A single-arm study of systemic and sub-Tenon chemotherapy for Groups C and D intraocular retinoblastoma: A Children's Oncology Group study (ARET 0231)

Rima F. Jubran, Judith G. Villablanca, Mark Krailo, Jin Piao, Li Huang, A. Linn Murphree, Joan O'Brien, Dan Gombos, Carol L. Shields, Anna Meadows, Murali Chintagumpala

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Eyes with Group D intraocular retinoblastoma have low salvage rates. A pilot study showed safety and efficacy of sub-Tenon's fascia carboplatin with systemic chemotherapy supporting further study. Methods: Children with newly diagnosed bilateral intraocular retinoblastoma with at least one remaining Group C or D eye were treated with six courses of carboplatin/etoposide/vincristine (CEV) with sub-Tenon's fascia carboplatin for Group C/D eyes during courses 2-4. Local ophthalmic therapy started at course 3. The primary study objective was to determine the 1-year failure rate of Group D eyes. Results: The study closed prematurely due to poor accrual and 22 of 30 patients were evaluable for failure rate, contributing 25 Group D and four Group C eyes. Among the 25 Group D eyes, there were 13 failures within the first year of study enrollment including eight needing external beam radiotherapy (EBR) and five needing enucleation, resulting in 1-year failure rate of 52%. The failure rate was significantly lower than the historical rate of 70% (P =.039). The 1-year eye preservation rate for Group D eyes was 80% (20/25). One-year failure rate for Group C eyes was 25% (1/4); 1-year preservation rate was 100% without need for EBR. Systemic toxicity included Grade 3 hearing loss in two subjects, infections, neutropenia, and thrombocytopenia. Ocular toxicities included periorbital fat atrophy (13/29 = 45% eyes), optic nerve atrophy (1/29 = 3% eyes), and restrictive fibrosis (1/29 = 3% eyes). Conclusions: Sub-Tenon's fascia carboplatin plus CEV was partially effective in Group D intraocular retinoblastoma but had unacceptable ocular toxicities.

Original languageEnglish (US)
Article numbere28502
Pages (from-to)e28502
JournalPediatric Blood and Cancer
Issue number9
StatePublished - Sep 1 2020


  • clinical trial
  • retinoblastoma
  • sub-Tenon chemotherapy
  • Retinal Neoplasms/drug therapy
  • Prognosis
  • Follow-Up Studies
  • Humans
  • Child, Preschool
  • Infant
  • Male
  • Vincristine/administration & dosage
  • Tenon Capsule
  • Antineoplastic Combined Chemotherapy Protocols/therapeutic use
  • Etoposide/administration & dosage
  • Young Adult
  • Adolescent
  • Adult
  • Carboplatin/administration & dosage
  • Female
  • Child
  • Retinoblastoma/drug therapy

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Pediatrics, Perinatology, and Child Health


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