April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Intraarterial Chemotherapy (Ophthalmic Artery Chemosurgery) for Group D Retinoblastoma
Author Affiliations & Notes
  • Anthony Daniels
    Divisions of Ocular Oncology and Retina, Department of Ophthalmology, Vanderbilt Eye Institute, Nashville, TN
  • Y. Pierre Gobin
    Neurosurgery / Interventional Radiology, Weill Cornell Medical College, New York, TN
    Ophthalmic Oncology, Memorial Sloan-Kettering, New York, NY
  • Brian Marr
    Ophthalmic Oncology, Memorial Sloan-Kettering, New York, NY
  • Jasmine H Francis
    Ophthalmic Oncology, Memorial Sloan-Kettering, New York, NY
  • Scott E Brodie
    Ophthalmic Oncology, Memorial Sloan-Kettering, New York, NY
    Ophthalmology, Mount Sinai School of Medicine, New York, NY
  • David H Abramson
    Ophthalmic Oncology, Memorial Sloan-Kettering, New York, NY
  • Footnotes
    Commercial Relationships Anthony Daniels, None; Y. Pierre Gobin, None; Brian Marr, None; Jasmine Francis, None; Scott Brodie, None; David Abramson, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 3090. doi:https://doi.org/
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      Anthony Daniels, Y. Pierre Gobin, Brian Marr, Jasmine H Francis, Scott E Brodie, David H Abramson; Intraarterial Chemotherapy (Ophthalmic Artery Chemosurgery) for Group D Retinoblastoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3090. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To evaluate intraarterial chemotherapy (OAC) as a treatment for group D eyes, both those that have failed other treatments and in the treatment-naïve setting. While group A-C eyes can often be managed with other treatment modalities, these other treatments are less successful in group D eyes.

 
Methods
 

IRB-approved retrospective review of all Group D eyes treated with OAC from 5/2006-12/2012 at our institution. Patients were treated according to our previously-published techniques. Demographics, prior treatment, OAC agents used, outcomes and adverse events were recorded.

 
Results
 

100 patients (109 eyes) with group D retinoblastoma who underwent OAC were included. 45 eyes were treatment-naïve and 63 eyes had received prior treatments elsewhere. 6 infants (7 eyes) underwent IV carboplatin bridge until old enough to undergo OAC. Median age at first treatment was 16 months (range 3-252). Treatment-naïve patients were significantly younger than patients previously treated elsewhere (19.5 vs. 37.1 months, p=0.0005). Median number of OAC sessions/eye was 3 (range 1-9), with no difference between pretreated and naïve groups (p=0.34). 106/109 eyes received IA melphalan, but only 31 eyes received melphalan as the only agent. 41 eyes received carboplatin, and 76 eyes received topotecan (never as a single agent). 78/109 eyes received >1 drug over the course of treatment. 24 eyes (17 pretreated, 7 treatment-naïve, 0 bridge) failed treatment and required enucleation during the study period. Eyes that were treatment-naïve prior to us initiating OAC or bridge-OAC were much less likely to ultimately require enucleation (13% of treatment-naïve vs. 30% of pretreated eyes; OR for prior treatment=2.8; p=0.035). OAC-related adverse events included bronchospasm (44 patients), Grade 3/4 neutropenia (31 patients), periocular edema (16 eyes), forehead hyperemia (14 eyes) or madarosis (10 eyes). 3 patients developed metastases (all survived), and 1 child developed (and died from) a second non-ocular cancer. No patient developed a new intraocular tumor during treatment or follow-up.

 
Conclusions
 

In Group D eyes, primary OAC (or Carboplatin bridge to OAC in young infants) is able to achieve globe salvage in 87% of eyes. 70% of eyes that failed prior conventional therapy could be salvaged. OAC prevented the development of subsequent, new intraocular tumor foci. These results are notably better than published series using other methods.

 
Keywords: 703 retinoblastoma • 744 tumors  
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