Journal Article

Intravitreal chemotherapy in retinoblastoma: expanded use beyond intravitreal seeds

Francis, Jasmine H, Ji, Xunda, Habib, Larissa, Catalanotti, Federica, Abramson, David H, Brodie, Scott E

2019

Overview

Ophthalmic artery chemosurgery (OAC) has changed the face of retinoblastoma treatment and led to a higher rate of globe salvage. The introduction of intravitreal chemotherapy (IVitC) has further enhanced globe salvage with increased success in treatment of intravitreal seeds. Our group has seen success at treating non-vitreous disease that is refractory to OAC using IVitC. This study was undertaken to quantify and report on this success. A retrospective review was used to identify patients treated with IVitC for indications other than vitreous seeds from two centres. The indication, prior and concurrent treatment, response time and duration of treatment were documented. Kaplan-Meier estimates were used to evaluate ocular and recurrence-free survival. Ocular toxicity was evaluated using the 30 Hz flicker electroretinogram (ERG). Continuous and categorical variables were compared with Student's t-test and χ test, respectively. Fifty-six eyes from 52 retinoblastoma patients were identified. There were no disease-related or treatment-related deaths. One patient developed a second primary malignancy (pinealoblastoma) and subsequent leptomeningeal spread. Ninety-eight per cent of the eyes showed clinical regression. Recurrence was seen in 14.3%. Of the recurrences, five occurred in retinal tumours and three in subretinal seeds. The Kaplan-Meier estimated risk of recurrence in all patients treated was 83.5% (95% CI 7.9 to 14.1) at 10 months. The mean change in ERG over treatment course was -17.7 μV. Intravitreal chemotherapy is successful for the treatment of subretinal seeds and recurrent retinal tumours and could be considered as adjunctive therapy in globe-sparing treatment of retinoblastoma.

• Publisher: BMJ Publishing Group LTD
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Antineoplastic Agents, Alkylating - administration & dosage / Cancer / Chemotherapy / Child / Childrens health / Classification / Cryotherapy / Drug Implants / Electroretinography / Eye diseases / Female / Follow-Up Studies / Humans / Incidence / Intravitreal Injections / Male / Medical prognosis / Melphalan - administration & dosage / Middle Aged / Neoplasm Recurrence, Local - epidemiology / Ophthalmology / Ophthalmoscopy / Pediatrics / Retina / Retinal Neoplasms - diagnosis / Retinal Neoplasms - drug therapy / Retinoblastoma / Retinoblastoma - diagnosis / Retinoblastoma - drug therapy / Retrospective Studies / Slit Lamp Microscopy / Treatment Outcome / Tumors / United States - epidemiology / Veins & arteries / Young Adult