Intravitreal topotecan in the management of refractory and recurrent vitreous seeds in retinoblastoma

• Published in: British journal of ophthalmology Vol. 102; no. 4; pp. 490 - 495
• Main Authors: Rao, Raksha, Honavar, Santosh G, Sharma, Vishal, Reddy, Vijay Anand P
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2018
• Subjects: Antineoplastic Agents - administration & dosage; Cancer; Cancer therapies; Chemotherapy; Child, Preschool; Cryotherapy; Drug Administration Schedule; Drug dosages; Eye diseases; Female; Humans; Infant; Intravitreal Injections; Male; Neoplasm Seeding; Ophthalmology; Patients; Pediatrics; Retina; Retinoblastoma; Retinoblastoma - drug therapy; Retinoblastoma - pathology; Retrospective Studies; Seeds; Topoisomerase I Inhibitors - administration & dosage; Topotecan - administration & dosage; Tumors; Vitreous Body - pathology; treatment other; eye(globe); retina; neoplasia
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjophthalmol-2017-310641

Background/aimTo evaluate the efficacy of intravitreal topotecan for refractory or recurrent vitreous seeds in retinoblastoma.MethodsIntravitreal injection of topotecan hydrochloride (30 µg/0.15 mL) was provided every 3 weeks by the safety enhanced technique.ResultsThe study included 17 consecutive patients with retinoblastoma with refractory or recurrent vitreous seeds. Five eyes (29%) belonged to International Classification of Retinoblastoma group C and 12 eyes (71%) belonged to group D. Primary treatment included triple drug intravenous chemotherapy for a mean of 10 cycles (median, 9 cycles; range, 6–18 cycles). Fifteen patients (88%) had undergone 56 periocular carboplatin injections with a mean of 4 injections (median, 3 injections; range, 1–8 injections), concurrent with intravenous chemotherapy. A total of 53 intravitreal topotecan injections were performed in 17 eyes of 17 consecutive patients with refractory or recurrent vitreous seeds with a mean of 3 injections (median, 3 injections; range, 2–6 injections). Complete regression of vitreous seeds was achieved in 17 of 17 eyes (100%). At a mean follow-up of 23.8 months (median, 24 months; range, 15.1–34.1 months), one eye (6%) with a recurrent retinal tumour needed enucleation, and the rest of the 16 eyes (94%) maintained complete regression. Final visual acuity could be reliably assessed in all 16 eyes (100%), of whom 12 eyes (75%) had visual acuity ≥20/200. None of the patients developed ocular or systemic complications.ConclusionThree-weekly intravitreal topotecan appears effective and safe in controlling focal or diffuse refractory or recurrent vitreous seeds in retinoblastoma.