Ten-year experience with ophthalmic artery chemosurgery: Ocular and recurrence-free survival Journal Article

Authors: Francis, J. H.; Levin, A. M.; Zabor, E. C.; Gobin, Y. P.; Abramson, D. H.
Article Title: Ten-year experience with ophthalmic artery chemosurgery: Ocular and recurrence-free survival
Abstract: Purpose To report associations between disease- and treatment-related variables and rates of recurrence-free survival and ocular survival in eyes treated with ophthalmic artery chemosurgery (OAC) for retinoblastoma. Design Pre-post study. Subjects All eyes treated with OAC for retinoblastoma at Memorial Sloan Kettering Cancer Center between May 2006 and February 2017. Methods This retrospective review included 452 retinoblastoma eyes treated with OAC. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS), progression-free survival (PFS) and ocular survival (OcS), and Cox regression was used to estimate hazard ratios. Eyes treated in the pre-intravitreous chemotherapy era were analyzed separately from eyes treated in the intravitreal era. Main outcome measures Recurrence-free survival, ocular survival, associations with risk of recurrence Results Disease and treatment characteristics were recorded over a median 23.6 month follow-up. One-year OcS, PFS and RFS were 96% (95% CI 93–99%), 88% (95% CI 88–94%) and 74% (95% CI 67–81%) in the pre-intravitreal era and 96% (95% CI 94–99%), 93% (95% CI 89–96%) and 78% (95% CI 72–83%) in the intravitreal era, respectively. Presence of vitreous seeds was associated with increased risk of recurrence in the pre-intravitreal era but not in the intravitreal era. Longer time interval between OAC sessions was associated with increased risk of recurrence and majority OAC access via the ophthalmic artery was associated with decreased risk of recurrence in both eras. Conclusions Approximately a quarter of eyes initially treated with ophthalmic artery chemosurgery develop recurrent disease, with the majority of recurrences within the first year following completion of OAC. Despite this, these eyes have a very good chance of salvage. In eyes with vitreous seeds at presentation, intravitreal injections are useful in minimizing future vitreous recurrence. Eyes that receive the majority of drug infusions via non-ophthalmic artery routes or greater interval between OAC are more likely to recur and might warrant closer monitoring. © 2018 Francis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: adolescent; child; survival rate; major clinical study; treatment duration; topotecan; outcome assessment; recurrence risk; antineoplastic agent; carboplatin; progression free survival; etoposide; melphalan; vincristine; retinoblastoma; retrospective study; infant; newborn; therapy delay; brachytherapy; ophthalmic artery; eye enucleation; drug treatment failure; chemosurgery; cryotherapy; low level laser therapy; recurrence free survival; pretest posttest design; vitreous seed; time to treatment; human; male; female; article; tissue survival; ocular survival; vitreous disease
Journal Title: PLoS ONE
Volume: 13
Issue: 5
ISSN: 1932-6203
Publisher: Public Library of Science  
Date Published: 2018-05-23
Start Page: e0197081
Language: English
DOI: 10.1371/journal.pone.0197081
PROVIDER: scopus
PMCID: PMC5965845
PUBMED: 29791475
Notes: Article -- Export Date: 2 July 2018 -- Source: Scopus
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MSK Authors
  1. Jasmine Helen Francis
    95 Francis
  2. David H Abramson
    247 Abramson
  3. Emily Craig Zabor
    119 Zabor