Intra-arterial Chemotherapy for Retinoblastoma in 70 Eyes

Shields, Carol L.; Manjandavida, Fairooz P; Lally, Sara E.; Pieretti, Giulia; Arepalli, Sruthi; Caywood, Emi; Jabbour, Pascal; Shields, Jerry A.

doi:10.1016/j.ophtha.2014.01.026

Cited by 239 publications

(139 citation statements)

References 25 publications

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“…In our study, the ocular salvage rate was 66% with a median follow-up of 11.9 months. Based on a 5-year analysis, Shields et al [11] reported that melphalan therapy is remarkably effective for primary or secondary treatment. Although its efficacy is well known, the success rate is low in group E eyes [12].…”

Section: Discussionmentioning

confidence: 99%

Intra-Arterial Chemotherapy for Retinoblastoma: A Single-Center Experience

Akyüz

Kıratlı²,

Şen

et al. 2015

Ophthalmologica

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Background: Studies conducted in recent years have reported promising results regarding the treatment of retinoblastoma with the intra-arterial use of melphalan. In the present study, we intended to report the results of intra-arterial chemotherapy with melphalan (IACT) in the treatment of newly diagnosed or relapsed-refractory retinoblastoma patients at the Department of Pediatric Oncology of Hacettepe University, Ankara, Turkey. Materials and Methods: This was a retrospective study of patients with intraocular retinoblastoma who were treated with IACT from December 2011 to May 2014. A total of 56 eyes of 46 consecutive patients (30 males and 16 females) were included in the study. Forty-four eyes received systemic chemotherapy upon diagnosis (systemic chemotherapy group, SCG), and 12 eyes were those of newly diagnosed patients (primary intra-arterial melphalan group, PIAG). The choice of the IACT dose was based on age. Tumor control and globe salvage with IACT were analyzed. Complete blood counts were examined 7 days after the IACT for systemic toxicity. Ocular toxicities such as proptosis, eyelid edema, ocular motility, and retinal and optic atrophy were assessed by an ocular oncologist with regular ophthalmologic examinations. Results: Enucleation was avoided overall in 66% (37/56) of the eyes, including 75% (9/12) in the PIAG and 64% (28/44) in the SCG patients. The 1-year enucleation-free survival rate was 56.7% at a median follow-up time of 11.9 months (range 0.27-27.6). IACT was administered in a total of 124 cycles (ranging from 1 to 7 cycles, mean 2.3). The responses were as follows: regression of the retinal tumor in 27 eyes and improvements in vitreous seeding in 5 of 15 eyes. The further treatment requirements after IACT were as follows: enucleation in 19 eyes (10 with vitreous seeding), radiotherapy in 3 eyes, systemic chemotherapy in 1 eye, and local therapy in 1 eye. No severe systemic side effects occurred. Transient swelling of the eyelids (22 patients), conjunctival chemosis (12 patients), upper eyelid ptosis (5 patients), redness over the frontal area (3 patients), limitation of ocular motility (3 patients) and mild proptosis (1 patient) were detected. Retinal pigment epithelial alterations (30 patients) and optic atrophy (3 patients) were seen in the late follow-up. Conclusions: Globe salvage and avoidance of radiotherapy may be achieved by IACT with limited toxicity. This treatment is efficient, repeatable and safe.

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Section: Discussionmentioning

confidence: 99%

Intra-Arterial Chemotherapy for Retinoblastoma: A Single-Center Experience

Akyüz

Kıratlı²,

Şen

et al. 2015

Ophthalmologica

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“…Among its several uses, IAC has proven to be a powerful tool for globe salvage following failure of other therapies, particularly intravenous chemotherapy [1]. Despite the efficacy of IAC, serious local and systemic adverse events can occur [2].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the efficacy of IAC, serious local and systemic adverse events can occur [2]. Previously reported ophthalmic complications include eyelid/orbital edema, blepharoptosis, cutaneous erythema, strabismus, branch/central retinal artery occlusion, ophthalmic artery spasm or occlusion, choroidal ischemia, optic neuropathy, vitreous hemorrhage, and others [1, 3]. In this case report, we focus specifically on choroidal ischemia.…”

Section: Introductionmentioning

confidence: 99%

“…The choroidal vascular abnormalities included reduced perfusion in a sectoral ( n = 5) or diffuse ( n = 1) pattern, but none with watershed zone sparing [3]. In a more recent analysis, Shields et al [1] found that the combined incidence of ophthalmic, retinal, and choroidal ischemia has decreased to 1%, possibly due to changes in the technique of IAC administration. Herein, we describe a unique post-IAC finding of choroidal ischemia with watershed zone sparing.…”

Section: Introductionmentioning

confidence: 99%

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Choroidal Ischemia Sparing the Watershed Zone following Intra-Arterial Chemotherapy for Retinoblastoma

et al. 2018

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Purpose: Intra-arterial chemotherapy (IAC) has become a mainstay in the management of retinoblastoma, especially in advanced or refractory disease. However, IAC is not without complications, and chemotherapy toxic effects can lead to partial or complete choroidal ischemia, often causing vision loss. Methods: This is a case report. Results: A 4-month-old girl with bilateral retinoblastoma was treated with secondary IAC (melphalan 5 mg) for recurrent tumor following intravenous chemotherapy. One month later, complete tumor control was achieved. However, she demonstrated broad choroidal ischemia in the nasal and temporal quadrants but sparing of the watershed zone superior and inferior to the optic disc and in the papillomacular region. Fluorescein angiography revealed poor perfusion of the choriocapillaris with visibility of the large choroidal vessels in the nasal and temporal areas but preserved perfusion of the watershed zone. The watershed zone remained intact on the 10-month follow-up, and the final visual acuity was fix and follow without strabismus. Conclusion: The pathophysiology of choroidal ischemia is not well understood, but the fortuitous watershed zone preservation in this case could represent uneven distribution of the chemotherapeutic drug, resulting in partial chemo-dilution of the medication in the watershed region, which represents the final downstream overlapping choroidal perfusion from both medial and lateral posterior ciliary arteries.

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“…These studies led to the modern era of treatment with primary chemoreduction and concurrent local consolidative therapies, reserving external beam radiation for refractory disease [7]. In the last decade, local or regional delivery of chemotherapy to patients with retinoblastoma including intra-arterial and intravitreal approaches has also been described and implemented globally [8,9,10,11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Group B Eyes in Patients with Retinoblastoma Treated with Short-Course Chemoreduction: Experience from Children's Hospital Los Angeles/University of Southern California

et al. 2015

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Background/Aims: Chemoreduction protocols for retinoblastoma vary widely across institutions. Herein, we compare a 3- versus 6-cycle chemotherapy approach for group B retinoblastoma. Methods: A nonrandomized, retrospective review of patients diagnosed with group B retinoblastoma from 1991-2011 at Children's Hospital Los Angeles was performed. A total of 72 eyes of 63 patients were analyzed. Mean follow-up time was 82 months (range 6-272 months). Main outcome measures were globe salvage and need for external beam radiation. Results: Forty-six patients (55 eyes) were treated upfront with 3 cycles of carboplatin, etoposide, and vincristine; 17 patients (17 eyes) received 6 cycles. Thirty-seven eyes (67%) in the 3-cycle group were cured with initial chemoreduction alone. An additional 10 eyes with persistent or recurrent tumors were rescued with 3 more cycles for a total salvage rate of 85% (47/55 eyes). In the 6-cycle group, 16 of 17 eyes (94%) avoided radiation and enucleation. Conclusion: The initial recurrence rate was higher for the 3-cycle group (p = 0.03). However, eyes failing short-course chemoreduction were rescued with 3 additional cycles and achieved a similar overall event-free survival rate (p = 0.16). In our cohort, this short-course approach spared 63% (29/46) of patients with group B retinoblastoma the extra 3 cycles of systemic chemotherapy.

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Intra-arterial Chemotherapy for Retinoblastoma in 70 Eyes

Cited by 239 publications

References 25 publications

Intra-Arterial Chemotherapy for Retinoblastoma: A Single-Center Experience

Intra-Arterial Chemotherapy for Retinoblastoma: A Single-Center Experience

Choroidal Ischemia Sparing the Watershed Zone following Intra-Arterial Chemotherapy for Retinoblastoma

Long-Term Outcomes of Group B Eyes in Patients with Retinoblastoma Treated with Short-Course Chemoreduction: Experience from Children's Hospital Los Angeles/University of Southern California

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