Three-drug intra-arterial chemotherapy using simultaneous carboplatin, topotecan and melphalan for intraocular retinoblastoma: Preliminary results Journal Article

  

Authors:	Marr, B. P.; Brodie, S. E.; Dunkel, I. J.; Gobin, Y. P.; Abramson, D. H.
Article Title:	Three-drug intra-arterial chemotherapy using simultaneous carboplatin, topotecan and melphalan for intraocular retinoblastoma: Preliminary results
Abstract:	Aims: To report outcomes with selective intra-arterial chemotherapy (SIAC) using simultaneous carboplatin, topotecan, and melphalan for advanced intraocular retinoblastoma. Methods: A retrospective chart review was conducted of patients who received three-drug (melphalan, topotecan, and carboplatin) SIAC during 2006-2011. Results: Twenty-six eyes of 25 patients received the three-drug chemotherapy for treatment of advanced retinoblastoma. Reese-Ellsworth group was 5b in 21 eyes, 5a in 2, 4a in 2, and 3a in 1. Seventeen patients (68%) had recurrence after prior intravenous chemotherapy with or without radiotherapy. In the three-drug therapy, dose ranges were 2.5 -7.5 mg for melphalan, 0.3-0.6 mg for topotecan, and 25-50 mg for carboplatin, and median infusions per eye was 2 (range 1-4). At a mean follow-up of 14 months (range 1-43 months), all patients are alive and no patient developed metastatic disease. Twenty-three of 26 eyes (88%) survived. Eleven of the 26 eyes (35%) developed recurrent disease and were treated with enucleation (n=3) or with focal therapy (n=8) with or without plaque brachytherapy (n=3). The Kaplan-Meier estimate of ocular survival at 24 months was 75% (95% CI). Electroretinogram showed improvement greater than 25 μV in 4 eyes (15%), loss greater than 25 μV in 12 eyes (46%), and no change greater than 25 μV in 10 eyes (39%). Conclusions: Three-drug SIAC has been used successfully to rescue eyes after treatment failure of intravenous chemotherapy and/or single- or double-agent SIAC. Twenty-three of 26 eyes avoided both enucleation and external beam radiotherapy and retained electroretinogram function.
Keywords:	adolescent; adult; child; clinical article; preschool child; school child; treatment outcome; child, preschool; middle aged; survival rate; treatment failure; retrospective studies; young adult; advanced cancer; cancer combination chemotherapy; topotecan; follow up; carboplatin; blood toxicity; antineoplastic combined chemotherapy protocols; melphalan; retinoblastoma; retinal neoplasms; medical record review; infant; infant, newborn; pilot projects; tumor recurrence; antineoplastic agents, alkylating; infusions, intra-arterial; brachytherapy; enucleation; ophthalmic artery; external beam radiotherapy; cryotherapy; electroretinogram; balloon catheter; topoisomerase i inhibitors; diode laser; meningeal artery; middle meningeal artery; selective intraarterial chemotherapy
Journal Title:	British Journal of Ophthalmology
Volume:	96
Issue:	10
ISSN:	0007-1161
Publisher:	BMJ Publishing Group Ltd.
Date Published:	2012-10-01
Start Page:	1300
End Page:	1303
Language:	English
DOI:	10.1136/bjophthalmol-2012-301925
PROVIDER:	scopus
PUBMED:	22863945
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84867083442&partnerID=40&md5=3bade809efa6a46199e864e9462d2129
Notes:	--- - "Export Date: 2 November 2012" - "CODEN: BJOPA" - "Source: Scopus"

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