Superselective Ophthalmic Artery Chemotherapy as Primary Treatment for Retinoblastoma (Chemosurgery)

• Published in: Ophthalmology (Rochester, Minn.) Vol. 117; no. 8; pp. 1623 - 1629
• Main Authors: Abramson, David H., MD, Dunkel, Ira J., MD, Brodie, Scott E., MD, PhD, Marr, Brian, MD, Gobin, Y. Pierre, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2010
• Subjects: Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Carboplatin - administration & dosage; Carboplatin - adverse effects; Child; Child, Preschool; Electroretinography; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Infant; Infusions, Intra-Arterial; Male; Melphalan - administration & dosage; Melphalan - adverse effects; Ophthalmic Artery - drug effects; Ophthalmology; Prospective Studies; Retinal Neoplasms - drug therapy; Retinal Neoplasms - pathology; Retinoblastoma - drug therapy; Retinoblastoma - pathology; Topotecan - administration & dosage; Topotecan - adverse effects; Treatment Outcome; Visual Acuity
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2009.12.030

Purpose To report on our 3-year experience with the use of superselective ophthalmic artery infusion of chemotherapy as initial, primary treatment for intraocular retinoblastoma. Design Prospective, institutional review board-approved clinical trial. Participants Twenty-eight eyes of 23 newly diagnosed retinoblastoma patients (Reese-Ellsworth [RE] group V, 25 eyes; RE IV, 1 eye; RE III, 1 eye; RE II, 1 eye), ages 3–88 months (mean, 22; median, 11) followed for 3–37 months (mean, 15; median, 14). Methods Cannulation of 1 or both ophthalmic arteries in young children with retinoblastoma was performed via the femoral artery under general anesthesia on an outpatient basis and chemotherapy (melphalan [n = 12], melphalan plus topotecan [n = 7], melphalan plus topotecan and carboplatin [n = 3], or melphalan plus carboplatin [n = 1]) infused. Main Outcome Measures Patient survival, eye survival, systemic toxicity, complete blood counts, ophthalmic examination, retinal photography, and electroretinograms. Results We treated 23 newly diagnosed retinoblastoma patients initially with 75 separate intra-arterial chemotherapy infusions (range, 1–6 treatments; mean, 3.2) over a 3-year period. All children survived. Only 1 of the 28 eyes came to enucleation (for progressive disease). No eye was enucleated for ocular complications of the procedure and the only adverse ophthalmic findings were occasional transient lid edema, forehead hyperemia, and loss of nasal lashes. Kaplan-Meier enucleation free was 100% at 12 months and 89% at 2 years (95% confidence interval, 43%–98%). There were no deaths, strokes, or transfusions of any blood products; no effect on red cell count; 9 cycles of grade 3 and 1 cycle of grade 4 neutropenia; and no hospitalizations, episodes of fever/neutropenia, or complications at the site of femoral artery puncture. Conclusions The ophthalmic artery(s) of children can safely be repeatedly canulated in very young children and high concentrations (but low doses) of chemotherapy infused on an outpatient basis. When used as initial therapy superselective chemotherapy delivered through the ophthalmic artery prevented enucleation, primary radiation or the use of systemic chemotherapy in 27 of 28 eyes. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.