Ophthalmic Vascular Events after Primary Unilateral Intra-arterial Chemotherapy for Retinoblastoma in Early and Recent Eras

Dalvin, Lauren A; Ancona‐Lezama, David; Lucio-Alvarez, J. Antonio; Masoomian, Babak; Jabbour, Pascal; Shields, Carol L.

doi:10.1016/j.ophtha.2018.05.013

Cited by 46 publications

(28 citation statements)

References 23 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Locally, adverse effects consist of redness (29%), transient eyelid edema (5%), loss of eyelashes (5%), blepharoptosis (5%), forehead hyperemia (2%), and rarely third or sixth nerve palsy, each of them resolving within 2-3 months (Wyse et al, 2016). Intraocular vascular complications, such as ophthalmic artery obstruction (2%), vitreous hemorrhage (2%), choroidal occlusive vasculopathy (7%), are of greater concern (see 7.3.5.2), especially in eyes with visual potential, as they can irreversibly compromise vision (Dalvin et al, 2018;Shields et al, 2014).…”

Section: Table 11mentioning

confidence: 99%

Section: Concomitant Drug Interactionsmentioning

confidence: 99%

“…Its incidence varies substantially in the literature ranging from 7% (Dalvin et al, 2018) (Bianciotto et al, 2012) to 47% (Muen et al, 2012). This variability may be explained at least in part by a learning curve (Dalvin et al, 2018;Reddy et al, 2017), and/or by the fact that not all grades of the complication are necessarily reported (see Table 16). According to the Lausanne data collected over the last 10 years, this complication was observed in 21 of 560 injection procedures (3.8%) administered to 213 eyes (9.8%), and typically occurred after a mean number of 2.4 injections (range 1-5), distributed in 10% grade 1, 52% grade 3, 10% grade 4, and 28% grade 5.…”

Section: Concomitant Drug Interactionsmentioning

confidence: 99%

“…Different hypotheses have been proposed to account for the occurrence of choroidal occlusive vasculopathy, including the injection mode and technique of cannulation of the ophthalmic artery, the injected drug toxicity as well as intrinsic predisposing factors. In the literature, there is a decline in the reported vascular events over time, most likely due to a learning curve enabling complications of ophthalmic artery catheterization to be avoided, with the complication occurring in about 7-10% of the injected eyes (Dalvin et al, 2018;FLM unpublished data). However, when isolated choroidal atrophy (i.e.…”

Section: Concomitant Drug Interactionsmentioning

confidence: 99%

“…However, when isolated choroidal atrophy (i.e. not associated with ophthalmic artery occlusion) and choroidal atrophy resulting from ophthalmic artery occlusion are cumulated, the overall choroidal vasculopathy incidence is between 10 and 15% of injected eyes (Ancona-Lezama et al, 2018;Dalvin et al, 2018).…”

Section: Concomitant Drug Interactionsmentioning

confidence: 99%

See 4 more Smart Citations

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

149

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: Table 11mentioning

confidence: 99%

Section: Concomitant Drug Interactionsmentioning

confidence: 99%

Section: Concomitant Drug Interactionsmentioning

confidence: 99%

Section: Concomitant Drug Interactionsmentioning

confidence: 99%

Section: Concomitant Drug Interactionsmentioning

confidence: 99%

See 3 more Smart Citations

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

149

157

View full text Add to dashboard Cite

show abstract

Incidence and Risk Factors for Neutropenia After Intra-Arterial Chemotherapy for Retinoblastoma

Lee,

Donkor,

Parvus

et al. 2023

JAMA Ophthalmol

View full text Add to dashboard Cite

ImportanceIntra-arterial chemotherapy (IAC) has quickly gained popularity as a mainstay of treatment for retinoblastoma. Intra-articular chemotherapy has been described as having several advantages over systemic chemotherapy, including reduced systemic toxicity and neutropenia; however, studies on the risk of neutropenia after IAC remain limited.ObjectiveTo estimate the incidence of neutropenia after IAC, as well as identify risk factors associated with the development of neutropenia.Design, Setting, and ParticipantsThis case series included pediatric patients with unilateral or bilateral retinoblastoma who were treated with IAC at a single quaternary care center from July 13, 2013, to January 6, 2023.ExposureAll patients were treated with IAC and underwent multiple IAC cycles depending on treatment response. The primary chemotherapy agent used was melphalan, but topotecan or carboplatin could be used along with melphalan. Melphalan doses were kept to 0.4 mg/kg or less per cycle. After each IAC cycle, complete blood cell counts were obtained within 10 to 12 days and repeated until the absolute neutrophil count (ANC) was greater than or equal to 1000/μL.Main Outcomes and MeasuresThe primary outcome was the minimum ANC after each IAC cycle. The secondary outcome was the development of severe (grade 3 or 4) neutropenia (ANC &lt;1000/μL). Regression analyses were used to identify associations between variables and outcomes. Receiver operating characteristic curves were used to calculate threshold dose for each chemotherapy agent potentially associated with the development of severe neutropenia.ResultsA total of 64 eyes of 49 patients (mean [SD] age, 1.7 [1.2] years; 25 females [51.0%]) with retinoblastoma were treated with 171 cycles of IAC. The mean (SD) nadir ANC was 1325.3 (890.7)/μL and occurred a median (IQR) of 10 (10-14) days (range, 6-28 days) after IAC administration. The frequency distribution of post-IAC neutropenia grades 0, 1, 2, 3, 4, and missing was 31 (18.1% of cycles), 25 (14.6%), 40 (23.4%), 37 (21.6%), 26 (15.2%), and 12 (7.0%), respectively. Factors weakly correlated with a lower ANC were higher melphalan dose (β = −2356 [95% CI, –4120.6 to −611.2]; adjusted R2 = 0.251; P = .01) and higher topotecan dose (β = −4056 [95% CI, –7003.6 to −1344.5]; adjusted R2 = 0.251; P = .006).Conclusions and RelevanceIn this case series of patients with retinoblastoma, the incidence of severe neutropenia after IAC was nearly 40%, which is higher than previously reported. Extended laboratory monitoring may aid in capturing previously overlooked cases of neutropenia. Topotecan may be associated with the development of neutropenia; limiting topotecan doses, especially in the setting of a high melphalan dose, may be beneficial in reducing the risk of neutropenia.

show abstract

Intravenous chemotherapy versus intra-arterial chemotherapy for retinoblastoma

Rokohl

Skoetz

Mor

et al. 2020

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Ophthalmic Vascular Events after Primary Unilateral Intra-arterial Chemotherapy for Retinoblastoma in Early and Recent Eras

Cited by 46 publications

References 23 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”

Incidence and Risk Factors for Neutropenia After Intra-Arterial Chemotherapy for Retinoblastoma

Intravenous chemotherapy versus intra-arterial chemotherapy for retinoblastoma

Contact Info

Product

Resources

About