Pearls and pitfalls of intraarterial chemotherapy for retinoblastoma

A review

View More View Less
  • 1 Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience; and
  • | 2 Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online Sign in

Retinoblastoma is a deadly eye cancer in children, leading to death in 50%–70% of children in undeveloped nations who are diagnosed with it. This malignancy is the most common intraocular tumor in childhood worldwide. The good prognosis in developed nations is related to early detection and advanced treatments. With the advent of intraarterial chemotherapy, neurosurgeons have taken a central role in the treatment of this pediatric condition. Intraarterial chemotherapy is a novel treatment for retinoblastoma whereby chemotherapeutic agents are precisely delivered into the ophthalmic artery, minimizing systemic toxicity. This procedure has shown impressive results and has allowed a dramatic decrease in the rate of enucleation (eye removal) in advanced and refractory retinoblastoma. Recent reports have raised some concerns about the risk of ocular vasculopathy, radiation-related toxicity, and the potential for metastatic disease after intraarterial chemotherapy. In the authors' experience of more than 3 years, tumor control is excellent with globe salvage at 67% and vascular events less than 5%, mostly related to improvement in technique. The role of this novel approach in the management of retinoblastoma has yet to be defined. As more centers are adopting the technique, the topic will decidedly become the focus of intensive future research. In this paper, the authors review and discuss current data regarding intraarterial chemotherapy for retinoblastoma.

Abbreviations used in this paper:

IAC = intraarterial chemotherapy; ICRB = International Classification of Retinoblastoma.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Abramson DH, , Dunkel IJ, , Brodie SE, , Kim JW, & Gobin YP: A phase I/II study of direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma initial results. Ophthalmology 115:13981404, 1404 e1, 2008

    • Search Google Scholar
    • Export Citation
  • 2

    Abramson DH, , Dunkel IJ, , Brodie SE, , Marr B, & Gobin YP: Bilateral superselective ophthalmic artery chemotherapy for bilateral retinoblastoma: tandem therapy. Arch Ophthalmol 128:370372, 2010

    • Search Google Scholar
    • Export Citation
  • 3

    Abramson DH, , Dunkel IJ, , Brodie SE, , Marr B, & Gobin YP: Superselective ophthalmic artery chemotherapy as primary treatment for retinoblastoma (chemosurgery). Ophthalmology 117:16231629, 2010

    • Search Google Scholar
    • Export Citation
  • 4

    Bayar E, , Robinson MG, & Kurczynski TW: Unilateral retinoblastoma with acquired monosomy 7 and secondary acute myelomonocytic leukemia. Cancer Genet Cytogenet 105:7982, 1998

    • Search Google Scholar
    • Export Citation
  • 5

    Benz MS, , Scott IU, , Murray TG, , Kramer D, & Toledano S: Complications of systemic chemotherapy as treatment of retinoblastoma. Arch Ophthalmol 118:577578, 2000

    • Search Google Scholar
    • Export Citation
  • 6

    Bianciotto C, , Shields CL, , Iturralde JC, , Sarici A, , Jabbour P, & Shields JA: Fluorescein angiographic findings after intra-arterial chemotherapy for retinoblastoma. Ophthalmology 119:843849, 2012

    • Search Google Scholar
    • Export Citation
  • 7

    Broaddus E, , Topham A, & Singh AD: Survival with retinoblastoma in the USA: 1975–2004. Br J Ophthalmol 93:2427, 2009

  • 8

    Chintagumpala M, , Chevez-Barrios P, , Paysse EA, , Plon SE, & Hurwitz R: Retinoblastoma: review of current management. Oncologist 12:12371246, 2007

    • Search Google Scholar
    • Export Citation
  • 9

    De Potter P, , Shields CL, & Shields JA: Clinical variations of trilateral retinoblastoma: a report of 13 cases. J Pediatr Ophthalmol Strabismus 31:2631, 1994

    • Search Google Scholar
    • Export Citation
  • 10

    De Potter P, , Shields CL, , Shields JA, & Singh AD: Use of the hydroxyapatite ocular implant in the pediatric population. Arch Ophthalmol 112:208212, 1994

    • Search Google Scholar
    • Export Citation
  • 11

    Doz F: [Retinoblatoma: a review.]. Arch Pediatr 13:13291337, 2006. (Fr)

  • 12

    Dunkel IJ, , Lee TC, , Shi W, , Beaverson KL, , Novetsky D, & Lyden D, et al.: A phase II trial of carboplatin for intraocular retinoblastoma. Pediatr Blood Cancer 49:643648, 2007

    • Search Google Scholar
    • Export Citation
  • 13

    Eagle RC Jr, , Shields CL, , Bianciotto C, , Jabbour P, & Shields JA: Histopathologic observations after intra-arterial chemotherapy for retinoblastoma. Arch Ophthalmol 129:14161421, 2011

    • Search Google Scholar
    • Export Citation
  • 14

    Ferris FL III, & Chew EY: A new era for the treatment of retinoblastoma. Arch Ophthalmol 114:1412, 1996

  • 15

    Gobin YP, , Dunkel IJ, , Marr BP, , Brodie SE, & Abramson DH: Intra-arterial chemotherapy for the management of retinoblastoma: four-year experience. Arch Ophthalmol 129:732737, 2011

    • Search Google Scholar
    • Export Citation
  • 16

    Greenwald MJ, & Strauss LC: Treatment of intraocular retinoblastoma with carboplatin and etoposide chemotherapy. Ophthalmology 103:19891997, 1996

    • Search Google Scholar
    • Export Citation
  • 17

    Gündüz K, , Shields CL, , Shields JA, , Meadows AT, , Gross N, & Cater J, et al.: The outcome of chemoreduction treatment in patients with Reese-Ellsworth group V retinoblastoma. Arch Ophthalmol 116:16131617, 1998

    • Search Google Scholar
    • Export Citation
  • 18

    Imhof SM, , Mourits MP, , Hofman P, , Zonneveld FW, , Schipper J, & Moll AC, et al.: Quantification of orbital and mid-facial growth retardation after megavoltage external beam irradiation in children with retinoblastoma. Ophthalmology 103:263268, 1996

    • Search Google Scholar
    • Export Citation
  • 19

    Inomata M, & Kaneko A: Chemosensitivity profiles of primary and cultured human retinoblastoma cells in a human tumor clonogenic assay. Jpn J Cancer Res 78:858868, 1987

    • Search Google Scholar
    • Export Citation
  • 20

    Kingston JE, , Hungerford JL, , Madreperla SA, & Plowman PN: Results of combined chemotherapy and radiotherapy for advanced intraocular retinoblastoma. Arch Ophthalmol 114:13391343, 1996

    • Search Google Scholar
    • Export Citation
  • 21

    Kiss S, , Leiderman YI, & Mukai S: Diagnosis, classification, and treatment of retinoblastoma. Int Ophthalmol Clin 48:135147, 2008

  • 22

    Kivelä T: The epidemiological challenge of the most frequent eye cancer: retinoblastoma, an issue of birth and death. Br J Ophthalmol 93:11291131, 2009

    • Search Google Scholar
    • Export Citation
  • 23

    Kleinerman RA, , Tucker MA, , Tarone RE, , Abramson DH, , Seddon JM, & Stovall M, et al.: Risk of new cancers after radiotherapy in long-term survivors of retinoblastoma: an extended follow-up. J Clin Oncol 23:22722279, 2005

    • Search Google Scholar
    • Export Citation
  • 24

    Laurie NA, , Gray JK, , Zhang J, , Leggas M, , Relling M, & Egorin M, et al.: Topotecan combination chemotherapy in two new rodent models of retinoblastoma. Clin Cancer Res 11:75697578, 2005

    • Search Google Scholar
    • Export Citation
  • 25

    Linn Murphree A: Intraocular retinoblastoma: the case for a new group classification. Ophthalmol Clin North Am 18:4153, viii, 2005

  • 26

    MacCarthy A, , Birch JM, , Draper GJ, , Hungerford JL, , Kingston JE, & Kroll ME, et al.: Retinoblastoma in Great Britain 1963–2002. Br J Ophthalmol 93:3337, 2009

    • Search Google Scholar
    • Export Citation
  • 27

    Munier FL, , Beck-Popovic M, , Balmer A, , Gaillard MC, , Bovey E, & Binaghi S: Occurrence of sectoral choroidal occlusive vasculopathy and retinal arteriolar embolization after superselective ophthalmic artery chemotherapy for advanced intraocular retinoblastoma. Retina 31:566573, 2011

    • Search Google Scholar
    • Export Citation
  • 28

    Murphree AL, , Villablanca JG, , Deegan WF III, , Sato JK, , Malogolowkin M, & Fisher A, et al.: Chemotherapy plus local treatment in the management of intraocular retinoblastoma. Arch Ophthalmol 114:13481356, 1996

    • Search Google Scholar
    • Export Citation
  • 29

    Peterson EC, , Elhammady MS, , Quintero-Wolfe S, , Murray TG, & Aziz-Sultan MA: Selective ophthalmic artery infusion of chemotherapy for advanced intraocular retinoblastoma: initial experience with 17 tumors. Clinical article. J Neurosurg 114:16031608, 2011

    • Search Google Scholar
    • Export Citation
  • 30

    Reese AB, , Hyman GA, , Merriam GR Jr, , Forrest AW, & Kligerman MM: Treatment of retinoblastoma by radiation and triethylenemelamine. AMA Arch Opthalmol 53:505513, 1954

    • Search Google Scholar
    • Export Citation
  • 31

    Rizzuti AE, , Dunkel IJ, & Abramson DH: The adverse events of chemotherapy for retinoblastoma: what are they? Do we know?. Arch Ophthalmol 126:862865, 2008

    • Search Google Scholar
    • Export Citation
  • 32

    Shields CL, , Bianciotto CG, , Jabbour P, , Griffin GC, , Ramasubramanian A, & Rosenwasser R, et al.: Intra-arterial chemotherapy for retinoblastoma: report No. 2, treatment complications. Arch Ophthalmol 129:14071415, 2011

    • Search Google Scholar
    • Export Citation
  • 33

    Shields CL, , Bianciotto CG, , Jabbour P, , Ramasubramanian A, , Lally SE, & Griffin GC, et al.: Intra-arterial chemotherapy for retinoblastoma: report No. 1, control of retinal tumors, subretinal seeds, and vitreous seeds. Arch Ophthalmol 129:13991406, 2011

    • Search Google Scholar
    • Export Citation
  • 34

    Shields CL, , De Potter P, , Himelstein BP, , Shields JA, , Meadows AT, & Maris JM: Chemoreduction in the initial management of intraocular retinoblastoma. Arch Ophthalmol 114:13301338, 1996

    • Search Google Scholar
    • Export Citation
  • 35

    Shields CL, , Honavar SG, , Meadows AT, , Shields JA, , Demirci H, & Singh A, et al.: Chemoreduction plus focal therapy for retinoblastoma: factors predictive of need for treatment with external beam radiotherapy or enucleation. Am J Ophthalmol 133:657664, 2002

    • Search Google Scholar
    • Export Citation
  • 36

    Shields CL, , Kaliki S, , Shah SU, , Bianciotto CG, , Liu D, & Jabbour P, et al.: Minimal exposure (one or two cycles) of intra-arterial chemotherapy in the management of retinoblastoma. Ophthalmology 119:188192, 2012

    • Search Google Scholar
    • Export Citation
  • 37

    Shields CL, , Mashayekhi A, , Au AK, , Czyz C, , Leahey A, & Meadows AT, et al.: The International Classification of Retinoblastoma predicts chemoreduction success. Ophthalmology 113:22762280, 2006

    • Search Google Scholar
    • Export Citation
  • 38

    Shields CL, , Mashayekhi A, , Cater J, , Shelil A, , Meadows AT, & Shields JA: Chemoreduction for retinoblastoma. Analysis of tumor control and risks for recurrence in 457 tumors. Am J Ophthalmol 138:329337, 2004

    • Search Google Scholar
    • Export Citation
  • 39

    Shields CL, , Ramasubramanian A, , Rosenwasser R, & Shields JA: Superselective catheterization of the ophthalmic artery for intraarterial chemotherapy for retinoblastoma. Retina 29:12071209, 2009

    • Search Google Scholar
    • Export Citation
  • 40

    Shields CL, & Shields JA: Basic understanding of current classification and management of retinoblastoma. Curr Opin Ophthalmol 17:228234, 2006

    • Search Google Scholar
    • Export Citation
  • 41

    Shields CL, & Shields JA: Intra-arterial chemotherapy for retinoblastoma: the beginning of a long journey. Clin Experiment Ophthalmol 38:638643, 2010

    • Search Google Scholar
    • Export Citation
  • 42

    Shields CL, & Shields JA: Retinoblastoma management: advances in enucleation, intravenous chemoreduction, and intraarterial chemotherapy. Curr Opin Ophthalmol 21:203212, 2010

    • Search Google Scholar
    • Export Citation
  • 43

    Shields CL, , Uysal Y, , Marr BP, , Lally SE, , Rodriques E, & Kharod B, et al.: Experience with the polymer-coated hydroxyapatite implant after enucleation in 126 patients. Ophthalmology 114:367373, 2007

    • Search Google Scholar
    • Export Citation
  • 44

    Suzuki S, , Yamane T, , Mohri M, & Kaneko A: Selective ophthalmic arterial injection therapy for intraocular retinoblastoma: the long-term prognosis. Ophthalmology 118:20812087, 2011

    • Search Google Scholar
    • Export Citation
  • 45

    Vajzovic LM, , Murray TG, , Aziz-Sultan MA, , Schefler AC, , Fernandes CE, & Wolfe SC, et al.: Clinicopathologic review of enucleated eyes after intra-arterial chemotherapy with melphalan for advanced retinoblastoma. Arch Ophthalmol 128:16191623, 2010

    • Search Google Scholar
    • Export Citation
  • 46

    Vijayakrishnan R, , Shields CL, , Ramasubramanian A, , Emrich J, , Rosenwasser R, & Shields JA: Irradiation toxic effects during intra-arterial chemotherapy for retinoblastoma: should we be concerned?. Arch Ophthalmol 128:14271431, 2010

    • Search Google Scholar
    • Export Citation
  • 47

    Yamane T, , Kaneko A, & Mohri M: The technique of ophthalmic arterial infusion therapy for patients with intraocular retinoblastoma. Int J Clin Oncol 9:6973, 2004

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1306 384 19
Full Text Views 268 37 2
PDF Downloads 281 44 2
EPUB Downloads 0 0 0