1. Retinoblastoma case - Brazil
National Cancer Institute – (INCA)
Rio de Janeiro – Brazil
Evandro Lucena, MD
Sima Ferman, MD

2. Retinoblastoma case - Brazil
Age: 10 month-old girl.
Diagnosed bilateral retinoblastoma at age of 3 mos (July 2006) when parents noticed deviation in the OS and also noticed leukocoria OU on pictures previously taken.

3. Retinoblastoma case - Brazil
Underwent EUA on late July, 2006 – Bilateral retinoblastoma B.
OD – Lesion on the macula with 6 mm base and 2 mm height (Ultrasound) and a second lesion with 2 mm base and almost no elevation. Periphery OK. ON OK.
OS – Lesion on the macula compromising the foveal area with 8 mm base and 3 mm height. Periphery and ON normal.

4. Retinoblastoma case - Brazil
Systemic workup was OK and she started chemo (2 drugs - Vincristine and Carboplatin) on July 26th – 6 cycles and 4 local treatments after the second cycle (TTT X4 in the whole lesion).
The tumors regressed nicely in both eyes.
Last chemo on Nov 13th.

5. Retinoblastoma case - Brazil
She was followed with monthly EUAs.
In Dec 2006 – OD tumor completely regressed with calcification of the whole lesion. The other lesion (smaller) was flat with a circunjacent pigmented scar.
OS exam showed a completely regressed lesion in the fish-flesh pattern with cincunjacent pigmented scar. The macula is compromised but no active lesion or area was noticed.

6. Retinoblastoma case - Brazil
Jan 29th - EUA OD - Small lesion (Less than 1 DD) just ½ disc from the pigmentary boundary of the bigger lesion OD was noticed.
The dilated OS exam was unchanged.

7. Retinoblastoma case - Brazil
March 2nd, EUA OD - Showed multiple snowball lesions OD with different sizes (1 to 3 DD) some close to the posterior pole and some to the inferior periphery. Superior hemisphere was OK.
No vitreous seeding weas noticed.
The neovascularization to the lesions is very important and we could see new tumors close to the periphery.
Stage D (good D). OS is OK. NO tumor growth or seeding to the vitreous or to the retina.

8. Retinoblastoma case - Brazil
Questions:
10 month old D with no hope for chemo plus local treatment OD. Next step?
EBRT with that little age?
Start chemo and wait for at least 15 months for EBRT?
Local carboplatin (Subtenon)?
Enucleation?
We were thinking about 4+ more cicles of Vincristine, carboplatin and VP16, close follow up for the OS and EBRT OD as soon as the age allows us. Any place for subtenon carboplatin?
Any insights?