Chemoreduction in the Management of Intraocular Retinoblastoma Using New International Classification

Purpose: To evaluate the effectiveness of chemoreduction (CRD) for globe saving in patients with intraocular retinoblastoma Methods: In this interventional case series all patients with intraocular retinoblastoma were included and classified according to the international classification of retinoblastoma (ICRB) from group A to E. Six cycles of intravenous Vincristine, Etoposide and Carboplatin (VEC) were used for all groups, except for unilateral group A and E. After reduction of tumor volume adjuvant therapy was applied in all cases. Main outcome measure was CRD success, defined as globe salvage by avoidance of external beam radiotherapy or enucleation (EBRT). Results: Forty-three eyes from 31 patients were enrolled, 12 patients had bilateral involvement. 5 eyes were in group A, 7 in group B, 6 in group C, 8 in group D and 15 in group E. Thirty-one eyes were treated with VEC protocol and aggressive focal consolidation. Successful response was observed in 24 patients, de-novo recurrences occurred in 6 eyes that treated with additional VEC and neoadjuvant therapy. Success rate was 100% for groups A, B and C and 55% for group D during 6-18 months (mean=11.4 months) follow-up. Overall 19 eyes were enucleated (group E=15 and group D=4). Conclusion: CRD is an effective treatment modality for globe salvage in patients with intraocular retinoblastoma with a high success rate in groups B and C, and an acceptable success in group D.