WASHINGTON — Direct intra-arterial chemotherapy in children with advanced retinoblastoma preserved the eyes in 14 children and vision in 9 eyes, according to research presented at the annual meeting of the Society for Interventional Radiology.
Without the treatment, all affected eyes would have been destined for enucleation, said Dr. Pierre Gobin, professor of radiology and neurosurgery and director of the Division of Interventional Neuroradiology at New York-Presbyterian Hospital and Cornell University, New York.
A total of 22 children aged 1 month to 10 years (median age 2 years) with advanced retinoblastoma in a total of 23 eyes underwent catheterization of the ophthalmic artery via a femoral artery approach. The children were anesthetized and anticoagulated during the procedure. The chemotherapy agent melphalan was used initially in doses of 3.0–7.5 mg, but later switched to 3.5 mg and infused in combination with topotecan over a 30-minute period. The dose was a function of the eye size, not body surface area, Dr. Gobin noted.
Eleven children had bilateral retinoblastoma, with previous enucleation of the contralateral eye in 5. Eleven had previously received intravenous chemotherapy, and 8 had undergone external beam radiotherapy. Eleven patients were treatment naive. All but one had Reese-Ellsworth stage V; the remaining patient had a stage IB tumor on the macula.
Of the 20 who completed treatment (2 are still being treated), catheterization of the ophthalmic artery was possible in 18. Eleven patients underwent three treatments, 3 had two treatments, and the rest had more treatments (up to six). There were no procedure-related complications in the total of 64 procedures. There were no hospital admissions, infections, transfusions, or other complications commonly seen with intravenous chemotherapy.
Transient skin discoloration occurred in two patients. Retinopathy occurred in four patients, for whom it was determined the dose was too high and therefore was lowered in subsequent patients. An inflammatory reaction during the procedure predicted the development of retinopathy, Dr. Gobin noted.
The tumors were cured in 16 of 18 patients, with 14 able to keep the eye in place and 9 with restored vision. Treatment failed in two cases, including one in which there was tumor growth.
Dr. Gobin disclosed that he had no conflicts of interest.