Superselective ophthalmic artery chemotherapy as primary treatment for retinoblastoma (chemosurgery) Journal Article
| Authors: | Abramson, D. H.; Dunkel, I. J.; Brodie, S. E.; Marr, B.; Gobin, Y. P. |
| Article Title: | Superselective ophthalmic artery chemotherapy as primary treatment for retinoblastoma (chemosurgery) |
| Abstract: | 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. © 2010 American Academy of Ophthalmology. |
| Keywords: | cancer survival; child; controlled study; preschool child; treatment outcome; child, preschool; clinical trial; neutropenia; cancer combination chemotherapy; topotecan; follow-up studies; prospective study; prospective studies; carboplatin; controlled clinical trial; antineoplastic combined chemotherapy protocols; melphalan; retinoblastoma; retinal neoplasms; confidence interval; infant; blood transfusion; outpatient department; general anesthesia; infusions, intra-arterial; electroretinography; artery catheterization; enucleation; eyelid edema; ophthalmic artery; blood cell count; kaplan meier method; chemosurgery; eye examination; forehead; electroretinogram; erythrocyte count; eye photography; femoral artery; hyperemia; fluorescein angiography; visual acuity |
| Journal Title: | Ophthalmology |
| Volume: | 117 |
| Issue: | 8 |
| ISSN: | 0161-6420 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2010-08-01 |
| Start Page: | 1623 |
| End Page: | 1629 |
| Language: | English |
| DOI: | 10.1016/j.ophtha.2009.12.030 |
| PUBMED: | 20381868 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: OPHTD" - "Source: Scopus" |
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