title: Three-drug intra-arterial chemotherapy using simultaneous carboplatin, topotecan and melphalan for intraocular retinoblastoma: preliminary results.
abstract: OBJECTIVE
  To report outcomes with selective intra-arterial chemotherapy (SIAC) using simultaneous carboplatin, topotecan, and melphalan for advanced intraocular retinoblastoma.
  
  
  METHODS
  A retrospective chart review was conducted of patients who received three-drug (melphalan, topotecan, and carboplatin) SIAC during 2006-2011.
  
  
  RESULTS
  Twenty-six eyes of 25 patients received the three-drug chemotherapy for treatment of advanced retinoblastoma. Reese-Ellsworth group was 5b in 21 eyes, 5a in 2, 4a in 2, and 3a in 1. Seventeen patients (68%) had recurrence after prior intravenous chemotherapy with or without radiotherapy. In the three-drug therapy, dose ranges were 2.5-7.5 mg for melphalan, 0.3-0.6 mg for topotecan, and 25-50 mg for carboplatin, and median infusions per eye was 2 (range 1-4). At a mean follow-up of 14 months (range 1-43 months), all patients are alive and no patient developed metastatic disease. Twenty-three of 26 eyes (88%) survived. Eleven of the 26 eyes (35%) developed recurrent disease and were treated with enucleation (n=3) or with focal therapy (n=8) with or without plaque brachytherapy (n=3). The Kaplan-Meier estimate of ocular survival at 24 months was 75% (95% CI). Electroretinogram showed improvement greater than 25 µV in 4 eyes (15%), loss greater than 25 µV in 12 eyes (46%), and no change greater than 25 µV in 10 eyes (39%).
  
  
  CONCLUSIONS
  Three-drug SIAC has been used successfully to rescue eyes after treatment failure of intravenous chemotherapy and/or single- or double-agent SIAC. Twenty-three of 26 eyes avoided both enucleation and external beam radiotherapy and retained electroretinogram function.
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. marrb@mskcc.org
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brodie
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Dunkel
authors.forename: Y Pierre
authors.initials: YP
authors.lastname: Gobin
authors.forename: David H
authors.initials: DH
authors.lastname: Abramson
mesh_terms: D000293:Adolescent; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007261:Infusions, Intra-Arterial; D008297:Male; D008558:Melphalan / Q000032:analysis; D008875:Middle Aged; D010865:Pilot Projects; D019572:Retinal Neoplasms / Q000188:drug therapy*; D012175:Retinoblastoma / Q000188:drug therapy*; D012189:Retrospective Studies; D059004:Topoisomerase I Inhibitors / Q000008:administration & dosage; D019772:Topotecan / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D059004:Topoisomerase I Inhibitors; D019772:Topotecan; D016190:Carboplatin; D008558:Melphalan