title: Intra-Arterial Chemotherapy (Ophthalmic Artery Chemosurgery) for Group D Retinoblastoma.
abstract: OBJECTIVE
  To report globe salvage rates, patient survival and adverse events of ophthalmic artery chemosurgery (OAC) for International Classification of Retinoblastoma (ICRB) group D retinoblastoma (naive and after prior failures).
  
  
  METHODS
  Single institution retrospective review of all Group D eyes treated with OAC from 5/2006-12/2012. Patients were treated according to our previously-published techniques. Primary outcome was globe retention without need for external beam radiotherapy (EBRT). Demographics, prior treatments, OAC agents used, and adverse events were also recorded.
  
  
  RESULTS
  112 group D eyes (103 patients) that underwent OAC were included (average follow-up was 34 months, range: 2-110 months). 47 eyes were treatment-naïve, 58 eyes received prior treatments elsewhere, and 7 young infants (7 eyes) underwent our published "bridge therapy" (single agent intravenous carboplatin) until old enough to undergo OAC. Median number of OAC sessions/eye was 3 (range 1-9). 110/112 eyes received intra-arterial melphalan, but only 31 eyes received melphalan alone. 43 eyes received carboplatin, and 78 eyes received topotecan (never as a single agent). 80/112 eyes received >1 drug over their treatment course, and 39 eyes received all three agents. 24 eyes (16 pretreated, 7 treatment-naïve, 1 bridge) failed treatment and required enucleation during the study period. Enucleation and EBRT were avoided in 88/112 eyes (78.6%; including 40/47 [85.1%] treatment-naïve eyes, 42/58 [72.4%] previously-treated eyes, and 6/7 eyes [85.7%] among bridge patients). By Kaplan-Meier survival analysis, globe salvage rate was 74% at 110 months among all patients, and 85% at 110 months in the treatment-naïve subgroup. Transient grade 3/4 neutropenia was more common in patients receiving OAC bilaterally. No child died of metastatic disease.
  
  
  CONCLUSIONS
  OAC is effective for curing group D retinoblastoma, achieving rates of globe salvage many times higher than systemic chemotherapy (10-47%), even in eyes that previously failed other treatments. OAC can be performed multiple times, using multiple agents, on one or both eyes of patients.
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.
authors.forename: David H
authors.initials: DH
authors.lastname: Abramson
authors.affiliation: Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States.|Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee, United States.|Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, United States.|Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Daniels
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.
authors.forename: Jasmine H
authors.initials: JH
authors.lastname: Francis
authors.affiliation: Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York, United States.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brodie
authors.affiliation: Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, United States.|Department of Pediatrics, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Dunkel
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.|Neurosurgery / Interventional Radiology, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Y Pierre
authors.initials: YP
authors.lastname: Gobin
mesh_terms: D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial; D009880:Ophthalmic Artery / Q000187:drug effects / Q000473:pathology; D012175:Retinoblastoma / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents