Intra-arterial chemotherapy with melphalan for intraocular retinoblastoma

Bracco, Sandra; Leonini, Sara; Francesco, Sonia De; Cioni, Samuele; Vallone, Ignazio Maria; Piu, Pietro; Galimberti, Daniela; Romano, Daniele Giuseppe; Caini, Mauro; Luca, Maria De; Toti, Paolo; Galluzzi, Paolo; Hadjistilianou, Theodora; Cerase, Alfonso

doi:10.1136/bjophthalmol-2013-303267

Cited by 24 publications

(14 citation statements)

References 5 publications

(3 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Choroidal occlusive vasculopathy. The occurrence of intraocular adverse effects after intra-arterial chemotherapy was first reported in 2011, (Munier et al, 2011), with choroidal occlusive vasculopathy being the most frequently observed (Bianciotto et al, 2012;Bracco et al, 2013;Eagle et al, 2011;Muen et al, 2012;Munier et al, 2011). 7.3.5.2.1.…”

Section: Concomitant Drug Interactionsmentioning

confidence: 99%

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Munier

Beck‐Popovic

Chantada

et al. 2019

Progress in Retinal and Eye Research

160

157

View full text Add to dashboard Cite

Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.

show abstract

Section: Concomitant Drug Interactionsmentioning

confidence: 99%

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Munier

Beck‐Popovic

Chantada

et al. 2019

Progress in Retinal and Eye Research

160

157

View full text Add to dashboard Cite

show abstract

“…Since our introduction of ophthalmic artery chemosurgery in 2006 it has been replicated in more than 40 countries worldwide, and its advantage over conventional treatments have been emphasized by many authors. It has been successful in avoiding enucleation for eyes with advanced unilateral disease[ 15 ], bilateral disease (called “tandem therapy”[ 16 ]), eyes with extensive retinal detachment[ 17 , 18 ], eyes with vitreous and subretinal seeding[ 19 , 20 ] for both naive and eyes that progressed with conventional therapy[ 21 , 22 ]. Both single agent and multiple drug regimens are used; the drugs used are Melphalan (most commonly), Carboplatin and Topotecan.…”

Section: Discussionmentioning

confidence: 99%

Advanced Unilateral Retinoblastoma: The Impact of Ophthalmic Artery Chemosurgery on Enucleation Rate and Patient Survival at MSKCC

et al. 2015

View full text Add to dashboard Cite

PurposeTo report on the influence of ophthalmic artery chemosurgery (OAC) on enucleation rates, ocular and patient survival from metastasis and impact on practice patterns at Memorial Sloan Kettering for children with advanced intraocular unilateral retinoblastoma.Patients and MethodsSingle-center retrospective review of all unilateral retinoblastoma patients with advanced intraocular retinoblastoma treated at MSKCC between our introduction of OAC (May 2006) and December 2014. End points were ocular survival, patient survival from metastases and enucleation rates.Results156 eyes of 156 retinoblastoma patients were included. Primary enucleation rates have progressively decreased from a rate of >95% before OAC to 66.7% in the first year of OAC use to the present rate of 7.4%. The percent of patients receiving OAC has progressively increased from 33.3% in 2006 to 92.6% in 2014. Overall, ocular survival was significantly better in eyes treated with OAC in the years 2010–2014 compared to 2006–2009 (p = 0.023, 92.7% vs 68.0% ocular survival at 48 months). There have been no metastatic deaths in the OAC group but two patients treated with primary enucleation have died of metastatic disease.ConclusionOAC was introduced in 2006 and its impact on patient management is profound. Enucleation rates have decreased from over 95% to less than 10%. Our ocular survival rate has also significantly and progressively improved since May 2006. Despite treating more advanced eyes rather then enucleating them patient survival has not been compromised (there have been no metastatic deaths in the OAC group). In our institution, enucleation is no longer the most common treatment for advanced unilateral retinoblastoma.

show abstract

“…Despite the significant advances made in retinoblastoma management over the last decades, secondary enucleation (SE) is sometimes inevitable in order to preserve the patient from metastatic disease and death, and remains to date the treatment of choice for eyes that did not respond favorably to conservative strategies. Current indications to discontinue eye-preserving therapies include progressive/relapsing disease [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], persistent disease obscuring the optic nerve head, loss of fundus view (secondary to poor pupillary dilatation, intraocular hemorrhage and/or cataract) [ 2 , 5 , 17 , 18 , 40 , 41 , 43 , 44 ], neovascular complications [ …”

Section: Introductionmentioning

confidence: 99%

Current Indications of Secondary Enucleation in Retinoblastoma Management: A Position Paper on Behalf of the European Retinoblastoma Group (EURbG)

Stathopoulos

Rouic

Moll

et al. 2021

Cancers

View full text Add to dashboard Cite

Secondary enucleation (SE) puts an irreversible end to eye-preserving therapies, whenever their prolongation is expected to violate the presumed state of metastatic grace. At present, it must be acknowledged that clear criteria for SE are missing, leading to empiric and subjective indications commonly related to disease progression or relapse, disease persistence masking the optic nerve head or treatment-related complications obscuring the fundus view. This absence of evidence-based consensus regarding SE is explained by the continuously moving frontiers of the conservative management as a result of diagnostic and therapeutic advances, as well as by the lack of studies sufficiently powered to accurately stratify the risk of metastasis in conservatively treated patients. In this position paper of the European Retinoblastoma Group (EURbG), we give an overview of the progressive shift in the indications for SE over the past decades and propose guidelines to assist decision-making with respect to when SE becomes imperative or recommended, with corresponding absolute and relative SE indications. Further studies and validation of biologic markers correlated with the risk of metastasis are expected to set more precisely the frontiers of conservative management and thus consensual criteria for SE in the future.

show abstract

Intra-arterial chemotherapy with melphalan for intraocular retinoblastoma

Cited by 24 publications

References 5 publications

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Advanced Unilateral Retinoblastoma: The Impact of Ophthalmic Artery Chemosurgery on Enucleation Rate and Patient Survival at MSKCC

Current Indications of Secondary Enucleation in Retinoblastoma Management: A Position Paper on Behalf of the European Retinoblastoma Group (EURbG)

Contact Info

Product

Resources

About