Combined, sequential intravenous and intra-arterial chemotherapy (bridge chemotherapy) for young infants with retinoblastoma Journal Article

   

Authors:	Gobin, Y. P.; Dunkel, I. J.; Marr, B. P.; Francis, J. H.; Brodie, S. E.; Abramson, D. H.
Article Title:	Combined, sequential intravenous and intra-arterial chemotherapy (bridge chemotherapy) for young infants with retinoblastoma
Abstract:	Background: Intra-arterial (IA) chemotherapy has more risks of procedural complications in neonates and young infants. For these reasons, we have developed a strategy of bridge intravenous single agent chemotherapy to postpone IA chemotherapy in these children Procedure: Neonates and young infants with retinoblastoma who required chemotherapy were treated with systemic carboplatin chemotherapy (18.7 mg/kg IV every 3-4 weeks) until they reached the age of 3 months and a weight of 6 Kg. If necessary, IA chemotherapy was subsequently performed at 4 weeks intervals. Efficacy was judged by tumor regression on ophthalmological examination. Retinal toxicity was judged by electroretinography. Results: Eleven children (19 eyes) were treated. All patients are alive and no patient has developed metastatic disease or second malignancies (mean follow-up 27 months, range 9-46 months). Intravenous carboplatin (median 2 cycles, range 1-5) combined with cryotherapy and laser was given to all children. This was effective for five eyes, which did not require IA chemotherapy. IA chemotherapy was administered to 14 eyes (median 3.5 cycles per eye, range 1 to 6). No radiation therapy was required. The Kaplan Meier estimate of ocular radiation-free survival was 94.7% at one year (95% confidence interval 68.1-99.2%). One eye was enucleated due to tumor progression. ERG showed no deterioration of retinal function. Conclusion: Bridge IV-IA chemotherapy was feasible and safe, and is a promising strategy to treat retinoblastoma in neonates and young infants. © 2012 Gobin et al.
Keywords:	survival; cancer chemotherapy; clinical article; treatment outcome; neutropenia; side effect; unspecified side effect; antineoplastic agents; topotecan; follow up; antineoplastic agent; carboplatin; multiple cycle treatment; anemia; thrombocytopenia; melphalan; retinoblastoma; tumor regression; retinal neoplasms; infant; infant, newborn; tumor recurrence; newborn; erythema; electroretinography; enucleation; ophthalmic artery; tumor growth; erythrocyte transfusion; granulocyte colony stimulating factor; ptosis; cryotherapy; low level laser therapy; balloon occlusion; eyelash; injections, intra-arterial; internal carotid artery; meningeal artery; middle meningeal artery; radiation free survival; administration, intravenous
Journal Title:	PLoS ONE
Volume:	7
Issue:	9
ISSN:	1932-6203
Publisher:	Public Library of Science
Date Published:	2012-01-01
Start Page:	e44322
Language:	English
DOI:	10.1371/journal.pone.0044322
PROVIDER:	scopus
PUBMED:	23028521
PMCID:	PMC3445577
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84866509736&partnerID=40&md5=d87a73b06dc6e1544f47fc1246c796ed
Notes:	--- - "Export Date: 1 October 2012" - "Source: Scopus"

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