The effect of chemoreduction on retinoblastoma-induced retinal detachment

Retinoblastoma with total retinal detachment traditionally has been managed with enucleation. We employed a chemoreduction protocol in an effort to reduce the tumor size to allow for focal treatment and salvage of the eye.

A prospective study was performed to assess the effects of a 2-month chemoreduction regimen of vincristine, etoposide, and carboplatin on massive retinoblastoma with total retinal detachment.

We treated 17 eyes with total retinal detachment from retinoblastoma in 13 patients over a 14-month period. At the initial examination, the mean tumor base was 15 mm and mean thickness was 10 mm. The eyes were classified as Reese-Ellsworth group V in 16 cases (94%) and group III in one case (6%). The retina was totally detached with serous subretinal fluid in all cases. After 2 months of chemoreduction, all tumors showed a response, and the tumors decreased to a mean base of 10 mm and thickness of 5 mm. Overall, a mean of 33% decrease in base and 47% decrease in thickness was noted. The subretinal fluid had resolved completely in seven eyes (41%), leaving flat retina. In three eyes (18%), partial resolution was achieved; in seven eyes (41%), minimal resolution of the subretinal fluid at the 2-month period was noted. By last follow up, at a mean of 10 months after initiation of chemoreduction, complete resolution of the subretinal fluid occurred in 13 eyes (76%) and partial resolution of subretinal fluid occurred in four eyes (24%).

Preliminary observations suggest that chemoreduction may be an important tool in the initial management of retinoblastoma, even for large tumors with total retinal detachment. Tumor shrinkage may be dramatic and subretinal fluid resolution may be complete.