 1/3 (33.3%); V 0/0 (0%). Considering the total we conserved 26.6% of the unilateral cases. There was no case of nephrotoxicity or ototoxicity among our patients.
Retinoblastoma; Retinal neoplasms; Carboplatin; Antineoplastic combined chemotherapy protocols; Eye enucleation; Prospective studies; Child; Male; Female
