medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2016, Number 3

<< Back Next >>

Rev Invest Clin 2016; 68 (3)

Globe salvage with intra-arterial topotecan-melphalan chemotherapy in children with a single eye

Leal-Leal CA, Asencio-López L, Higuera-Calleja J, Bernal-Moreno M, Bosch-Canto V, Chávez-Pacheco J, Isaac-Otero G, Beck-Popovic M

Language: English
References: 23
Page: 137-142
PDF size: 113.75 Kb.


ABSTRACT

Introduction: Intra-arterial chemotherapy is a novel therapeutic modality for retinoblastoma patients. Intra-arterial chemotherapy involves the administration of a super-selective drug through the ophthalmic artery, resulting in better ocular penetration and low systemic toxicity.
Objective: The aim of this report was to evaluate the feasibility of intra-arterial chemotherapy in a large referral center in Mexico City.
Methods: We included patients with bilateral retinoblastoma, one enucleation, and active disease in the other eye after at least two courses of systemic chemotherapy combined with topical treatments. All patients were treated with three courses of a combination of melphalan 4 mg and topotecan 1 mg. Patients were examined under general anesthesia three weeks after each chemotherapy cycle.
Results: From 14 eligible patients, three could not be treated due to inaccessibility of the ophthalmic artery. A complete response was observed in 5/11 patients, three in Stage C according to the International Classification for Intraocular Retinoblastoma, one in Stage D, and one in Stage B. The eyes of three patients were enucleated as a result of active/progressive disease, one in Stage B and two in Stage D. Eye preservation was 55% after a mean follow-up of 171 days (range 21-336).
Conclusions: Super-selective intra-arterial chemotherapy is safe and effective for preventing the enucleation of 55% of affected eyes in this group of patients.


REFERENCES

  1. Abramson DH, Schefler A. Update on Retinoblastoma. Retina. 2004;24:828-48.

  2. Secretaría de Salud. Diagnóstico y Manejo de Retinoblastoma. MEXICO: SECRETARIA DE SALUD; 2013.

  3. Abramson DH, Dunkel IJ, Brodie SE, Marr B, Gobin YP. Superselective ophthalmic artery chemotherapy as primary treatment for retinoblastoma (chemosurgery). Ophthalmology. 2010;117: 1623-9.

  4. Abramson DH, Dunkel IJ, Brodie SE, Kim JW, Gobin YP. A phase I/II study of direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma initial results. Ophthalmology. 2008;115:1398-404.

  5. Friedrich MJ. Retinoblastoma therapy delivers power of chemotherapy with surgical precision. JAMA. 2011;305:2276-8.

  6. Shields CL, Mashayekhi A, Au AK, et al. The International Classification of Retinoblastoma predicts chemoreduction success. Ophthalmology. 2006;113:2276-80.

  7. Shields CL, Bianciotto CG, Jabbour P, et al. Intra-arterial chemotherapy for retinoblastoma: report No. 1, control of retinal tumors, subretinal seeds, and vitreous seeds. Arch Ophthalmol. 2011;129:1399-406.

  8. Gobin YP, Dunkel IJ, Marr BP, Brodie SE, Abramson DH. Intraarterial chemotherapy for the management of retinoblastoma: four-year experience. Arch Ophthalmol. 2011;129:732-7.

  9. Ellsworth RM. The practical management of retinoblastoma. Trans Am Ophthalmol Soc. 1969;67:462-534.

  10. Kaneko A, Suzuki S. Eye preservation treatment of retinoblastoma with vitreous seeding. Jpn J Clin Oncol. 2003;33:601-7.

  11. Abramson DH, Fabius AW, Issa R, et al. Advanced unilateral retinoblastoma: The impact of ophthalmic artery chemosurgery on enucleation rate and patient survival at MSKCC. PLoS One. 2015;10:e0145436.

  12. Schaiquevich P, Ceciliano A, Millan N, et al. Intra-arterial chemotherapy is more effective than sequential periocular and intravenous chemotherapy as salvage treatment for relapsed retinoblastoma. Pediatr Blood Cancer. 2013;60:766-70.

  13. Abramson DH, Marr BP, Dunkel IJ, et al. Intra-arterial chemotherapy for retinoblastoma in eyes with vitreous and/or subretinal seeding: 2-year results. Br J Ophthalmol. 2012;96:499-502.

  14. Grigorovski N, Lucena E, Mattosinho C, et al. Use of intra-arterial chemotherapy for retinoblastoma: results of a survey. Int J Ophthalmol. 2014;7:726-30.

  15. Leal-Leal CA. Retinoblastoma. In: Rivera-Luna R (ed). El Niño Con Cáncer. Los Padecimientos Más Comunes Para El Médico No Especialista. México: ETM; 2007:123-136.

  16. Schaiquevich P, Buitrago E, Ceciliano A, et al. Pharmacokinetic analysis of topotecan after superselective ophthalmic artery infusion and periocular administration in a porcine model. Retina. 2012;32:387-95.

  17. Schaiquevich P, Buitrago E, Taich P, et al. Pharmacokinetic analysis of melphalan after superselective ophthalmic artery infusion in preclinical models and retinoblastoma patients. Invest Ophthalmol Vis Sci. 2012;53:4205-12.

  18. Abramson DH. Benefits and risks of intraarterial chemotherapy for retinoblastoma: An Update. Retina Today; Nov-Dec 2011.

  19. Binaghi M, Zerlauth JB, Beck Popovic M, Munier F. Efficacy of intra- arterial ophthalmic artery chemotherapy for retinoblastoma in children : 3-years Lausanne experience. 99th Annual Meeting of the Swiss Society of Radiology. Lausanne, Switzerland; 2012.

  20. Marr BP, Brodie SE, Dunkel IJ, Gobin YP, Abramson DH. Threedrug intra-arterial chemotherapy using simultaneous carboplatin, topotecan and melphalan for intraocular retinoblastoma: preliminary results. Br J Ophthalmol. 2012;96:1300-3.

  21. Monroy J, Orbach D, VanderVeen D. Complications of intra-arterial chemotherapy for retinoblastoma. Semin Ophthalmol. 2014;29:429-33.

  22. Instituto Nacional de Estadística y Geografía (INEGI). http:// www.inegi.org.mx.

  23. Shields C, Shields J. New strategies in the treatment of unilateral sporadic retinoblastoma. J Pediatr Ophthalmol Strabismus. 2015;52:134-7.




2020     |     www.medigraphic.com