Efficacy of second-course ophthalmic artery chemosurgery for retinoblastoma

Abstract

Purpose: To evaluate the efficacy of second-course ophthalmic artery chemosurgery (OAC) following progression of disease after completing initially successful ophthalmic artery chemosurgery for retinoblastoma.

Methods: Single-arm, retrospective study of 31 eyes in 32 patients treated with second-course OAC at Memorial Sloan-Kettering Cancer Center between May 2006 and July 2013, with a median 34 months follow-up. The study included patients who underwent a successful course of IA chemotherapy, with a minimum of 2 months of progression-free follow-up at monthly examinations, but who subsequently required additional OAC for recurrent tumor. Outcome measurements included progression free survival and ocular survival. Kaplan Meier survival estimates were generated and the Mantel-Cox test was used to compare curves.

Results: Eyes requiring second-line OAC had initially received a mean of 3.1 OAC infusions. They developed progression of disease and necessity for second-course OAC at a mean of 8.7 mos following initial OAC. The 2-year Kaplan-Meier ocular survival and progression free survival estimates following second-course OAC were 80.2% (95% confidence interval [CI], 58.5-91.3%) and 47.0% (95% confidence interval [CI], 27.8-64.0%), respectively. Vitreous seeds were present in 17 (53%) of eyes requiring second-course OAC and were significantly associated with progression of disease following second-course OAC (p=0.01). Neither prior treatment status, age at initial OAC, addition of new drug, or increasing number of infusions during second-course OAC was significantly associated with progression free survival.

Conclusions: Retinoblastoma eyes requiring second-course OAC following initial OAC treatment have good salvage rates. However, these eyes often require additional (third or fourth-course) OAC or other treatment modalities due to progression of disease after second-line OAC, particularly if vitreous seeds are present at the time of initial OAC failure.

Keywords: 703 retinoblastoma • 744 tumors • 462 clinical (human) or epidemiologic studies: outcomes/complications