Electroretinogram monitoring of dose-dependent toxicity after ophthalmic artery chemosurgery in retinoblastoma eyes: six year review.
OBJECTIVE
To report electroretinogram responses of retinoblastoma children under anesthesia before and after treatment with chemotherapeutic drugs (melphalan, topotecan, carboplatin) delivery by ophthalmic artery chemosurgery (OAC).


METHODS
A cohort study of 81 patients with retinoblastoma treated with OAC. All patients treated with OAC at our center through May 2012 for whom the requisite ERG data were available are included in the analysis. This study recorded the ERG 30 Hz flicker amplitude response changes from baseline, at 3 and 12 months following OAC treatment completion. Both univariate and multivariate linear regression models were evaluated, with generalized estimating equations to correct for correlations within patients. Independent numerical variables included maximum doses and cumulative doses of melphalan, topotecan and carboplatin.


RESULTS
By univariate analysis, both melphalan and topotecan appear to be associated with changes in ERG amplitude at both 3 and 12 months; but for the most part, these changes are minimal and likely clinically insignificant. By multivariate analysis, maximum and cumulative melphalan have a modest, temporary effect on the ERG amplitude change, which is apparent at 3 months but no longer evident at 12 months after completing treatment. By multivariate analysis, topotecan and carboplatin do not appear to adversely effect the change in ERG response.


CONCLUSIONS
Melphalan has the strongest, and carboplatin the weakest association with reduction in ERG response amplitudes; but for the most part, these changes are minimal and likely clinically insignificant. These conclusions apply only over the dose ranges used here, and should be applied with caution.
Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
Jasmine H
JH
Francis
Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America ; Department of Ophthalmology, Weill Cornell Medical College, New York, New York, United States of America.
David H
DH
Abramson
Service of Interventional Neuroradiology, Departments of Neurosurgery Neurology and Radiology, Weill Cornell Medical College of New York Presbyterian Hospital, New York, New York, United States of America.
Y Pierre
YP
Gobin
Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America ; Department of Ophthalmology, Weill Cornell Medical College, New York, New York, United States of America.
Brian P
BP
Marr
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America ; Department of Pediatrics, Weill Cornell Medical College, New York, New York, United States of America.
Ira J
IJ
Dunkel
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
Elyn R
ER
Riedel
Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America ; Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York, United States of America.
Scott E
SE
Brodie
D016190:Carboplatin / Q000627:therapeutic use; D004596:Electroretinography; D006801:Humans; D008558:Melphalan / Q000627:therapeutic use; D009880:Ophthalmic Artery / Q000187:drug effects* / Q000473:pathology*; D019572:Retinal Neoplasms / Q000188:drug therapy; D012175:Retinoblastoma / Q000188:drug therapy*; D019772:Topotecan / Q000627:therapeutic use; D016896:Treatment Outcome
D019772:Topotecan; D016190:Carboplatin; D008558:Melphalan