Intra-arterial chemotherapy for retinoblastoma: First Indian report

• Main Authors: Pukhraj Rishi, Tarun Sharma, Vikram Koundanya, Nishat Bansal, M Saravanan, R Ravikumar, Satheesh Ramamurthy
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2015-01-01
• Series: Indian Journal of Ophthalmology
• Subjects: Advanced glaucoma; optical coherence tomography; reproducibility; retinal nerve fiber layer thickness; spectral domain; Ophthalmology; residents; surgical training; survey; Cytokine; diabetic macular edema; Macular GHPC; pulse cyclophosphamide; serpiginous choroidopathy; Contact lens; Corvis ST; intraocular pressure; Confocal microscopy; meibomian gland; meibomian gland microenvironment; papillary formation; vernal keratoconjunctivitis; Eye; intra-arterial chemotherapy; retinoblastoma; tumor
• Online Access: http://www.ijo.in/article.asp?issn=0301-4738;year=2015;volume=63;issue=4;spage=331;epage=334;aulast=Rishi

Aim: To describe treatment outcomes and complications of selective intra-arterial chemotherapy (IAC) for retinoblastoma (RB) in Indian eyes. Materials and Methods: Single center, retrospective interventional case series of 6 eyes with RB who underwent IAC using Melphalan (3 mg/5 mg/7.5 mg) and topetecan (1 mg) (n = 4) or melphalan (3 mg/5 mg/7.5 mg) alone (n = 2) between December 2013 and June 2014. In all, 17 IAC procedures were performed using selective ophthalmic artery cannulation. Treatment outcomes were evaluated in terms of tumor control, vitreous and subretinal seeds control and globe salvage rates. Results: IAC was employed as primary (n = 1) or secondary (n = 5) modality of treatment. Each eye received mean 3 IAC sessions (median: 3; range: 1-4 sessions). Eyes were classified according to international classification of RB as Group B (n = 1), C (n = 1), D (n = 2) and E (n = 2). Following IAC, complete regression of the main tumor was seen in 3 cases (50%), partial regression in 2 (33%), while 1 case (15%) showed no response. Of 4 eyes with subretinal seeds, 1 (25%) eye had complete regression while 3 (75%) eyes had partial regression. Of 5 eyes with vitreous seeds, 2 (40%) eyes had complete regression while 3 (60%) eyes had a partial response. Globe salvage was achieved in 5 of 6 eyes (83%). Diffuse choroidal atrophy and vitreous hemorrhage were observed in 1 (17%) eye, each. No hematologic toxicity or cerebro-vascular events were observed. Mean follow-up period was 5.5 months (median: 6 months, range: 1-6 months). Conclusion: IAC is an effective therapy for globe preservation in eyes with RB. Larger studies with longer follow-up are required to validate these results.