title: Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments.
abstract: OBJECTIVE
  To report our experience in superselective ophthalmic artery infusion of melphalan (SOAIM) for intraocular retinoblastoma.
  
  
  METHODS
  From June 2008 to October 2010, 38 patients (18 women, 20 men; age range at first treatment, 7 months to 22 years) with 41 eyes with retinoblastoma were scheduled for SOAIM, for 17 newly diagnosed retinoblastomas Tumour, Node and Metastasis (TNM) 7th Edition 1a (n = 1), 1b (n = 1), 2a (n = 7), 2b (n = 4) and 3a (n = 4) and 24 retinoblastomas with partial remission/relapse TNM 7th Edition 1b (n = 13), 2a (n = 1) and 2b (n = 10). Eight patients (ten eyes) have been treated by SOAIM alone. Follow-up was 6-27 months in 28 patients (30 eyes).
  
  
  RESULTS
  Ophthalmic artery cannulation failed in two patients. Thirty-six patients underwent 140 treatments by internal (n = 112) or external (n = 28) carotid arteries. No major procedural complications occurred. Two patients have been lost to follow-up. Remaining 34 patients (37 eyes) had no metastatic disease. Four patients suffered permanent ocular complications: chorioretinal dystrophy (n = 2), ptosis (n = 1) and strabismus/exotropia (n = 1). Eight (22%) eyes in eight (24%) patients underwent enucleation: 7/16 (43%) newly diagnosed retinoblastomas and 1/22 (4.5%) retinoblastomas undergoing partial remission/relapse. For all treated eyes, Kaplan-Meier eye enucleation-free rates (K-M) were 85.4% (95% CI, 73.3-97.5%), 74.4% (95% CI, 57-91.8%) and still stable at 6, 12 months and 2 years, respectively. For eyes with partial remission/relapse, and eyes at presentation, K-M at 2 years were 95.5% (95% CI, 86.9-100%) and 45.6% (95% CI, 16.6-74.6%), respectively.
  
  
  CONCLUSIONS
  Superselective ophthalmic artery infusion of melphalan was safe and powerful, especially following other therapies. Superselective ophthalmic artery infusion of melphalan should be added to focal therapies spectrum. In selected cases, melphalan should be combined with other chemotherapeutic agents.
authors.affiliation: Unit NINT Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy. venturic@ao-siena.toscana.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Venturi
authors.forename: Sandra
authors.initials: S
authors.lastname: Bracco
authors.forename: Alfonso
authors.initials: A
authors.lastname: Cerase
authors.forename: Samuele
authors.initials: S
authors.lastname: Cioni
authors.forename: Paolo
authors.initials: P
authors.lastname: Galluzzi
authors.forename: Paola
authors.initials: P
authors.lastname: Gennari
authors.forename: Ignazio M
authors.initials: IM
authors.lastname: Vallone
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tinturini
authors.forename: Cesare
authors.initials: C
authors.lastname: Vittori
authors.forename: Sonia
authors.initials: S
authors.lastname: De Francesco
authors.forename: Mauro
authors.initials: M
authors.lastname: Caini
authors.forename: Alfonso
authors.initials: A
authors.lastname: D'Ambrosio
authors.forename: Paolo
authors.initials: P
authors.lastname: Toti
authors.forename: Alessandra
authors.initials: A
authors.lastname: Renieri
authors.forename: Theodora
authors.initials: T
authors.lastname: Hadjistilianou
mesh_terms: D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial; D007558:Italy / Q000453:epidemiology; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D009367:Neoplasm Staging; D009880:Ophthalmic Artery; D009887:Ophthalmoscopy; D019572:Retinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012175:Retinoblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan