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Chapter-12 Local Chemotherapy

BOOK TITLE: Retinoblastoma

Author
1. Schefler Amy C
2. Braich Puneet S
ISBN
9789350257845
DOI
10.5005/jp/books/11629_12
Edition
1/e
Publishing Year
2012
Pages
10
Author Affiliations
1. Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
2. SUNY Upstate Medical University, Syracuse, New York, USA
Chapter keywords

Abstract

More than 95–98% of patients with retinoblastoma in the developed world survive with current therapy, and most efforts are now concentrated at increasing the rate of eye preservation. In the early 1990s, systemic chemoreduction with varying combinations of carboplatin, etoposide and vincristine followed by local therapy became the most commonly used treatment approach for intraocular retinoblastoma at large centers worldwide. Systemic chemotherapy for retinoblastoma is associated with attainment of relatively low intraocular drug concentrations with many devastating adverse systemic affects necessitating the investigation of local routes of drug delivery. Periocular chemotherapeutic agents, when compared to intravenous drugs, reach higher intraocular concentrations with low systemic concentrations and systemic side effects. Local adverse effects with periocular carboplatin include ocular motility changes and fibrosis, ischemic necrosis and atrophy of the optic nerve, and ophthalmic vascular alterations. Exciting new combination drug strategies such as episcleral implants, fibrin sealants, nanomolecules of carboplatin, and antiangiogenic agents (2-deoxy-D-glucose) will be increasingly utilized in the future. Intravitreous chemotherapy for retinoblastoma addresses the challenge of attaining high concentrations of drug delivery in the vitreous, but its use is limited by the potential for iatrogenic extraocular tumor recurrence.

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