Globe Salvage With Intra-Arterial Topotecan-Melphalan Chemotherapy in Children With a Single Eye

• Published in: Revista de investigacion clinica Vol. 68; no. 3; pp. 137 - 142
• Main Authors: Leal-Leal, Carlos A, Asencio-López, Laura, Higuera-Calleja, Jesús, Bernal-Moreno, Max, Bosch-Canto, Vanessa, Chávez-Pacheco, Juan, Isaac-Otero, Gabriela, Beck-Popovic, Maja
• Format: Journal Article
• Language: English
• Published: Mexico 01.05.2016
• Subjects: Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Injections, Intra-Arterial; Longitudinal Studies; Male; Melphalan - administration & dosage; Mexico; Ophthalmic Artery; Prospective Studies; Retinal Neoplasms - drug therapy; Retinal Neoplasms - pathology; Retinoblastoma - drug therapy; Retinoblastoma - pathology; Salvage Therapy - methods; Topotecan - administration & dosage; Treatment Outcome
• ISSN: 0034-8376

Intra-arterial chemotherapy is a novel therapeutic modality for retinoblastoma patients. Intra-arterial chemotherapy involves the administration of a super-selective drug through the ophthalmic artery, resulting in better ocular penetration and low systemic toxicity. The aim of this report was to evaluate the feasibility of intra-arterial chemotherapy in a large referral center in Mexico City. We included patients with bilateral retinoblastoma, one enucleation, and active disease in the other eye after at least two courses of systemic chemotherapy combined with topical treatments. All patients were treated with three courses of a combination of melphalan 4 mg and topotecan 1 mg. Patients were examined under general anesthesia three weeks after each chemotherapy cycle. From 14 eligible patients, three could not be treated due to inaccessibility of the ophthalmic artery. A complete response was observed in 5/11 patients, three in Stage C according to the International Classification for Intraocular Retinoblastoma, one in Stage D, and one in Stage B. The eyes of three patients were enucleated as a result of active/progressive disease, one in Stage B and two in Stage D. Eye preservation was 55% after a mean follow-up of 171 days (range 21-336). Super-selective intra-arterial chemotherapy is safe and effective for preventing the enucleation of 55% of affected eyes in this group of patients.