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Intra-arterial chemotherapy is more effective than sequential periocular and intravenous chemotherapy as salvage treatment for relapsed retinoblastoma.

AbstractBACKGROUND:
Treatment of eyes with retinoblastoma failing systemic chemoreduction and external beam radiotherapy is seldom efficacious. This study compares the efficacy and toxicity of intra-arterial ophthalmic artery chemotherapy (IAO) to our historical cohort of sequential periocular and systemic chemotherapy in such patients.
PATIENTS AND METHODS:
Eighteen eyes (15 consecutive patients) were retrospectively evaluated. Eight eyes received IAO for a median of four cycles (range: 2-9) including melphalan alone (n = 3) or after topotecan and carboplatin (n = 4) or topotecan and carboplatin without melphalan (n = 1). Ten eyes received a median of two cycles (range: 1-3) of periocular topotecan (n = 9) or carboplatin (n = 1) followed by intravenous topotecan and cyclophosphamide in three patients if at least stable disease was achieved. Both groups were comparable for disease extension and prior therapy.
RESULTS:
No extraocular dissemination or second malignancy occurred and all patients are alive. The probability of enucleation-free eye survival at 12 months was 0.87 (95% CI: 0.42-0.97) for the IAO group, compared to 0.1 (95% CI: 0.06-0.35) for the periocular group (P < 0.01). Ocular toxicity was mild and similar in both groups (mostly mild orbital edema). Systemic toxicity was low for IAO and periocular injection, but children who received sequentially intravenous chemotherapy (n = 12 cycles) had five episodes of grade 4 neutropenia, three of which resulted in hospitalizations. No case in the IAO group presented these complications.
CONCLUSIONS:
IAO is significantly superior to sequential periocular-intravenous topotecan-containing regimens in eyes with relapsed intraocular retinoblastoma with a more favorable toxicity profile.
AuthorsPaula Schaiquevich, Alejandro Ceciliano, Natalia Millan, Paula Taich, Francisco Villasante, Adriana C Fandino, Julieta Dominguez, Guillermo L Chantada
JournalPediatric blood & cancer (Pediatr Blood Cancer) Vol. 60 Issue 5 Pg. 766-70 (May 2013) ISSN: 1545-5017 [Electronic] United States
PMID23024125 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2012 Wiley Periodicals, Inc.
Chemical References
  • Vincristine
  • Etoposide
  • Topotecan
  • Melphalan
Topics
  • Administration, Intravenous
  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
  • Etoposide (administration & dosage, therapeutic use)
  • Female
  • Humans
  • Injections, Intra-Arterial
  • Injections, Intraocular
  • Male
  • Melphalan (administration & dosage, adverse effects, therapeutic use)
  • Middle Aged
  • Neoplasm Recurrence, Local (drug therapy)
  • Ophthalmic Artery
  • Retinal Neoplasms (drug therapy, pathology)
  • Retinoblastoma (drug therapy, pathology)
  • Retrospective Studies
  • Salvage Therapy
  • Topotecan (administration & dosage, adverse effects, therapeutic use)
  • Treatment Outcome
  • Vincristine (administration & dosage, therapeutic use)
  • Young Adult

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