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Francis L Munier, Marie-Claire Gaillard, Christina Stathopoulos, Maja Beck-Popovic, Francesco Puccinelli, Susan L Houghton; Concomitant first line intra-arterial (IAC) and intra-vitreal (IVC) chemotherapy with melphalan for unilateral group D retinoblastoma (Rb) with diffuse vitreous seeding at presentation. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3682.
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© ARVO (1962-2015); The Authors (2016-present)
IAC with melphalan is widely used as first line or salvage therapy for Rb with unprecedented rates of eye survival. However, the presence of vitreous seeding has remained the first cause of failure prior to the advent of IVC. In this study we explored the efficacy and toxicity of concomitant use of IAC and IVC with melphalan (IAV-IVC).
A retrospective study was carried out in patients who received concomitant first line IAC-IVC for Rb with diffuse vitreous seeding at presentation. Globe salvage and best-corrected visual acuity were assessed, together with any toxicity.
Between April 2010 and July 2015, 9 unilateral group D eyes with mean age at diagnosis of 37 months (range 17.5-58.9) received first line concomitant IAC (mean number: 2.55, range 1-3; mean injected dose 4.7mg) and IVC: mean number 5.6, range 3-8; mean intravitreal dose: 28.7µg (range 20-38µg). The mean interval between first IAC and first IVC was 7 days (range 3-12). In 2 eyes, diffuse sub-retinal seeding was also present. Mean follow-up after the first injection to November 2015 was 29.1 months (range 3.7-64.8). Mean time to success following the first injection was achieved after 4.3 months (range 1.0-8.9) for retinal tumors and 6.9 months (range 1.6-15.0) for vitreous seeding. No further treatment was required in 4 cases, while the other 5 received additional focal therapies. Concerning toxicity, 1 case of occlusive choroidopathy was noted after the last of 3 IAC and melphalan-related pigment retinopathy (grades 1 to 3) was observed in 5 cases. Transient bronchospasm occurred during the 3rd IAC in 1 patient and there was 1 case of non-febrile neutropenia. All patients are alive without metastasis and none have undergone external beam radiotherapy or secondary enucleation. Mean measurable visual acuity in 6 eyes was 0.54 (range 0.1 – 1.0), 2 eyes had light perception only and 1 was too young to assess reliably.
Administration of less than 3 concomitant IAC-IVC appears to be highly efficient and fast in controlling the retinal and vitreous disease as well as in preventing vitreous relapse in unilateral group D eyes. In addition this regimen seems to be associated with a limited toxicity and compatible with useful vision, provided that aggressive amblyopia treatment is carried out.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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