Rescue intra-arterial chemotherapy in unilateral multirelapsed peripapillary retinoblastoma: Decision making and the role of MRI

Abstract

Introduction: In this case report we report our experience with rescue intra-arterial chemotherapy in a case of multi-relapsed peripapillary Retinoblastoma (RB) and the importance of high resolution MRI in detecting possible optic disc infiltration. Case report: In 2007, a 14 month-old caucasian girl was referred to our ocular oncology unit for leukocoria. Only left eye was interested, with a single mass of the posterior pole. Patient underwent six cycles of systemic chemotherapy and focal laser consolidation. Several relapses occurred during follow-up. Selective intra-arterial chemotherapy (SIAC) with Melphalan was performed and type IV remission was achieved. A new relapse occurred next to the optic disc. MRI was performed and we decided to try to save the globe with a rescue cycle of SIAC. Conclusion: MRI has demonstrated to be useful in decision making in RB, giving us a last chance to save the globe.

"Unifocality as Prognostic Factor for Unilateral Retinoblastoma: Preliminary Results of 32 Eyes Treated with Intra-Arterial Chemotherapy Alone"

“…New therapeutic paradigms significantly improved the chances of anatomical and, often, functional preservation of the globe even with advanced stage diseases [7][8][9]. The introduction of selective for eyes with subretinal and vitreous seeding, with the majority of patients receiving 3 or less cycles of IAC with one to three drugs [11].…”

Bmi-1 promotes the proliferation, migration and invasion, and inhibits cell apoptosis of human retinoblastoma cells via RKIP

“…Retinoblastoma is more common in children under 5 years old, and is prone to intracranial and distant metastasis, which seriously threatens the life and health of children 2 , 3 . The existing treatments for retinoblastoma include chemotherapy, laser photocoagulation, cryotherapy, radiotherapy, and enucleation 4 . The preferred treatment option is systemic chemotherapy combined with local consolidation therapy, such as photocoagulation and cryotherapy 5 .…”