Ophthalmic Artery Chemosurgery for Retinoblastoma Babies Less than 3 months old or under 6 KG Weight.

Abstract

Importance: Children younger than 3 months of age and/or weighing less than 6kg have not been treated with Ophthalmic Artery Chemosurgery (OAC) because of concerns about causing scarring in the tiny femoral artery. Instead, they receive systemic chemotherapy.

Objective: To determine the feasibility, safety and efficacy of 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 less than 6 kg. treated at Memorial Sloan Kettering Cancer Center (MSKCC).

Setting: Single tertiary referral cancer center.

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

Exposures: OAC 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 measure: Ocular salvage, serial ERG's, patient survival, second cancers, fever/neutropenia, transfusion of any blood product, groin bleeding or femoral artery occlusion and anesthetic complications CONCLUSION AND RELEVANCE: Very young children (< 3 months old and <6kg weight) with unilateral or bilateral retinoblastoma can be safely and effectively treated with OAC (intraarterial chemotherapy) without significant complications despite the fact that the majority had advanced intraocular disease (Reese-Ellsworth (RE)Vb or International Classification of Retinoblastoma (ICRb) "D" and "E"). This includes treating both eyes in the same session and as young as 5 weeks and weighing 3.6kg. This eliminates the need for systemic chemotherapy which is well known to be toxic to the youngest children.