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Renelle Pointdujour Lim, Emil A Say, Christopher Cao, Carol L Shields; Rescue Intra-Arterial Chemotherapy Following Retinoblastoma Recurrence After Initial Intra-Arterial Chemotherapy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6058.
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To determine the efficacy of rescue intra-arterial chemotherapy (IAC) for tumor recurrence after previous IAC for retinoblastoma.
Retrospective interventional case series of 12 patients treated with repeat (rescue) IAC for tumor, subretinal seed or vitreous seed control after previous IAC for retinoblastoma.
Median age at presentation was 16 months and 8 were female. The initial International Classification of Retinoblastoma was group B (n=1), group D (n=7), and group E (n=4). In all cases, initial IAC was delivered at Thomas Jefferson University Hospital or elsewhere using M3 (n=3) or M5 (n= 7), M5+T1 (n=2) median 3 cycles (range 1-4). Of the 12 patients, 17% (n=2) had the opposite eye previously enucleated so the rescue IAC was planned for the only remaining eye. Rescue IAC was delivered for recurrent solid tumor (n=1) recurrent extensive subretinal seeds (n=7), recurrent extensive vitreous seeds (n=1), or for combination recurrent subretinal and vitreous seeds (n=3). The median interval between final cycle of initial IAC to first cycle of rescue IAC was 4 months (range 2-10 months). IAC was successful through the ophthalmic artery (10/12, 83%) or through the middle meningeal artery (2/12, 17%) when ophthalmic artery obstruction was present from initial IAC elsewhere. Each case received median 3 IAC cycles of Melphalan alone (4/12, 33%) or combination Melphalan and Topotecan (8/12, 67%). At median follow-up of 7 months (range 3-31 months), complete tumor control was achieved in 10 eyes (83%) and globe salvage in 9 eyes (75%). Three eyes underwent enucleation for persistent subretinal seeds (n=2) or neovascular glaucoma without viable tumor on histopathology (n=1). There was no case of cerebrovascular stroke, systemic metastasis, or death.
Rescue IAC following tumor recurrence after initial IAC provided 83% tumor control and 75% globe salvage in this series.
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