Original articleSelective Ophthalmic Arterial Injection Therapy for Intraocular Retinoblastoma: The Long-Term Prognosis
Section snippets
Patients and Methods
All patients with retinoblastoma who received eye preservation treatment including SOAI at the National Cancer Center Hospital between 1988 and December 2007 were included in this study. Patients' medical charts were reviewed to assess their ocular prognosis, the adverse events associated with SOAI, and their systemic prognosis. The following information was collected: age at first visit, laterality, initial tumor stage (Reese-Ellsworth classification and International Classification for
Results
In this study, 343 patients underwent eye preservation treatment involving SOAI within this period. Of the 343 patients, 134 had unilateral disease, 209 had bilateral retinoblastoma, and 65 bilateral had both eyes treated with SOAI. As a result, 1469 SOAI procedures were performed on 408 eyes.
Selective ophthalmic arterial injection was successful in 1452 procedures of 1469 trials, and the success rate was 98.8% (we defined success as successfully injecting melphalan into the ophthalmic artery).
Concurrent Treatments
In total, 209 eyes (188 patients) were initially treated using external radiotherapy; 129 eyes (99 patients) were initially administered chemotherapy; 50 eyes (42 patients) were initially treated using SOAI; and 16 eyes (14 patients) were initially treated using laser, cryotherapy, or plaque radiotherapy. In the initial radiotherapy group, 8 eyes (8 patients) also received systemic chemotherapy to prevent enucleation, 15 patients received intensive chemotherapy after enucleation, and 3 patients
Adverse Events Associated with Selective Ophthalmic Arterial Injection
Severe ocular adverse events were rare; 2 eyes (0.5%) developed severe postoperative orbital inflammation, such as orbital cellulitis, after 13 rounds of SOAI, resulting in enucleation of the eyes. Another 2 eyes (0.5%), which had received 8 and 9 courses of SOAI, respectively, had diffuse chorioretinal and iris atrophy. Transient periocular swelling or redness occurred in some cases, but all of these complications had diminished within several hours. Postoperative localized retinal
Secondary Neoplasms
Secondary neoplasms are some of the most important long-term adverse events of intraocular retinoblastoma. Twelve secondary neoplasms occurred in 11 patients, all of whom had also received orbital external beam radiotherapy (Table 3). Two patients (cases 3 and 5) had unilateral retinoblastoma, and 9 patients had bilateral retinoblastoma. One patient (case 9) had preauricular rhabdomyosarcoma after 77 months of ocular treatment and orbital bone osteosarcoma as a tertiary neoplasm. Eight
Systemic Prognosis
Twelve patients died within this period. Three patients died of brain metastasis or direct invasion into the central nerve system, 5 patients died of multiple systemic metastases, 1 patient died of secondary AML, 1 patient died of a tertiary neoplasm (osteosarcoma), and 1 patient died of pinealoblastoma. One other patient died of AML recurrence, which had been diagnosed and treated before the diagnosis of retinoblastoma. The overall survival rate was 96.6% at 5 years, 96.1% at 10 years, and
Ocular Prognosis
The ocular prognoses of the patients according to the International Classification of Intraocular Retinoblastoma are presented in Figure 4. The eye preservation rate was 100% in group A (5 eyes), 88% in group B (130 eyes), 65% in group C (30 eyes), 45% in group D (216 eyes), and 30% in group E (18 eyes). The main reason for enucleation was residual retinal tumors (36%), anterior chamber invasion (17%), residual vitreous seeds (11%), vitreous hemorrhaging (18%), and glaucoma (6%).
The visual
Discussion
This study demonstrated that SOAI using a balloon catheter and melphalan achieved a high technical success rate (98.8%) and caused few severe adverse events, including secondary neoplasms. More than half of the treated eyes were preserved by treatment with SOAI, and more than half of the eyes retained a visual acuity >0.5 when the foveola was not affected by the tumor. In other words, SOAI with a balloon catheter is an established treatment procedure that does not cause severe eye damage or
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Manuscript no. 2010-1507.
Funding: This work was supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health, Labor, and Welfare, Tokyo, Japan. The funding organization had no role in the design or conduct of this research.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.