Abstract | OBJECTIVE: Report on the 7-year experience with bilateral ophthalmic artery chemosurgery (OAC-Tandem therapy) for bilateral retinoblastoma. DESIGN: Retrospective, single institution study. SUBJECTS: 120 eyes of 60 children with bilateral retinoblastoma treated since March 2008. METHODS: Retrospective review of all children treated at Memorial Sloan Kettering with bilateral ophthalmic artery chemosurgery ( Melphalan, Carboplatin, Topotecan, Methotrexate) delivered in the same initial session to both naïve and previously treated eyes. MAIN OUTCOME MEASURES: Ocular survival, metastatic disease, patient survival from metastases, second cancers, systemic adverse effects, need for transfusion of blood products, electroretinogram before and after treatment. RESULTS: 116 eyes were salvaged (4 eyes were enucleated: 3 because of progressive disease, 1 family choice). Kaplan Meier ocular survival was 99.2% at one year, 96.9% at 2 and 3 years and 94.9% for years 4 through 7. There were no cases of metastatic disease or metastatic deaths with a mean follow-up of 3.01 years. Two children developed second cancers (both pineoblastoma) and one of them died. Transfusion of blood products was required in 3 cases (4 transfusions), 1.9%. Two children developed fever/ neutropenia requiring hospitalization (0.95%). ERGs were improved in 21.6% and unchanged after treatment in 52.5% of cases (increase or decrease of less than 25μV). CONCLUSIONS: Bilateral ophthalmic artery chemosurgery is a safe and effective technique for managing bilateral retinoblastoma-even when eyes are advanced bilaterally, and if both eyes have progressed after systemic chemotherapy. Ocular survival was excellent (94.9% at 8 years), there were no cases of of metastatic disease and no deaths from metastatic disease, but children remain at risk for second cancers. In 21.6% of cases ERG function improved. Despite using chemotherapy in both eyes in the same session, systemic toxicity was low.
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Authors | David H Abramson, Brian P Marr, Jasmine H Francis, Ira J Dunkel, Armida W M Fabius, Scott E Brodie, Ijah Mondesire-Crump, Y Pierre Gobin |
Journal | PloS one
(PLoS One)
Vol. 11
Issue 6
Pg. e0156806
( 2016)
ISSN: 1932-6203 [Electronic] United States |
PMID | 27258771
(Publication Type: Journal Article)
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Chemical References |
- Topotecan
- Carboplatin
- Melphalan
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Topics |
- Carboplatin
(therapeutic use)
- Child
- Child, Preschool
- Electroretinography
- Female
- Humans
- Kaplan-Meier Estimate
- Male
- Melphalan
(therapeutic use)
- Ophthalmic Artery
(drug effects, surgery)
- Retinal Neoplasms
(drug therapy, mortality, surgery)
- Retinoblastoma
(drug therapy, mortality, surgery)
- Retrospective Studies
- Topotecan
(therapeutic use)
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