Direct intra‐arterial (ophthalmic artery) chemotherapy with melphalan for advanced intraocular retinoblastoma: the Italian experience

Abstract

Abstract Purpose To report the preliminary results of the conservative treatment of advanced retinoblastoma (Stage Va e Vb) obtained with the melphalan protocol (direct intraarterial‐ophthalmic artery infusion ). Methods 33 children (35 eyes) with advanced retinoblastoma who were eligible for enucleation were entered in phase two of one center open study‐approved protocol of ophthalmic artery infusion of Melphalan to avoid enucleation (Italian Melphalan protocol, approved by the Ethic Commettee – University Hospital of Siena). Two cases have been treated bilaterally. 15 eyes were first diagnosis and 18 were relapses following chemo and/or radiotherapy. In two cases has not been possible to conclude the procedure due to haemodynamic problems. Results The ophthalmic artery was successfully cannulated in 35 eyes (total, 121 procedures). In 2 attempts was impossible to successfully conclude the procedure due to hemodynamic problems. Cannulation of the ophthalmic artery was performed by a femoral artery approach using microcatheters (magic 1.5) while the children were under general anesthesia and anticoagulated. Melphalan was infused into the artery over a 30‐minute period (dose of 3‐7 mg according to the age and size of the globe). Local and systemic toxicity have been evaluated and documented. Conclusion 33 children (35 eyes) with advanced retinoblastoma (Stage Va and Vb Reese classification) were eligible for the Melphalan Italian Protocol. The 78.7% of treated eyes is in complete remission. Superselective chemotherapy delivered through the ophthalmic artery can avoid enucleation, primary radiation or abuse of systemic chemotherapy.