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C. Hung, Y. P. Gobin, B. P. Marr, I. J. Dunkel, S. E. Brodie, D. H. Abramson; Salvage Chemosurgery for Resistant or Recurrent Retinoblastoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2071.
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Super selective intra-ophthalmic arterial chemotherapy (chemosurgery, or IOAC) is a novel technique by which high-dose chemotherapy can be delivered to the eye for treatment of retinoblastoma. In many cases, the disease has resisted or recurred after other treatment modalities such as systemic chemotherapy, periocular chemotherapy, external beam radiation (EBR), brachytherapy, focal laser, and/or cryotherapy. Here, we investigate the impact of IOAC on the survival of this subset of eyes.
Charts of patients who received IOAC between 5/30/2006 and 10/4/2009 were reviewed and those who had received treatment prior to IOAC were included in the study. Follow-up time was measured by the time of the first chemosurgery to two endpoints: enucleation or the study end-date. A Kaplan-Meier analysis of time to recurrence and time to enucleation after the first IOAC treatment was performed.
Between 5/30/2006 and 10/4/2009, 71 eyes underwent IOAC at this institution, of which 41 eyes had received prior treatment. The mean and median follow-up time was 12 months, ranging from 1 month to 40 months. Prior to IOAC, 35 eyes had received systemic chemotherapy, 5 eyes received periocular chemotherapy, 13 eyes received EBR, 4 eyes had received brachytherapy, 24 eyes had received focal laser, and 13 eyes had received cryotherapy. There was a total of 10 recurrences and 8 enucleations. Of the 8 enucleations, 3 had no viable tumor cells on pathology. Enucleated eyes were kept an average of 4.9 months. The likelihood of being disease-free at 40 months was 65%; the likelihood of keeping the eye at 40 months was 75% (Figure 1a,b).
Eyes that have failed other treatments prior to undergoing intra-ophthalmic arterial chemosurgery often have no other alternative besides enucleation for a cure. Chemosurgery is not only able to prolong the amount of time a patient can keep the eye, but also able to prevent disease recurrence in a significant number of eyes.
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