Ophthalmic artery chemosurgery for eyes with advanced retinoblastoma

ABSTRACT

Background: Surgical removal of one or both eyes has been the most common way to treat children with retinoblastoma worldwide for more than 100 years. Ophthalmic artery chemosurgery (OAC) was introduced 10 years ago and it has been used as an alternative to enucleation for eyes with advanced retinoblastoma. The purpose of this report is to analyze our 9-year experience treating advanced retinoblastoma eyes with OAC.

Materials and methods: Single-arm retrospective study from a single center of 226 eyes with eyes of retinoblastoma patients with advanced intraocular disease defined as both Reese-Ellsworth (RE) “Va” or ”Vb” and International Classification Retinoblastoma (ICRb) group “D” or ”E” (COG Classification). Ocular survival, patient survival, second cancers, and electroretinography (ERG) were assessed.

Results: Ocular survival at five years for these advanced eyes was 70.2% (95% confidence interval, 57.3%–79.8%). When eyes were divided into groups either by RE classification or ICRb, no significant differences in ocular survival were seen. Ocular survival was significantly better in naïve compared to non-naïve eyes (80.2% vs 58.4%, p = 0.041). The ERG distribution was very similar before and after OAC treatment for the patient population that did not receive intravitreal chemotherapy. Three patients (1.5%) have developed metastatic retinoblastoma (previously reported) and were successfully treated (no deaths).

Conclusion: Using OAC for advanced eyes (the majority of such eyes have been enucleated in the past) enables 70% 5-year ocular survival. Treated eyes have a similar ERG distribution before and after treatment. No patient has died of metastatic retinoblastoma.

KEYWORDS:

• Electroretinography Melphalan
• intrarterial chemotherapy
• ophthalmic artery chemosurgery
• retinoblastoma

Supplemental data

Supplemental data for this article can be accessed on the publisher’s website at http://dx.doi.org/10.1080/13816810.2016.1244695.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

This work was supported by the Fund for Ophthalmic Knowledge, Inc. (no grant number; philanthropic fund) and Perry’s Promise Fund (no grant number; philanthropic fund), and funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Additional information

Funding

This work was supported by the Fund for Ophthalmic Knowledge, Inc. (no grant number; philanthropic fund) and Perry’s Promise Fund (no grant number; philanthropic fund), and funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.