Periocular carboplatin for retinoblastoma: long-term report (12 years) on efficacy and toxicity.

AIM: To report the experience of the authors with efficacy and toxicity of periocular chemotherapy over a 12-year period.

METHODS

102 periocular injections of 2 cc (10 mg of carboplatin/1 cc) were given every 4-6 weeks in 33 eyes of 29 patients. Patient's data were reviewed retrospectively.

RESULTS

Thirty-three eyes were followed for 7-148 months following initiation of periocular injections, and 13 (39%) have avoided enucleation. There were two cases of second malignancy resulting in one death and one survivor, two survivors of metastatic disease, and two survivors of orbital recurrence. Twenty eyes were enucleated for disease progression at a mean time of 15 months postinitiation of periocular carboplatin (POC). The Kaplan-Meier estimate of eye survival at 36 months is 36%. Eleven of the 13 salvaged eyes received concurrent treatment with chemotherapy (n=4, 30%), external beam radiation and chemotherapy in (n=6, 46%), or brachytherapy (n=1, 8%). Two of the salvaged eyes (16%) were treated with POC alone. Orbital swelling occurred in 14/33 (42%) eyes. There were no symptomatic motility disorders. One severe toxicity reaction resulted in acute loss of vision, down to light perception, which failed to recover and one eye had progression of optic nerve pallor.

CONCLUSIONS

This paper demonstrates that POC has limited short-term and long-term systemic toxicity and most of the ocular complications were acute, not delayed. Only two select cases showed long-term complete responses to POC alone and the data do not support the use as monotherapy, although where it was used in combination with other modalities, 39% of the eyes were saved.