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Report No. 1, Control of Retinal Tumors, Subretinal Seeds, and Vitreous Seeds

Carol L. Shields, MD; Carlos G. Bianciotto, MD; Pascal Jabbour, MD; Aparna Ramasubramanian, MD; Sara E. Lally, MD; Gregory C. Griffin, MD; Robert Rosenwasser, MD; Jerry A. Shields, MD

Arch Ophthalmol. 2011;129(11):1399-1406. doi:10.1001/archophthalmol.2011.150

Objective  To describe tumor control following intra-arterial chemotherapy (IAC) for retinoblastoma.

Methods  A retrospective interventional series in which 17 patients were treated with ophthalmic artery injection of melphalan, 5 mg, was undertaken to determine retinoblastoma control.

Results  Of 190 children with retinoblastoma, 17 (9%) were treated with IAC. Catheterization was successful in 37 of 38 attempts. The treatment was primary in 13 cases (1 failed catheterization) and secondary in 4. The median retinoblastoma base was 20 mm and the median retinoblastoma thickness was 9.0 mm. Iris neovascularization was present in 5 cases. Following IAC, complete response of the main tumor was found in 14 cases (88%) and partial response was found in 2 (12%). Eyes with complete response and followed up for a minimum of 1 year (n = 10) showed no solid tumor recurrence. Of 11 eyes with subretinal seeds, 9 (82%) had complete response, 1 (9%) had partial response, and 1 (9%) had recurrence. Of 9 eyes with vitreous seeds, 6 (67%) had complete response, 2 (22%) had partial response, and 1 (11%) had recurrence. Globe salvage was achieved in 8 of 12 eyes (67%) treated with primary IAC, including 2 of 2 group C eyes, 4 of 4 group D eyes, and 2 of 6 group E eyes according to the International Classification of Retinoblastoma. Globe salvage was achieved in 2 of 4 eyes (50%) treated secondarily after failure of other methods.

Conclusions  Of 12 eyes managed with IAC as primary treatment, globe salvage was achieved in 67%. Eyes classified as group C or D showed 100% globe salvage, whereas group E had 33% salvage. Of 4 eyes managed with IAC as secondary treatment, globe salvage was achieved in 50%.

Author Affiliations: Ocular Oncology Service, Wills Eye Institute (Drs C. L. Shields, Bianciotto, Ramasubramanian, Lally, and J. A. Shields), Division of Neurovascular and Endovascular Surgery, Department of Neurological Surgery (Drs Jabbour and Rosenwasser), and Division of Pediatric Hematology/Oncology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children (Dr Griffin), Thomas Jefferson University, Philadelphia, Pennsylvania.

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