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Anthony Manassero, Marie-Claire Gaillard, christina stathopoulos, sue houghton, francesco puccinelli, maja Beck-Popovic, Francis L Munier; Combined Melphalan/Topotecan intra-arterial chemotherapy (MT-IAC) for salvage in retinoblastoma relapse following melphalan intra-arterial chemotherapy (M-IAC). Invest. Ophthalmol. Vis. Sci. 2016;57(12):3684.
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© ARVO (1962-2015); The Authors (2016-present)
M-IAC is widely used as first line therapy for retinoblastoma (Rb), achieving eye preservation in an unparalleled proportion of cases. However, for eyes failing initial IAC and not accessible to focal treatments, external beam radiotherapy (EBR) or enucleation are often the only remaining options. The purpose of this study is to evaluate the efficacy and visual outcome of CMT-IAC for relapse after M-IAC alone.
A retrospective study was carried out of patients who received salvage CMT-IAC for Rb after failure of M-IAC alone. Inclusion was restricted to relapsed eyes having exhausted all available focal treatments: hyperthermia, cryotherapy, plaque and intravitreal chemotherapy (IVC). Globe salvage and best-corrected visual acuity were assessed, and any toxicity.
Between January 2014 and June 2015, 13 eyes received salvage MT-IAC (mean dose Melphalan 4.4mg; range 3.3-5mg; Topotecan 2 mg) at a mean 5.8 months (range 0.9-20.8) after the last injection of M-IAC alone. Follow-up after the first salvage MT-IAC to November 2015 was mean 13.4 months (range 5.2-20.6). 15% (2/13) were group B Rb and 85% (11/13) group D. Mean age at diagnosis was 20.3 months (range 2.5-47.4). All eyes had received M-IAC (mean number of injections 2.3; range 1-3), and 10 intravenous chemotherapy (mean courses 3; range 1-6). In addition, focal treatments and brachytherapy were given in 12 and 1 case respectively. Six cases received IVC concomitant with or after salvage MT-IAC and 7 had additional focal consolidation treatments. All patients are alive without metastasis and none have undergone EBR or secondary enucleation. 85% of eyes (11/13) achieved complete tumor control with a mean number of 2.5 injections (range 1-3). Mean measurable visual acuity in 7 eyes was 0.3 (range 0.05-0.8), 2 eyes had light perception only and 4 were too young to assess reliably. Concerning toxicity, 4 presented transient palpebral edema and/or erythema, 2 transient ptosis. Occlusive choroidopathy was observed in one case after the final salvage melphalan/topotecan injection. There were no cardio-respiratory disturbances.
MT-IAC appears to be highly efficient in rescuing retinoblastoma relapse following M-IAC. However, this treatment modality is indicated only in relapsed eyes inaccessible to focal treatments alone.
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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