Chemotherapy For Retinoblastoma Research Articles

Intra-arterial chemotherapy for retinoblastoma: First Indian report.

Aim:To describe treatment outcomes and complications of selective intra-arterial chemotherapy (IAC) for retinoblastoma (RB) in Indian eyes.Materials and Methods:Single center, retrospective interventional case series of 6 eyes with RB who underwent IAC using Melphalan (3 mg/5 mg/7.5 mg) and topetecan (1 mg) (n = 4) or melphalan (3 mg/5 mg/7.5 mg) alone (n = 2) between December 2013 and June 2014. In all, 17 IAC procedures were performed using selective ophthalmic artery cannulation. Treatment outcomes were evaluated in terms of tumor control, vitreous and subretinal seeds control and globe salvage rates.Results:IAC was employed as primary (n = 1) or secondary (n = 5) modality of treatment. Each eye received mean 3 IAC sessions (median: 3; range: 1-4 sessions). Eyes were classified according to international classification of RB as Group B (n = 1), C (n = 1), D (n = 2) and E (n = 2). Following IAC, complete regression of the main tumor was seen in 3 cases (50%), partial regression in 2 (33%), while 1 case (15%) showed no response. Of 4 eyes with subretinal seeds, 1 (25%) eye had complete regression while 3 (75%) eyes had partial regression. Of 5 eyes with vitreous seeds, 2 (40%) eyes had complete regression while 3 (60%) eyes had a partial response. Globe salvage was achieved in 5 of 6 eyes (83%). Diffuse choroidal atrophy and vitreous hemorrhage were observed in 1 (17%) eye, each. No hematologic toxicity or cerebro-vascular events were observed. Mean follow-up period was 5.5 months (median: 6 months, range: 1-6 months).Conclusion:IAC is an effective therapy for globe preservation in eyes with RB. Larger studies with longer follow-up are required to validate these results.

Electrophysiological evaluation of retinal function after systemic and superselective intra-arterial chemotherapy for retinoblastoma

Since the prognosis for visual acuity after polychemotherapy or superselective intra-arterial chemotherapy (SIACT) is doubtful, studying retinal function in children with retinoblastoma by means of clinical electroretinography (ERG) is a relevant issue. The latter enables objective post-treatment assessment of retinal function and evaluation of possible infusion-related retinal toxicity. This review analyzes ERG findings in children with retinoblastoma treated with chemotherapy, including SIACT.

Exposure rate of smooth surface tunnel porous polyethylene implants after enucleation.

To determine the exposure rate after enucleation using the smooth surface tunnel (SST) and SST-EZ porous polyethylene (PP) orbital implants (Stryker Kalamazoo, MI, U.S.A.). The authors performed an institutional review board-approved retrospective review of 150 consecutively placed SST and SST-EZ PP implants after enucleation. Patient records were reviewed for comorbidities, surgical details, follow-up length, and presence of implant exposure. All prior published studies on porous orbital implant insertion were reviewed, and the exposure rate for patients undergoing enucleation with primary implant insertion was studied for comparison. Of the 150 implants, 30 were excluded due to follow up of less than 8 weeks. Of the remaining 120 implants, 4 (3.3%) became exposed during the follow-up period (mean, 2.1 years), 2 of which were in children who underwent chemotherapy for retinoblastoma. The authors calculated a 7.1% exposure rate for all porous implant materials placed primarily after enucleation from 58 previously published studies. The SST and SST-EZ PP implants are well tolerated when placed at the time of enucleation. The theoretical advantage of a smooth anterior surface may indeed lead to a lower rate of exposure compared with standard unwrapped porous materials as demonstrated by the relatively low exposure rate using this implant.

Enophthalmos and Choroidal Atrophy after Intraophthalmic Artery Chemotherapy for Retinoblastoma

Superselective intraophthalmic artery chemotherapy (SSIOAC) has come to the forefront in the treatment of retinoblastoma. We have presented the histopathologic and radiologic findings of a retinoblastoma patient who subsequently developed enophthalmos, choroidal ischemia, iris atrophy, and scleritis as delayed toxicities of SSIOAC.

Choroidal thickness after intraarterial chemotherapy for retinoblastoma.

To measure the choroidal thickness (CT) and analyze the morphologic features of chorioretinal structures using a portable handheld spectral domain-optical coherence tomography in patients with retinoblastoma after intraarterial chemotherapy. This was a case-control study. Eighteen eyes of 9 patients with unilateral retinoblastoma treated with intraarterial chemotherapy were assessed by spectral-domain optical coherence tomography. Submacular CT was measured at the foveola and at points located 500 μm and 2 mm from the foveola. The treated eye was compared with the untreated (control) eye. Mean submacular CT was 174 ± 111.1 μm in the treated eyes and 259 ± 42.2 μm in the control eyes (P = 0.054). Several point locations showed statistically significant differences comparing CT (treated eye vs. control eye), including subfoveolar (P = 0.030), nasal 0.5 mm (P = 0.037), nasal 2 mm (P = 0.049), and temporal 2 mm (P = 0.031). In 4 patients with ophthalmoscopically visible choroidal atrophy, submacular CT was reduced by 73.3 ± 14.1% compared with the control eye. In 5 patients with no ophthalmoscopically visible choroidal atrophy, submacular CT was reduced by 0.5 ± 11.9% compared with the control eye. Intraarterial chemotherapy for retinoblastoma can cause reduction in subfoveolar CT. Spectral-domain optical coherence tomography confirmed choroid to be thinned in eyes with or without clinical evidence of choroidal atrophy.

Targeted retinoblastoma management: when to use intravenous, intra-arterial, periocular, and intravitreal chemotherapy.

The management of retinoblastoma is complex and involves strategically chosen methods of enucleation, radiotherapy, chemotherapy, laser photocoagulation, thermotherapy, and cryotherapy. Chemotherapy has become the most common eye-sparing modality. There are four routes of delivery of chemotherapy for retinoblastoma, including intravenous, intra-arterial, periocular, and intravitreal techniques. The purpose of this review is to discuss the current rationale for each method and the anticipated outcomes. The diagnosis of retinoblastoma should be clinically established prior to embarking on a chemotherapy protocol. There are over 25 conditions that can closely simulate retinoblastoma in a young child. In addition, enucleation is an acceptable method for management, particularly with advanced retinoblastoma. Intravenous chemotherapy is generally used for germline mutation (bilateral, familial) retinoblastoma with excellent tumor control for groups A, B, and C and intermediate control for group D eyes. Intra-arterial chemotherapy is used as primary therapy in selected cases for nongermline mutation (unilateral) retinoblastoma with excellent control, and also used as secondary therapy for recurrent solid retinoblastoma, subretinal seeds, and vitreous seeds. Periocular chemotherapy is employed to boost local chemotherapy dose in advanced bilateral groups D and E eyes or for localized recurrences. Intravitreal chemotherapy is used for recurrent vitreous seeds from retinoblastoma. Patients at high risk for metastases should receive intravenous chemotherapy. Chemotherapy is effective for retinoblastoma and the targeted treatment route depends on the clinical features and anticipated outcomes.

Use of intra-arterial chemotherapy for retinoblastoma: results of a survey.

To obtain baseline knowledge about the current use of intra-arterial chemotherapy (SSOAIC) in centers worldwide. A survey including questions about the use of SSOAIC was emailed to retinoblastoma experts. Seventy-nine (response rate 69.9%) doctors from 63 centers in 35 countries responded. Thirty-one centers from 19 countries use SSOAIC. Twelve performed more than 50 procedures. Melphalan is the most commonly used drug but 15 centers use more than one drug. First line therapy for advanced unilateral disease is the most common use of SSOAIC (74.2%). Centers with larger experience (>50 applications) were less likely using melphalan alone (P=0.06) and significantly more likely using SSOAIC in more situations such as second line in preference to radiotherapy P=0.05. Nineteen (61.2%) stated that SSOAIC improved their results and 21 (77.8%) reported less toxicity compared to other treatments. Three centers reported that SSOAIC did not improve their results. There were regional variations in the use of SSOAIC which is used more frequently as secondary treatment in Europe compared to the USA and Japan. Ten centers identified cost is the major limiting factor for SSOAIC. SSOAIC is used in an increasing number of centers worldwide with regional variations. Centers with more experience in SSOAIC use it in more situations including other drugs than melphalan. The majority of the centers using this technique reported improved results and few complications.

Death by water: precautionary water submersion for intravitreal injection of retinoblastoma eyes.

There is growing interest in intravitreal injections of chemotherapy for retinoblastoma. However, concerns for potential tumor seeding through the needle track has prompted the use of risk-reducing precautionary methods. Presented here is a novel technique, which can be easily replicated, requires minimal sophisticated equipment and with laboratory data supporting its concept. Sterile distilled water submersion for 3 minutes renders retinoblastoma cells nonviable and can be employed as a precautionary method following intravitreal injection in the technique described here.

Intra-arterial Chemotherapy for Retinoblastoma in 70 Eyes: Outcomes Based on the International Classification of Retinoblastoma

To analyze our 5-year experience of intra-arterial chemotherapy (IAC) for retinoblastoma as primary or secondary therapy.Retrospective interventional case series.A total of 70 eyes of 67 patients.Ophthalmic artery chemotherapy infusion under fluoroscopic guidance was performed using melphalan (3, 5, or 7.5 mg) in every case, with additional topotecan (1 mg) and/or carboplatin (30 or 50 mg) as necessary.Tumor control and treatment complications.The mean patient age at IAC was 30 months. The treatment was primary in 36 eyes and secondary in 34 eyes. Those primary therapy eyes were classified according to the International Classification of Retinoblastoma (ICRB) as group A (n = 0), B (n = 1), C (n = 4), D (n = 17), or E (n = 14). The secondary therapy eyes had failed previous intravenous chemotherapy (n = 34) in every case. Each eye received a mean of 3 IAC sessions per eye (median, 3; range, 1-7 sessions). After IAC with a mean follow-up of 19 months, globe salvage was achieved in 72% of primary-treated cases and in 62% of secondary-treated cases. Specifically, primary therapy achieved globe salvage for group B (100%), group C (100%), group D (94%), and group E (36%). Of all 70 eyes, complete regression was achieved for solid tumor in 48 of 51 eyes (94%), subretinal seeds in 40 of 42 eyes (95%), and vitreous seeds in 34 of 39 eyes (87%). After each catheterization (n = 198), the main complications included transient eyelid edema (5%), blepharoptosis (5%), and forehead hyperemia (2%). More lasting complications included vitreous hemorrhage (2%), branch retinal artery obstruction (1%), ophthalmic artery spasm with reperfusion (2%), ophthalmic artery obstruction (2%), partial choroidal ischemia (2%), and optic neuropathy (<1%). Over the past 3 years, the combined incidence of ophthalmic, retinal, and choroidal vascular ischemia was reduced to 1%. There was no patient with stroke, seizure, neurologic impairment, limb ischemia, secondary leukemia, metastasis, or death.Five-year experience with IAC indicates that this technique is remarkably effective for the management of retinoblastoma as both a primary and a secondary treatment.

Safety and Efficacy of Intra-Arterial Chemotherapy in Retinoblastoma

Background: The most common ocular neoplasm in children is retinoblastoma which can spreads to the brain via the optic nerve in untreated patients. The most common treatment is enucleation, but modern eye-preserving therapies may save the globe. In advanced stages, globe-preserving strategies are often insufficient to prevent enucleation and direct infusion of chemotherapeutic agents into the ophthalmic artery may be required to control the tumor. Objectives: In this presentation, we aim to report our experience about the safety and efficacy of intra-ophthalmic artery melphalan (IAM) injection in the treatment of retinoblastoma. : Patients and Methods: Totally 46 patients were enrolled into the study. Mean age was 36.8 + 22.2 months (7100 months). Using digital subtraction angiography, under roadmap guidance a microcatheter was introduced into the ophthalmic artery, subsequently melphalan was injected over 3040 minutes. The response of the retinoblastoma tumor(s) and any associated local side effects of the treatment were observed. Results: Twenty-three patients were male (50%). Mean weight was 11.2 + 3.9 Kg (420) and mean height was 89.3 + 16.2 cm (65110). The disease was in the right eye in 19 patients (41.3%), left eye in 23 patients (50%) and bilateral in 3 patients (6.5%). The ophthalmic arteries were successfully cannulated except in one patient. There were not severe systemic side effects in our patients. Vasospasm happened in one patient. Canulization failed in one patient out of 29 (3.4%). Conclusions: Intra-arterial melphalan injection into the ophthalmic artery is an effective and safe therapeutic modality for retinoblastoma.

Reply to Dr Harris’ comments re “Autonomic cardio‐respiratory reflex reactions and superselective ophthalmic arterial chemotherapy for retinoblastoma” by Phillips, McGuirk, Chahal, et al.

Reply to Dr Harris’ comments re “Autonomic cardio‐respiratory reflex reactions and superselective ophthalmic arterial chemotherapy for retinoblastoma” by Phillips, McGuirk, Chahal, et al.

Letter to the Editor regarding ‘Autonomic cardio‐respiratory reflex reactions and superselective ophthalmic arterial chemotherapy for retinoblastoma’ by Phillips, McGuirk, Chahal, et al.

Letter to the Editor regarding ‘<scp>A</scp>utonomic cardio‐respiratory reflex reactions and superselective ophthalmic arterial chemotherapy for retinoblastoma’ by <scp>P</scp>hillips, <scp>M</scp>c<scp>G</scp>uirk, <scp>C</scp>hahal, <i>et al</i>.

Intra-arterial chemotherapy for retinoblastoma: a practical review

Abstract The use of chemotherapy for retinoblastoma constitutes a promising treatment strategy. Retinoblastoma is the most common eye cancer in the childhood.. Treatment depends on the laterality, intraocular location and tumor extension. Radiation therapy became an important element in the management of this type of injury risk of extraocular secondary tumor development. Eye salvage is mandatory when vision preserved. The current neuroendovascular techniques constitute a therapeutic tool for these tumors. We present a practical review of current concepts in the management of these tumors.

Clinical observation on superselective ophthalmic artery chemotherapy for retinoblastoma

Clinical observation on superselective ophthalmic artery chemotherapy for retinoblastoma

Intra-arterial Chemotherapy for Group C Retinoblastoma With Adjacent High-flow Infantile Hemangioma

Intra-arterial chemotherapy for retinoblastoma is an emerging technique that is being adopted at various centers worldwide. The authors report the first case of an infantile hemangioma that shunted flow during intra-arterial chemotherapy in a 4-month-old girl who presented with macular group C retinoblastoma. Excellent tumor response was noted despite only a fraction of the dose entering the central retinal artery. Further studies to examine intra-arterial chemotherapy's pharmacokinetics and dose-response relations are warranted in order to minimize the necessary exposure to chemotherapy.

Giardiasis in a patient undergoing chemotherapy for retinoblastoma and acute myelogenous leukemia

Giardiasis is a common cause of diarrhea in undeveloped countries, but is very rare in developed countries. A patient with acute myelogenous leukemia and retinoblastoma presented with a high fever and severe watery diarrhea during induction chemotherapy. On microscopy, cysts were seen in her stool, suggesting Giardia intestinalis, which was confirmed on polymerase chain reaction (PCR). G. intestinalis was also detected in the patient's asymptomatic parents, who may have transmitted it to the patient. Giardiasis should be tested for in patients with severe and persistent diarrhea during chemotherapy, when other etiologies have been excluded. PCR used to amplify the DNA of G. intestinalis is rapid and sensitive.

Blue Toe Syndrome as a Complication of Intra-arterial Chemotherapy for Retinoblastoma

Blue Toe Syndrome as a Complication of Intra-arterial Chemotherapy for Retinoblastoma

An unusual superolateral origin of ophthalmic artery: an anatomic case report

If ophthalmic artery's (OphA) origin anomalies are frequent, the superolateral origin of the OphA was rarely described. During an aneurysmal surgery, a superolateral origin of the left OphA was found. This variation was associated with a sylvian aneurysm. The anatomical, embryological features, the neurosurgical implications of this origin such as treatment of carotid-ophthalmic aneurysm or intra arterial retinoblastoma chemotherapy are discussed. To the best of our knowledge, this is a very rare operative case of both superolateral origin and initial course of OphA.

Autonomic cardio‐respiratory reflex reactions and superselective ophthalmic arterial chemotherapy for retinoblastoma

To describe our experience with superselective ophthalmic artery chemotherapy (SOAC) in retinoblastoma and to report the serious adverse cardio-respiratory reactions we have observed. SOAC was performed using a standardized protocol for general anesthesia, ophthalmic artery catheterization, and pulsed infusion of melphalan. Adverse reactions were defined as those in which the patient required active treatment to maintain cardio-respiratory stability. Between December 2008 and May 2012, 54 eyes in 52 patients were treated. 143 catheterization procedures were performed, with a technical success rate of 93% (n = 133). There were no deaths or major complications. Adverse cardio-respiratory reactions developed during 35 procedures (24%; 95% CI, 18-32%). All reactions occurred during second or subsequent catheterization procedures (39%; 95% CI, .29-49%) and were characterized by hypoxia, reduced lung compliance, systemic hypotension and bradycardia. Adverse events were successfully treated in all patients. One procedure was abandoned due to prolonged hemodynamic instability. Adverse cardio-respiratory reactions are commonly observed in SOAC for retinoblastoma. We believe that the adverse clinical signs represent an autonomic reflex response, akin to the trigemino-cardiac or oculo-respiratory reflexes, and all patients should be considered at-risk. Reactions occur only during second or subsequent procedures and can be life-threatening. The routine use of intravenous atropine does not seem to have altered the incidence or severity of these reactions. Anesthetists and interventional neuroradiologists involved in SOAC must be vigilant to ensure adverse reactions, when they develop, are treated quickly and effectively.

Pilomatrixoma in a patient with bilateral retinoblastoma

A 3-year-old girl with a history of bilateral retinoblastoma presented with a new right lower periorbital mass that showed calcifications on ultrasound. She had previously undergone systemic and intra-arterial chemotherapy for retinoblastoma but had no evidence of active disease for at least 6 months previously. Her family and oncologists feared that this mass was an extraocular metastasis of her retinoblastoma. On excision, it was diagnosed as a pilomatrixoma, an uncommon benign neoplasm that originates from the matrix of the hair root. This is the first reported case of pilomatrixoma ina patient with retinoblastoma.