title: Globe Salvage With Intra-Arterial Topotecan-Melphalan Chemotherapy in Children With a Single Eye.
abstract: BACKGROUND
  Intra-arterial chemotherapy is a novel therapeutic modality for retinoblastoma patients. Intra-arterial chemotherapy involves the administration of a super-selective drug through the ophthalmic artery, resulting in better ocular penetration and low systemic toxicity.
  
  
  OBJECTIVE
  The aim of this report was to evaluate the feasibility of intra-arterial chemotherapy in a large referral center in Mexico City.
  
  
  METHODS
  We included patients with bilateral retinoblastoma, one enucleation, and active disease in the other eye after at least two courses of systemic chemotherapy combined with topical treatments. All patients were treated with three courses of a combination of melphalan 4 mg and topotecan 1 mg. Patients were examined under general anesthesia three weeks after each chemotherapy cycle.
  
  
  RESULTS
  From 14 eligible patients, three could not be treated due to inaccessibility of the ophthalmic artery. A complete response was observed in 5/11 patients, three in Stage C according to the International Classification for Intraocular Retinoblastoma, one in Stage D, and one in Stage B. The eyes of three patients were enucleated as a result of active/progressive disease, one in Stage B and two in Stage D. Eye preservation was 55% after a mean follow-up of 171 days (range 21-336).
  
  
  CONCLUSIONS
  Super-selective intra-arterial chemotherapy is safe and effective for preventing the enucleation of 55% of affected eyes in this group of patients.
authors.affiliation: Oncology Service, Instituto Nacional de Pediatría, Mexico City, Mexico.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Leal-Leal
authors.affiliation: Oncology Service, Instituto Nacional de Pediatría, Mexico City, Mexico.
authors.forename: Laura
authors.initials: L
authors.lastname: Asencio-López
authors.affiliation: Radiology and Imaging Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: Jesús
authors.initials: J
authors.lastname: Higuera-Calleja
authors.affiliation: Radiology and Imaging Service, Instituto Nacional de Pediatría, Mexico City, Mexico.
authors.forename: Max
authors.initials: M
authors.lastname: Bernal-Moreno
authors.affiliation: Ophthalmology Service, Instituto Nacional de Pediatría, Mexico City, Mexico.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Bosch-Canto
authors.affiliation: Oncology Service, Instituto Nacional de Pediatría, Mexico City, Mexico.
authors.forename: Juan
authors.initials: J
authors.lastname: Chávez-Pacheco
authors.affiliation: Oncology Service, Instituto Nacional de Pediatría, Mexico City, Mexico.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Isaac-Otero
authors.affiliation: Oncology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland.
authors.forename: Maja
authors.initials: M
authors.lastname: Beck-Popovic
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007269:Injections, Intra-Arterial; D008137:Longitudinal Studies; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008800:Mexico; D009880:Ophthalmic Artery; D011446:Prospective Studies; D019572:Retinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D012175:Retinoblastoma / Q000188:drug therapy* / Q000473:pathology; D016879:Salvage Therapy / Q000379:methods*; D019772:Topotecan / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D019772:Topotecan; D008558:Melphalan