title: Combined, sequential intravenous and intra-arterial chemotherapy (bridge chemotherapy) for young infants with retinoblastoma.
abstract: BACKGROUND
  Intra-arterial (i.a.) chemotherapy has more risks of procedural complications in neonates and young infants. For these reasons, we have developed a strategy of bridge intravenous single agent chemotherapy to postpone i.a. chemotherapy in these children
  
  
  METHODS
  Neonates and young infants with retinoblastoma who required chemotherapy were treated with systemic carboplatin chemotherapy (18.7 mg/kg i.v. every 3-4 weeks) until they reached the age of 3 months and a weight of 6 Kg. If necessary, i.a. chemotherapy was subsequently performed at 4 weeks intervals. Efficacy was judged by tumor regression on ophthalmological examination. Retinal toxicity was judged by electroretinography.
  
  
  RESULTS
  Eleven children (19 eyes) were treated. All patients are alive and no patient has developed metastatic disease or second malignancies (mean follow-up 27 months, range 9-46 months). Intravenous carboplatin (median 2 cycles, range 1-5) combined with cryotherapy and laser was given to all children. This was effective for five eyes, which did not require i.a. chemotherapy. I.a. chemotherapy was administered to 14 eyes (median 3.5 cycles per eye, range 1 to 6). No radiation therapy was required. The Kaplan Meier estimate of ocular radiation-free survival was 94.7% at one year (95% confidence interval 68.1-99.2%). One eye was enucleated due to tumor progression. ERG showed no deterioration of retinal function.
  
  
  CONCLUSIONS
  Bridge i.v.-i.a. chemotherapy was feasible and safe, and is a promising strategy to treat retinoblastoma in neonates and young infants.
authors.affiliation: Service of Interventional Neuroradiology, Department of Neurosurgery, Weill Cornell Medical College of New York Presbyterian Hospital, New York, New York, United States of America. yvg2001@med.cornell.edu
authors.forename: Y Pierre
authors.initials: YP
authors.lastname: Gobin
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Dunkel
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.forename: Jasmine H
authors.initials: JH
authors.lastname: Francis
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brodie
authors.forename: David H
authors.initials: DH
authors.lastname: Abramson
mesh_terms: D061605:Administration, Intravenous / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007269:Injections, Intra-Arterial / Q000009:adverse effects; D008297:Male; D019572:Retinal Neoplasms / Q000188:drug therapy*; D012175:Retinoblastoma / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin