Supraselective intra-arterial chemotherapy: Evaluation of treatment-related complications in advanced retinoblastoma

Lejla Mutapcic Vajzovic, Timothy G. Murray, Mohammad A. Aziz-Sultan, Amy C. Schefler, Stacey Quintero Wolfe, Ditte Hess, Cristina E. Fernandes, Sander Dubovy

Research output: Contribution to journalArticle

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Abstract

Purpose: The purpose of this study is to report the complication profile and safety evaluation of supra selective intra-arterial melphalan chemotherapy in children undergoing treatment with advanced retinoblastoma. Methods: Twelve eyes of 10 children with advanced retinoblastoma (Reese-Ellsworth Group Vb or International Classification Group D) were treated with supra selective intra-ophthalmic artery infusion of melphalan. Eleven eyes of nine children had previously failed traditional management with systemic chemotherapy and laser ablation and underwent intra-ophthalmic artery infusion of melphalan as an alternative to enucleation. Serial ophthalmic examinations, retinal photography, and ultra sonographic imaging were used to evaluate treatment regime. Results: Ophthalmic artery cannulation was successfully performed in 12 eyes of 10 patients (total 16 times). Striking regression of tumor, subretinal and vitreous seeds were seen early in each case. No severe systemic side effects occurred. Grade III neutropenia was seen in one patient. No transfusions were required. Three patients developed a vitreous hemorrhage obscuring tumor visualization. One patient developed periocular edema associated with inferior rectus muscle inflammation per orbital MRI. This same patient had scattered intraretinal hemorrhages and peripapillary cotton wool spots consistent with a Purtscher's-like retinopathy that resolved spontaneously. At the 6-month follow-up examination, nine eyes had no evidence of tumor progression, whereas three eyes were enucleated for tumor progression. In each enucleated case, viable tumor was identified on histopathologic examination. Conclusions: Ophthalmic intra-arterial infusion with melphalan is an excellent globe-conserving treatment option in advanced retinoblastoma cases with minimal systemic side effects. Local toxicities include microemboli to the retina and choroid (1/12, 8%), vitreous hemorrhage (3/12, 25%), and myositis (1/12, 8%). Enucleation remained a definitive treatment for tumor progression in 3 of 12 eyes in this small case series with limited follow-up. Further studies are necessary to establish the role of supra selective intra-arterial melphalan chemotherapy for children with retinoblastoma.

Original languageEnglish
Pages (from-to)171-176
Number of pages6
JournalClinical Ophthalmology
Volume5
Issue number1
DOIs
StatePublished - Mar 25 2011

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Retinoblastoma
Melphalan
Drug Therapy
Ophthalmic Artery
Vitreous Hemorrhage
Neoplasms
Therapeutics
Intra Arterial Infusions
Myositis
Choroid
Wool
Photography
Laser Therapy
Neutropenia
Catheterization
Retina
Edema
Seeds
Hemorrhage
Inflammation

Keywords

  • Intra-arterial chemotherapy
  • Melphalan
  • Retinoblastoma

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Supraselective intra-arterial chemotherapy : Evaluation of treatment-related complications in advanced retinoblastoma. / Vajzovic, Lejla Mutapcic; Murray, Timothy G.; Aziz-Sultan, Mohammad A.; Schefler, Amy C.; Wolfe, Stacey Quintero; Hess, Ditte; Fernandes, Cristina E.; Dubovy, Sander.

In: Clinical Ophthalmology, Vol. 5, No. 1, 25.03.2011, p. 171-176.

Research output: Contribution to journalArticle

Vajzovic, LM, Murray, TG, Aziz-Sultan, MA, Schefler, AC, Wolfe, SQ, Hess, D, Fernandes, CE & Dubovy, S 2011, 'Supraselective intra-arterial chemotherapy: Evaluation of treatment-related complications in advanced retinoblastoma', Clinical Ophthalmology, vol. 5, no. 1, pp. 171-176. https://doi.org/10.2147/OPTH.S12665
Vajzovic, Lejla Mutapcic ; Murray, Timothy G. ; Aziz-Sultan, Mohammad A. ; Schefler, Amy C. ; Wolfe, Stacey Quintero ; Hess, Ditte ; Fernandes, Cristina E. ; Dubovy, Sander. / Supraselective intra-arterial chemotherapy : Evaluation of treatment-related complications in advanced retinoblastoma. In: Clinical Ophthalmology. 2011 ; Vol. 5, No. 1. pp. 171-176.
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