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Intra-arterial chemotherapy for retinoblastoma in eyes with vitreous and/or subretinal seeding: 2-year results
  1. David H Abramson1,
  2. Brian P Marr1,
  3. Ira J Dunkel2,
  4. Scott Brodie3,
  5. Emily C Zabor4,
  6. Sarah J Driscoll1,
  7. Y Pierre Gobin5
  1. 1Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
  2. 2Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
  3. 3Department of Ophthalmology, Mt Sinai School of Medicine, New York, New York, USA
  4. 4Department of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
  5. 5Division of Interventional Neuroradiology, Department of Radiology, Neurosurgery and Neurology, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr David H Abramson, 70 East 66th Street, New York, NY 10021, USA; abramsod{at}mskcc.org

Abstract

Background/aims To review the effectiveness of intra-arterial chemotherapy for advanced intra-ocular retinoblastoma with vitreous and/or subretinal seeds in naive (untreated) and previously treated eyes.

Methods Retrospective study, approved by the institutional review board, of 76 eyes of 67 patients with retinoblastoma with subretinal and/or vitreous seeding treated with intra-arterial chemotherapy at Memorial Sloan-Kettering Cancer Center between May 2006 and August 2010.

Results Despite advanced intraocular disease with seeding, the majority (56/76) of eyes were saved; 20/76 eyes were enucleated. Among treatment-naive eyes, the 2-year probability of ocular salvage was 83% (95% CI 27% to 97%) for eyes with subretinal seeding only, 64% (95% CI 24% to 87%) for eyes with vitreous seeding only, and 80% (95% CI 40% to 95%) for eyes with both. Among eyes that received previous treatment and had progressed, the 2-year probability of ocular salvage was 50% (95% CI 15% to 78%) for eyes with only subretinal seeding, 76% (95% CI 48% to 91%) for eyes with vitreous seeding only, and 54% (95% CI 20% to 79%) for eyes with both. Nine of 29 naive eyes (31%) were cured with intra-arterial (super-selective ophthalmic artery infusion of chemotherapy) chemotherapy alone.

Conclusion Unlike radiation or systemic chemotherapy, intra-arterial chemotherapy can usually prevent the need for enucleation in naive eyes with advanced intraocular retinoblastoma with seeding—especially if the seeding is subretinal. Treatment appears to be less effective in previously treated eyes when subretinal seeding is present (50% at 2 years), but may be more effective in eyes that failed to respond to previous systemic chemotherapy and have only vitreous seeding.

  • Retinoblastoma
  • intra-arterial chemotherapy
  • vitreous seeds
  • subretinal seeds
  • neoplasia
  • iris
  • treatment other
  • conjunctiva
  • ciliary body
  • treatment lasers
  • electrophysiology
  • telemedicine
  • psychophysics
  • optics and refraction
  • treatment medical

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Footnotes

  • Funding This work was supported in part by grants from the Fund for Ophthalmic Knowledge, Inc (New York) and the Alcon Research Institute (Houston, Texas).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by IRB Memorial Sloan-Kettering Cancer Center, New York.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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