Simultaneous Bilateral Ophthalmic Artery Chemosurgery for Bilateral Retinoblastoma (Tandem Therapy).
OBJECTIVE
Report on the 7-year experience with bilateral ophthalmic artery chemosurgery (OAC-Tandem therapy) for bilateral retinoblastoma.


METHODS
Retrospective, single institution study.


METHODS
120 eyes of 60 children with bilateral retinoblastoma treated since March 2008.


METHODS
Retrospective review of all children treated at Memorial Sloan Kettering with bilateral ophthalmic artery chemosurgery (Melphalan, Carboplatin, Topotecan, Methotrexate) delivered in the same initial session to both naïve and previously treated eyes.


METHODS
Ocular survival, metastatic disease, patient survival from metastases, second cancers, systemic adverse effects, need for transfusion of blood products, electroretinogram before and after treatment.


RESULTS
116 eyes were salvaged (4 eyes were enucleated: 3 because of progressive disease, 1 family choice). Kaplan Meier ocular survival was 99.2% at one year, 96.9% at 2 and 3 years and 94.9% for years 4 through 7. There were no cases of metastatic disease or metastatic deaths with a mean follow-up of 3.01 years. Two children developed second cancers (both pineoblastoma) and one of them died. Transfusion of blood products was required in 3 cases (4 transfusions), 1.9%. Two children developed fever/neutropenia requiring hospitalization (0.95%). ERGs were improved in 21.6% and unchanged after treatment in 52.5% of cases (increase or decrease of less than 25μV).


CONCLUSIONS
Bilateral ophthalmic artery chemosurgery is a safe and effective technique for managing bilateral retinoblastoma-even when eyes are advanced bilaterally, and if both eyes have progressed after systemic chemotherapy. Ocular survival was excellent (94.9% at 8 years), there were no cases of of metastatic disease and no deaths from metastatic disease, but children remain at risk for second cancers. In 21.6% of cases ERG function improved. Despite using chemotherapy in both eyes in the same session, systemic toxicity was low.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America.|Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, United States of America.
David H
DH
Abramson
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America.|Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, United States of America.
Brian P
BP
Marr
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America.|Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, United States of America.
Jasmine H
JH
Francis
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 Presbyterian Hospital, New York, New York, United States of America.
Ira J
IJ
Dunkel
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America.|Department of Ophthalmology, VU University Medical Center, Amsterdam, Netherlands.
Armida W M
AW
Fabius
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America.|Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
Scott E
SE
Brodie
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America.
Ijah
I
Mondesire-Crump
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America.|Department of Radiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, United States of America.
Y Pierre
YP
Gobin
D016190:Carboplatin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004596:Electroretinography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D009880:Ophthalmic Artery / Q000187:drug effects / Q000601:surgery; D019572:Retinal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D012175:Retinoblastoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D019772:Topotecan / Q000627:therapeutic use
D019772:Topotecan; D016190:Carboplatin; D008558:Melphalan