Systemic Chemotherapy and Subtenon Carboplatin, and Local Ophthalmic Therapy in Children With Intraocular Retinoblastoma

Inclusion Criteria

• •Diagnosis of bilateral retinoblastoma with at least 1 eye group C or D intraocular retinoblastoma by ophthalmologic examination, defined by the International Classification System for Intraocular Retinoblastoma as the following:
• •* Group C: Discrete localized disease with minimal subretinal and/or vitreous seeding
• •* Subretinal fluid, without prior or concurrent seeding, involving ≤ one quarter of the retina
• •* Local fine vitreous seeding may be present close to discrete tumor
• •* Local subretinal seeding \< 3 mm from tumor
• •* Group D: Diffuse disease with significant vitreous and/or subretinal seeding
• •* Tumor(s) may be massive or diffuse
• •* Subretinal fluid, without prior or concurrent seeding, involving up to total retinal detachment
• •* Diffuse or massive vitreous disease may include "greasy" seeds or avascular tumor masses
• •* Diffuse subretinal seeding may include subretinal plaques or tumor nodules
• •Prior enucleation of 1 eye allowed provided the remaining eye is group C or D
• •No tumor present on histologic examination at the cut end of the optic nerve on any eye enucleated prior to study entry
• •* Evidence of choroidal and/or optic nerve invasion past the lumina cribrosa is allowed
• •No extraocular retinoblastoma clinically or by MRI of brain and orbits with and without gadolinium or CT scan with and without contrast of brain and orbits
• •No evidence of systemic metastases by bone marrow, lumbar puncture, bone scan, and/or any other additional test
• •Performance status - Karnofsky 50-100% (over 16 years of age)
• •Performance status - Lansky 50-100% (16 and under)
• •Bilirubin ≤ 1.5 times upper limit of normal (ULN) for age
• •AST and ALT \< 2.5 times ULN for age
• •Creatinine adjusted according to age as follows:
• •* No greater than 0.4 mg/dL (≤ 5 months)
• •* No greater than 0.5 mg/dL (6 months -11 months)
• •* No greater than 0.6 mg/dL (1 year-23 months)
• •* No greater than 0.8 mg/dL (2 years-5 years)
• •* No greater than 1.0 mg/dL (6 years-9 years)
• •* No greater than 1.2 mg/dL (10 years-12 years)
• •* No greater than 1.4 mg/dL (13 years and over \[female\])
• •* No greater than 1.5 mg/dL (13 years to 15 years \[male\])
• •* No greater than 1.7 mg/dL (16 years and over \[male\])
• •Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min/1.73m\^2
• •Not pregnant or nursing
• •Fertile patients must use effective contraception
• •Negative pregnancy test in postmenarchal females
• •No prior chemotherapy
• •No other concurrent chemotherapy
• •No prior radiotherapy
• •No other concurrent radiotherapy