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June 9, 2008

The Adverse Events of Chemotherapy for RetinoblastomaWhat Are They? Do We Know?

Arch Ophthalmol. 2008;126(6):862-865. doi:10.1001/archopht.126.6.862

External beam radiation (EBR) is an effective treatment for intraocular retinoblastoma, as it has been shown to save children's vision as well as their lives. While once standard therapy, and despite its success, EBR has largely been abandoned, owing to the concern of secondary malignancies,1 and has been replaced with systemic multiagent chemotherapy. It is unusual in cancer treatment that the decision for successful treatment be based not on the immediate result (eliminating the cancer), but rather on complications that may develop many (> 30) years later. Nonetheless, in the last 10 years there has been a shift in treatment preference, and numerous authors have reported favorable outcomes using various drug regimens.213 It has been demonstrated that Reese-Ellsworth groups I-V can be successfully treated with either EBR or multiagent systemic chemotherapy followed by focal treatments. Patient and ocular survival appear identical in all cases despite the approach, but a lighter drug regimen often calls for additional radiation. Knowledge of adverse effects is therefore critical in deciding which therapy is best for the patient. With more than 95 articles describing experiences with chemotherapy and retinoblastoma, one would expect there to be extensive reporting on the adverse effects of these drugs, but surprisingly, little has been published on toxicity, and what has been published is widely variable and often difficult to quantify. The information that does exist is relatively short-term, as there are few children treated with modern chemotherapy who are older than 10 years.

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