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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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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.
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.
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.
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.
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