title: Intra-arterial chemotherapy for retinoblastoma in 70 eyes: outcomes based on the international classification of retinoblastoma.
abstract: OBJECTIVE
  To analyze our 5-year experience of intra-arterial chemotherapy (IAC) for retinoblastoma as primary or secondary therapy.
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  A total of 70 eyes of 67 patients.
  
  
  METHODS
  Ophthalmic artery chemotherapy infusion under fluoroscopic guidance was performed using melphalan (3, 5, or 7.5 mg) in every case, with additional topotecan (1 mg) and/or carboplatin (30 or 50 mg) as necessary.
  
  
  METHODS
  Tumor control and treatment complications.
  
  
  RESULTS
  The mean patient age at IAC was 30 months. The treatment was primary in 36 eyes and secondary in 34 eyes. Those primary therapy eyes were classified according to the International Classification of Retinoblastoma (ICRB) as group A (n = 0), B (n = 1), C (n = 4), D (n = 17), or E (n = 14). The secondary therapy eyes had failed previous intravenous chemotherapy (n = 34) in every case. Each eye received a mean of 3 IAC sessions per eye (median, 3; range, 1-7 sessions). After IAC with a mean follow-up of 19 months, globe salvage was achieved in 72% of primary-treated cases and in 62% of secondary-treated cases. Specifically, primary therapy achieved globe salvage for group B (100%), group C (100%), group D (94%), and group E (36%). Of all 70 eyes, complete regression was achieved for solid tumor in 48 of 51 eyes (94%), subretinal seeds in 40 of 42 eyes (95%), and vitreous seeds in 34 of 39 eyes (87%). After each catheterization (n = 198), the main complications included transient eyelid edema (5%), blepharoptosis (5%), and forehead hyperemia (2%). More lasting complications included vitreous hemorrhage (2%), branch retinal artery obstruction (1%), ophthalmic artery spasm with reperfusion (2%), ophthalmic artery obstruction (2%), partial choroidal ischemia (2%), and optic neuropathy (<1%). Over the past 3 years, the combined incidence of ophthalmic, retinal, and choroidal vascular ischemia was reduced to 1%. There was no patient with stroke, seizure, neurologic impairment, limb ischemia, secondary leukemia, metastasis, or death.
  
  
  CONCLUSIONS
  Five-year experience with IAC indicates that this technique is remarkably effective for the management of retinoblastoma as both a primary and a secondary treatment.
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: carol.shields@shieldsoncology.com.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Fairooz P
authors.initials: FP
authors.lastname: Manjandavida
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Lally
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pieretti
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Sruthi A
authors.initials: SA
authors.lastname: Arepalli
authors.affiliation: Nemours Center for Cancer and Blood Disorders, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware.
authors.forename: Emi H
authors.initials: EH
authors.lastname: Caywood
authors.affiliation: Department of Neurovascular and Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial; D038801:International Classification of Diseases; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D033401:Microscopy, Acoustic; D009880:Ophthalmic Artery; D019572:Retinal Neoplasms / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D012175:Retinoblastoma / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D019772:Topotecan / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019772:Topotecan; D016190:Carboplatin; D008558:Melphalan