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AW02 SIOP19-0586 Intra‐arterial Chemotherapy (IAC) for Treatment of Intraocular Retinoblastoma: Successes and Lessons Learnt

In Pediatric Blood & Cancer
By: Srinivasan S.
Contributor(s): Mohd. S | Vora T | Prasad M | Baheti A | Qureshi S | Shetty N | Kembhavi S | Chinnaswamy G | Shetye N | Kulkarni S | Sd B.
Material type: materialTypeLabelArticlePublisher: 2019Description: .Subject(s): Intra‐arterial Chemotherapy (IAC) | Intraocular Retinoblastoma | Myelosuppression In: Pediatric Blood & CancerSummary: Background/Objectives: IAC is an effective modality for the treatment of intraocular Retinoblastoma (RB), potentially increasing globe salvage rates and avoiding toxicity of systemic chemotherapy. In LMICs, where fear of enucleation leads to high abandonment rates, IAC could be an effective strategy. We report the impact of IAC in retinoblastoma children at our centre. Design/Methods: This is a retrospective study (2012‐2018) of outcomes of RB children treated with IAC using melphalan, carboplatin and topotecan (single agent/combination). In all cases, treatment decisions were made by the multidisciplinary team which included a pediatric ophthalmologist. Study outcomes included globe salvage rates, treatment abandonment, therapy complications and analysis of risk factors for treatment failure. Results: A total of 71 eyes in 59 children were subjected to IAC, median age:20months (2‐97) and M: F=1.3:1. This included ICRB group B eyes:6 (9%), C:3 (4%), D:42 (59%) and E:20 (28%). Total IAC sessions were 223 and median sessions/eye was 4 (Range:1‐8). Eighteen (25%) received additional focal consolidative therapy. At a median follow up of 31 months, 3‐year globe salvage rate is 47±7% and 3‐year overall survival is 95±3%. The 3‐year globe salvage with primary (n‐32) and secondary (n‐39) IACis 29±9.5% and 63±8%(p= 0.005) respectively and 67%, 100%, 49% and 67% for ICRB Group B, C, D and E eyes respectively. Presence of vitreous seeds was associated with increased enucleation (HR:2.73;95%CI:1.32‐6.65;p=0.007). Two of 4 CNS relapses had tumor abutting the optic disc. Complications included transient loss of vision[4/71 (6%) eyes], retinal pigment changes[7/71 (10%) eyes], vitreous hemorrhage[6/71 (8%) eyes] and eyelid/orbital edema in 10%(23/223 sessions). Grade IV cytopenia was documented in 25%(15/59) of children and one child had a permanent loss of vision. Treatment abandonment rate reduced from 11% in 2012 to <5% post 2013. Conclusions: IAC is an effective strategy for globe salvage in retinoblastoma and helped decreasing treatment abandonment. Presence of vitreous seeds is associated with poor globe salvage rates. Use of combination IAC is associated with significant myelosuppression.
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Articles Articles Tata Memorial Hospital
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Abstracts from the 51st Congress of the International Society of Paediatric Oncology (SIOP) Lyon, France, October 23–26, 2019

Background/Objectives: IAC is an effective modality for the treatment of intraocular Retinoblastoma (RB), potentially increasing globe salvage rates and avoiding toxicity of systemic chemotherapy. In LMICs, where fear of enucleation leads to high abandonment rates, IAC could be an effective strategy. We report the impact of IAC in retinoblastoma children at our centre.

Design/Methods: This is a retrospective study (2012‐2018) of outcomes of RB children treated with IAC using melphalan, carboplatin and topotecan (single agent/combination). In all cases, treatment decisions were made by the multidisciplinary team which included a pediatric ophthalmologist. Study outcomes included globe salvage rates, treatment abandonment, therapy complications and analysis of risk factors for treatment failure.

Results: A total of 71 eyes in 59 children were subjected to IAC, median age:20months (2‐97) and M: F=1.3:1. This included ICRB group B eyes:6 (9%), C:3 (4%), D:42 (59%) and E:20 (28%). Total IAC sessions were 223 and median sessions/eye was 4 (Range:1‐8). Eighteen (25%) received additional focal consolidative therapy. At a median follow up of 31 months, 3‐year globe salvage rate is 47±7% and 3‐year overall survival is 95±3%. The 3‐year globe salvage with primary (n‐32) and secondary (n‐39) IACis 29±9.5% and 63±8%(p= 0.005) respectively and 67%, 100%, 49% and 67% for ICRB Group B, C, D and E eyes respectively. Presence of vitreous seeds was associated with increased enucleation (HR:2.73;95%CI:1.32‐6.65;p=0.007). Two of 4 CNS relapses had tumor abutting the optic disc. Complications included transient loss of vision[4/71 (6%) eyes], retinal pigment changes[7/71 (10%) eyes], vitreous hemorrhage[6/71 (8%) eyes] and eyelid/orbital edema in 10%(23/223 sessions). Grade IV cytopenia was documented in 25%(15/59) of children and one child had a permanent loss of vision. Treatment abandonment rate reduced from 11% in 2012 to <5% post 2013.

Conclusions: IAC is an effective strategy for globe salvage in retinoblastoma and helped decreasing treatment abandonment. Presence of vitreous seeds is associated with poor globe salvage rates. Use of combination IAC is associated with significant myelosuppression.

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