Elsevier

Ophthalmology

Volume 118, Issue 10, October 2011, Pages 2081-2087
Ophthalmology

Original article
Selective Ophthalmic Arterial Injection Therapy for Intraocular Retinoblastoma: The Long-Term Prognosis

Presented at: The XVth International Society of Ocular Oncology Congress, September 8–12, 2009, Cambridge, United Kingdom.
https://doi.org/10.1016/j.ophtha.2011.03.013Get rights and content

Purpose

To report the success rate, adverse events, and long-term prognosis of selective ophthalmic arterial injection (SOAI) therapy for intraocular retinoblastoma.

Design

Noncomparative case series.

Participants

A total of 408 eyes of 343 patients.

Methods

Retrospective chart review of patients with intraocular retinoblastoma treated with SOAI using a balloon catheter and melphalan between 1988 and 2007.

Main Outcome Measures

The technical success rate of SOAI (we defined success as the successful injection of melphalan into the ophthalmic artery), ocular adverse events, systemic adverse events, secondary neoplasms, eye survival, and visual acuity.

Results

Selective ophthalmic arterial injection was successful in 1452 procedures of 1469 trials, and the success rate was 98.8%. Each eye received 1 to 18 rounds of SOAI. Two eyes (0.5%) developed severe orbital inflammation, and 2 eyes (0.5%) had diffuse chorioretinal atrophy. Transient periocular swelling or redness occurred in some cases. No severe systemic adverse events were detected. Transient bronchospasm occurred in 1 patient (0.3%), and transient vomiting occurred in several patients. Twelve secondary neoplasms occurred in 11 patients, and the cumulative incidence was 1.3% at 5 years, 4.8% at 10 years, and 5.8% at 15 years. The eye preservation rate was 100% in group A, 88% in group B, 65% in group C, 45% in group D, and 30% in group E according to the International Classification of Intraocular Retinoblastoma. Fifty-one percent of eyes had a visual acuity >0.5, and 36% of eyes had a visual acuity >1.0 at the last follow-up examination in cases without macular tumors.

Conclusions

Selective ophthalmic arterial injection using a balloon catheter and melphalan achieved a success rate of 98.8% and was associated with few severe adverse events, including secondary neoplasms. More than half of the treated eyes were preserved, and more than half of the eyes without macular tumors maintained a visual acuity >0.5. Selective ophthalmic arterial injection is an established treatment method. We did not detect severe eye damage or severe systemic events; secondary neoplasms were seen but no more frequently than would otherwise have been expected.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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

References (19)

There are more references available in the full text version of this article.

Cited by (186)

  • Diagnosis of ophthalmic retinoblastoma tumors using 2.75D CNN segmentation technique

    2023, Computational Methods and Deep Learning for Ophthalmology
  • A case of retinoblastoma resulting in phthisis bulbi after proton beam radiation therapy

    2022, American Journal of Ophthalmology Case Reports
    Citation Excerpt :

    After six cycles of the regimen, additional focal treatments were administered. Local therapy included five consecutive intra-arterial melphalan injections (2 mg and 5 mg/m2/body surface area)9 with transpupillary thermotherapy for both eyes, two intravitreal melphalan injections (16 μg in 0.05 mL solution)10 for the right eye, and cutting-cryotherapy for the juxtapapillary tumor in the left eye. The tumors regressed first, but the right eye showed recurrence with diffuse subretinal and vitreous seeding, and the tumor near the optic disk persisted in the left eye.

  • Intra-arterial Chemotherapy for Retinoblastoma: An Update

    2022, Advances in Ophthalmology and Optometry
  • Global retinoblastoma survival and globe preservation: a systematic review and meta-analysis of associations with socioeconomic and health-care factors

    2022, The Lancet Global Health
    Citation Excerpt :

    They were included for qualitative review but not for meta-analysis because separate reporting for individual countries was not available. For the remaining 311 articles, 56 spanned at least 20 years and had no subperiods, with a median duration of 27 years (IQR 22–32).14–69 These articles were included for analysing the associations of socioeconomic and health-care factors but not for time-trend analysis (overall survival and globe salvage across decades) because subperiod data breakdown was not available (figure 1).14–69

View all citing articles on Scopus

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.

View full text