Ophthalmic Artery Chemosurgery for Retinoblastoma Babies Less than 3 Months Old or under 6-kg Weight.

IF 4.4 Q1 OPHTHALMOLOGY
David H Abramson, Jasmine H Francis, Jared Knopman, Ira J Dunkel, Yves Pierre Gobin
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Abstract

Objective: To determine the feasibility, safety, and efficacy of ophthalmic artery chemosurgery (OAC) for very young children who have unilateral and bilateral retinoblastoma.

Design: Retrospective, consecutive review of all children with retinoblastoma (unilateral and bilateral) treated with OAC in the first 3 months of life or, if weighing <6 kg, treated at the Memorial Sloan Kettering Cancer Center.

Participants: All children with retinoblastoma (unilateral or bilateral) treated with OAC (17 patients) in the first 3 months of life or weighing <6 kg.

Methods: Ophthalmic artery chemosurgery delivered by microcatheter inserted in the femoral artery and through the internal carotid artery. Combinations of melphalan, carboplatin, and topotecan were delivered in 60 sessions via the ophthalmic artery in 17 patients.

Main outcome measures: Ocular salvage, serial electroretinograms, patient survival, second cancers, fever/neutropenia, transfusion of any blood product, groin bleeding or femoral artery occlusion, and anesthetic complications.

Results: Seventeen retinoblastoma patients under the age of 3 months or weighing <6 kg were successfully canulated and treated a total of 60 times (11 bilateral patients and 6 unilateral patients) with combinations of Melphalan, Carboplatin, and Topotecan. All patients are alive; the mean follow-up 4 years. No patient developed metastatic disease, second cancer, or trilateral retinoblastoma and all eyes were salvaged. There were no cases of chemotherapy induced fever/neutropenia or need for transfusion of any blood product. Electroretinogram was not impaired by treatment, significant improvement in 30Hz function was seen (P = 0.02; mean before 61 μV, after 71 μV, SEM: 5.25 vs. 5.82).

Conclusions: Very young children (<3 months old and <6 kg weight) with unilateral or bilateral retinoblastoma can be safely and effectively treated with OAC (intra-arterial chemotherapy) without significant complications even though the majority had advanced intraocular disease (Reese-Ellsworth Vb or International Classification of Retinoblastoma "D" and "E"). This includes treating both eyes in the same session and as young as 5 weeks and weighing 3.6 kg. This eliminates the need for systemic chemotherapy, which is well known to be toxic to the youngest children.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

眼动脉化疗治疗视网膜母细胞瘤3个月以下或体重6公斤以下婴儿。
重要性:3个月以下和/或体重不足6公斤的儿童一直未接受眼动脉化疗(OAC)治疗,因为担心会在微小的股动脉中造成疤痕。相反,他们接受的是全身化疗:目的:确定对患有单侧和双侧视网膜母细胞瘤的幼童进行眼动脉化疗的可行性、安全性和有效性:对纪念斯隆-凯特琳癌症中心(MSKCC)收治的所有视网膜母细胞瘤患儿(单侧和双侧)在出生后 3 个月内或体重不足 6 千克时接受 OAC 治疗的情况进行回顾性、连续性审查:单一三级癌症转诊中心:所有视网膜母细胞瘤患儿(单侧或双侧)在出生后3个月内或体重不足6公斤时接受OAC治疗(17名患者):OAC通过插入股动脉和颈内动脉的微导管给药。17名患者通过眼动脉分60次接受美法仑、卡铂和托泊替康的联合治疗:主要结果测量指标:眼球挽救率、连续 ERG、患者存活率、二次癌症、发热/中性粒细胞减少症、输血、腹股沟出血或股动脉闭塞以及麻醉并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Ophthalmology. Retina
Ophthalmology. Retina Medicine-Ophthalmology
CiteScore
7.80
自引率
6.70%
发文量
274
审稿时长
33 days
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