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Scott E. Brodie, Amanda Kiely, Yasha Modi, Brian Marr, Ira J. Dunkel, Y Pierre Gobin, David H. Abramson; Safety Profiles For Intra-arterial Dosage Of Melphalan And Topotecan Treatment Of Retinoblastoma: ERG Results At Four Years. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6078.
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To estimate the maximal doses of melphalan and topotecan which do not adversely affect ERG responses after intra-arterial treatment of retinoblastoma.
Photopic ERG recordings of retinal responses were obtained according to ISCEV standards during examination under anesthesia at baseline and following intra-arterial chemotherapy treatments. Experience after four years was reviewed by comparing net change in 30-Hz flicker ERG amplitude against maximal dose of melphalan and topotecan. Data for analysis were available for 81 eyes.
Regression of ERG change against maximal topotecan or melphalan dosage showed significant loss of ERG amplitude only when the highest doses of drug were included in the analysis, even after controlling for initial ERG amplitudes at baseline. Upper limits of safety for maximal dose were 5.0 mg for melphalan and 0.4 mg for topotecan (p < 0.05 for both). Multiple regression against the maximal dose of both drugs simultaneously suggested that, in our hands, topotecan toxicity was potentially greater than melphalan toxicity.
Intra-arterial chemotherapy for retinoblastoma does not adversely affect retinal function for as long as 4 years, as monitored by photopic ERG at maximal doses up to 5.0mg for melphalan and 0.4 mg for topotecan. Higher doses, as may be indicated for tumor control, carry a greater risk of loss of retinal function.
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