High-dose chemotherapy with carboplatin, etoposide and cyclophosphamide followed by a haematopoietic stem cell rescue in patients with high-risk retinoblastoma: a SFOP and SFGM study

This study investigates the role of high-dose chemotherapy with haematopoietic stem cell rescue as consolidation treatment in high-risk retinoblastoma (extraocular disease at diagnosis or relapse or invasion of cut end of optic nerve). 25 patients received high-dose chemotherapy including carboplatin (250 mg/m2/day from day 1 to day 5 for the 6 first patients and 350 mg/m2/day from day 1 to day 5 for the other patients), etoposide (350 mg/m2/day from day 1 to day 5) and cyclophosphamide (1.6 g/m2/day from day 2 to day 5) (CARBOPEC) followed by autologous haematopoietic stem cell rescue. 19 patients received this drug combination for chemosensitive extraocular relapse. The other 6 patients with histological high-risk factors were given this treatment as consolidation after enucleation and conventional chemotherapy. The three year disease-free survival was 67.1%. In 7 of the 9 relapsing patients, the first site of relapse was the central nervous system. All patients with central nervous system disease died except one. The main toxicity was haematological and digestive (mucositis and diarrhoea). 2 of the 13 evaluable patients had grade III and IV ototoxicity. One patient experienced an acute grade I reversible cardiotoxicity. The CARBOPEC regimen seems to be a promising therapeutic strategy in patients with high-risk retinoblastoma, especially those with bone and/or bone marrow involvement. This treatment did not improve the outcome of patients with central nervous system disease.     

Correction factors for water-proofing sleeves in kilovoltage x-ray beams

This paper investigates the effect of the waterproofing sleeve on the calibration of kilovoltage photon beams (50-300 kV). The sleeve effect correction factor, ps has been calculated using the Monte Carlo method as the ratios of the air kerma in an air cavity of a cylindrical chamber without the waterproofing sleeve to that with a sleeve. Three sleeve materials have been studied, PMMA, nylon and polystyrene. The calculations were carried out using the EGS4 (Electron Gamma Shower version 4) code system with the application of a correlated-sampling variance-reduction technique. The results show that the sleeve correction factor for 1-mm thick nylon and polystyrene sleeves, ps varies from 0.992 to 1.000 and from 0.981 to 1.000, respectively, for the same beam quality range. The ps factor varies with sleeve thickness, beam quality and phantom depth. No significant dependence of the ps factor on field size and source-surface distance has been found. Measurements for PMMA, nylon and polystyrene sleeves of various thicknesses have also been carried out and show excellent agreement with Monte Carlo calculations.