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Abstract

Globe Salvage With Intra-Arterial Topotecan-Melphalan Chemotherapy in Children With a Single Eye

VOLUME 68 - NUMBER 3 / May - June (Original articles)

Carlos A. Leal-Leal, Oncology Service, Instituto Nacional de Pediatría, Mexico City, Mexico
Laura Asencio-López, Oncology Service, Instituto Nacional de Pediatría, Mexico City, Mexico
Jesús Higuera-Calleja, Radiology and Imaging Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Max Bernal-Moreno, Radiology and Imaging Service, Instituto Nacional de Pediatría, Mexico City, Mexico
Vanessa Bosch-Canto, Ophthalmology Service, Instituto Nacional de Pediatría, Mexico City, Mexico
Juan Chávez-Pacheco, Oncology Service, Instituto Nacional de Pediatría, Mexico City, Mexico
Gabriela Isaac-Otero, Oncology Service, Instituto Nacional de Pediatría, Mexico City, Mexico
Maja Beck-Popovic, Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland

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.

Keywords: Retinoblastoma. Intra-arterial chemotherapy. Ocular rescue. Melphalan. Topotecan.

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