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Abstract #69200 Published in IGR 18-1
Secondary and tertiary intra-arterial chemotherapy for massive persistent or recurrent subretinal retinoblastoma seeds following previous chemotherapy exposure: long-term tumor control and globe salvage in 30 eyes
Say EA; Iyer PG; Hasanreisoglu M; Lally SE; Jabbour P; Shields JA; Shields CLJournal of AAPOS 2016; 20: 337-342
PURPOSE: To describe the results of intra-arterial chemotherapy (IAC) for control of persistent or recurrent subretinal seeds (SRS) following previous chemotherapy for retinoblastoma. METHODS: We reviewed the medical records of patients with massive persistent or recurrent SRS after intravenous and/or intra-arterial chemotherapy and subsequently treated with superselective ophthalmic artery infusion of melphalan (3, 5, or 7.5 mg) and/or additional topotecan (1 mg) and/or carboplatin (20 or 30 mg) as necessary from January 2009 to March 2014. The main outcome measures were SRS control and globe salvage. RESULTS: A total of 30 eyes of 29 patients were included. Mean patient age was 19 months (median, 14 months; range, 2-58 months). Previous treatments included intravenous chemotherapy (n = 28) and intra-arterial chemotherapy (n = 5). The SRS occupied a median of 6 clock hours. Retinal detachment was present in 5 eyes (17%). Each eye received a mean of 3 IAC sessions (median, 2; range, 1-7) on a monthly basis. After a mean follow-up of 24 months (median, 18; range, 1-71 months), 27 of eyes (90%) demonstrated complete SRS regression. Overall, globe salvage was achieved in 15 eyes (50%). Fifteen eyes were enucleated because of recurrent SRS (4 eyes), recurrent SRS and vitreous seeds (3 eyes), recurrent solid tumor (1 eye), and neovascular glaucoma from total retinal detachment and/or vitreous hemorrhage (7 eyes), none of which had active tumor. CONCLUSIONS: IAC can be an effective second- or third-line therapy in the management of massive persistent or recurrent SRS from retinoblastoma following previous chemotherapy. All eyes in this study were all facing enucleation; lasting seed control was achieved in 70%.
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Full articleClassification:
9.4.8 Glaucomas associated with intraocular tumors (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
9.4.5.1 Neovascular glaucoma (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.5 Glaucomas associated with disorders of the retina, choroid and vitreous)