title: Minimal exposure (one or two cycles) of intra-arterial chemotherapy in the management of retinoblastoma.
abstract: OBJECTIVE
  To assess the efficacy of less than 3 cycles of intra-arterial chemotherapy (IAC) for retinoblastoma.
  
  
  METHODS
  Retrospective, nonrandomized, interventional case series.
  
  
  METHODS
  Eight patients.
  
  
  METHODS
  Intra-arterial chemotherapy.
  
  
  METHODS
  Tumor control and globe salvage.
  
  
  RESULTS
  Eight patients received fewer than 3 cycles of IAC for retinoblastoma because there was complete tumor control with no residual viable tumor (n = 7) or poor response (n = 1) with little hope that further therapy would benefit the patient. In 3 cases, additional vascular compromise precluded further IAC. The treatment was primary in 6 cases and secondary after failure of other treatment in 2 cases. The 8 eyes were classified (International Classification of Retinoblastoma) as group C (n = 2), group D (n = 3), group E (n = 1), and secondary treatment (n = 2). At initial examination, the main tumor showed a mean basal diameter of 16 mm, a thickness of 8.6 mm, vitreous seeds (n = 2), subretinal seeds (n = 6), and iris neovascularization (n = 1). Three patients were treated with a single cycle of IAC, and 5 patients were treated with 2 cycles of IAC. After IAC, complete tumor response was found in 7 eyes (88%) and partial response was found in 1 eye (13%). Over a mean of 13 months follow-up, there was intraretinal tumor recurrence (n = 1), subretinal seed recurrence (n = 1), and no case of vitreous seed recurrence. Globe salvage was achieved in 2 of 2 group C eyes (100%), 3 of 3 group D eyes (100%), 0 of 1 group E eye (0%), and 1 of 2 secondary treatment eyes (50%). Globe salvage was achieved in 6 of 8 eyes (75%), and 2 of 8 eyes (25%) required enucleation.
  
  
  CONCLUSIONS
  One or 2 cycles of IAC can be sufficient for selected eyes with group C or D retinoblastoma, with remarkable tumor control.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Philadelphia, PA 19107, USA. carol.shields@shieldsoncology.com
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Swathi
authors.initials: S
authors.lastname: Kaliki
authors.forename: Sanket U
authors.initials: SU
authors.lastname: Shah
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Bianciotto
authors.forename: David
authors.initials: D
authors.lastname: Liu
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Griffin
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D015353:Eye Enucleation; D005134:Eye Neoplasms / Q000188:drug therapy* / Q000556:secondary; D005260:Female; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D009366:Neoplasm Seeding; D019572:Retinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012175:Retinoblastoma / Q000188:drug therapy* / Q000556:secondary; D019233:Retreatment; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D014822:Vitreous Body / Q000187:drug effects* / Q000473:pathology
chemical_list: D016190:Carboplatin; D008558:Melphalan