Chemotherapy in retinoblastoma management.

Chemotherapy, in addition to surgery, irradiation, cryothermy and light coagulation has been used in three groups of patients with retinoblastoma. In the first group it was used to try to prevent the development of metastases in cases with large tumours (Reese-Ellsworth Grade 4-5), in the second group to treat local extra-ocular spread and in the third group to treat bony metastases. In the first group there were 14 children with unilateral and eight with bilateral disease (grade 4 or 5 in one or both eyes), who were given prophylactic chemotherapy; there were no significant complications. One child died from congenital heart disease five years after treatment with no signs of metastatic disease. The mean survival of the other 21 children is now 6.0 years (range 2.5-11 years). Six children with local extra-ocular spread, one with CNS involvement as well, had chemotherapy with only minor complications. One child who did not complete the chemotherapy or radiotherapy coursed died from CNS disease but the remaining five have survived for four to 13 years. Three children with bone metastases were treated with high dosage chemotherapy after marrow harvesting and then reinfusion of marrow; in two children this did not eliminate the tumour and they died but one child has now survived free from disease for six years. In our cases we have had encouraging results from the use of chemotherapy with few complications but other authors have suggested that there is a possibility of new primary tumours being caused by this treatment.