title: Alternated intra-arterial and intravitreal chemotherapy for advanced intraocular retinoblastoma: preliminary successful results without systemic chemotherapy.
abstract: To describe the efficacy of intravitreal chemotherapy (IViC) preceded by intra-arterial chemotherapy (IAC) for the treatment of advanced stage retinoblastoma. This non-comparative interventional case series retrospectively reviewed the medical records of six patients who presented within months of each other with unilateral retinoblastoma, Reese-Ellsworth stage Vb/D of ABC classification in the affected eye. After clinical and ophthalmoscopic evaluation, they underwent MRI to exclude local and CNS dissemination. The IAC was given to treat retinal masses and intravitreal injections to treat vitreous seeding. Patients had received two cycles (six infusions) of IAC, and from six up to ten melphalan injections into the vitreous, with an interval of 7-10 days between them. From one to four intravitreal injections were performed for partial remission or consolidation. No permanent complications of procedures have been reported. All patients underwent to bimonthly MRI examination, during treatment and every 3 months for 1 year after last injection, to exclude orbital dissemination. Successful control (100 %) of tumor masses and vitreous seeds was achieved in all cases at 12 months follow-up. Complications were posterior lens opacity, acute ischemic papillitis, partial CVR thrombosis, hypotonia (case 1), partial vitreous hemorrhage (case 4). No complications appeared in cases 2, 3, 5, and 6. No intraocular or orbital tumor recurrence or retinoblastoma metastases (follow-up range, 12-33 months) were observed. Sequential IAC and intravitreal melphalan for advanced retinoblastoma allowed to provide retinal and vitreous seed control.
authors.affiliation: Unit of Ophthalmology, Referral Center for Retinoblastoma, Department of Surgery, Policlinico "Santa Maria alle Scotte", Siena, Italy. defrancesco75@libero.it.
authors.forename: Sonia
authors.initials: S
authors.lastname: De Francesco
authors.affiliation: Unit NINT Neuroimaging and Neurointervention, Neurological and Sensorineural Department, Azienda Ospedaliera Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Galluzzi
authors.affiliation: Unit NINT Neuroimaging and Neurointervention, Neurological and Sensorineural Department, Azienda Ospedaliera Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Bracco
authors.affiliation: Unit of Ophthalmology, Department of Surgery, Policlinico "Santa Maria alle Scotte", Siena, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Menicacci
authors.affiliation: Unit of Ophthalmology, Department of Surgery, Policlinico "Santa Maria alle Scotte", Siena, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Motolese
authors.affiliation: Unit of Ophthalmology, Referral Center for Retinoblastoma, Department of Surgery, Policlinico "Santa Maria alle Scotte", Siena, Italy.
authors.forename: Theodora
authors.initials: T
authors.lastname: Hadjistilianou
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007269:Injections, Intra-Arterial; D058449:Intravitreal Injections; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D009366:Neoplasm Seeding; D019572:Retinal Neoplasms / Q000188:drug therapy*; D012175:Retinoblastoma / Q000188:drug therapy*; D012189:Retrospective Studies; D019772:Topotecan / Q000008:administration & dosage
chemical_list: D018906:Antineoplastic Agents, Alkylating; D019772:Topotecan; D008558:Melphalan
keywords: Intra-arterial chemotherapy; Intravitreal chemotherapy; Retinoblastoma