Salvage/Adjuvant Brachytherapy After Ophthalmic Artery Chemosurgery for Intraocular Retinoblastoma

Abstract

Summary The efficacy and toxicity of brachytherapy following ophthalmic artery chemo-surgery for retinoblastoma was investigated in 15 eyes of 15 patients. This combination was effective, even in eyes with vitreous seeding, and the toxicity appeared to be no worse than reported with other radiation/chemotherapy treatments for retinoblastoma. Brachytherapy represents a potentially valuable salvage treatment for patients with recurrent retinoblastoma following ophthalmic artery chemosurgery treatment. Purpose To evaluate the efficacy and toxicity of brachytherapy after ophthalmic artery chemo-surgery (OAC) for retinoblastoma. Methods and Materials This was a single-arm, retrospective study of 15 eyes in 15 patients treated with OAC followed by brachytherapy at (blinded institution) between May 1, 2006, and December 31, 2012, with a median 19 months' follow-up from plaque insertion. Outcome measurements included patient and ocular survival, visual function, and retinal toxicity measured by electroretinogram (ERG). Results Brachytherapy was used as adjuvant treatment in 2 eyes and as salvage therapy in 13 eyes of which 12 had localized vitreous seeding. No patients developed metastasis or died of retinoblastoma. The Kaplan-Meier estimate of ocular survival was 79.4% (95% confidence interval 48.7%-92.8%) at 18 months. Three eyes were enucleated, and an additional 6 eyes developed out-of-target volume recurrences, which were controlled with additional treatments. Patients with an ocular complication had a mean interval between last OAC and plaque of 2.5 months (SD 2.3 months), which was statistically less (P= .045) than patients without ocular complication who had a mean interval between last OAC and plaque of 6.5 months (SD 4.4 months). ERG responses from pre- versus postplaque were unchanged or improved in more than half the eyes. Conclusions Brachytherapy following OAC is effective, even in the presence of vitreous seeding; the majority of eyes maintained stable or improved retinal function following treatment, as assessed by ERG.

Intra-Arterial Chemotherapy (Ophthalmic Artery Chemosurgery) for Group D Retinoblastoma

“…[ 36 , 37 ] Plaque brachytherapy, due to its localized radiation field, has not been associated with the subsequent development of second cancers, and so the addition of plaque brachytherapy was not considered to denote a failure of OAC, but rather the application of a focal treatment. [ 38 ] While several patients had received, and failed, EBRT prior to being referred to us for OAC, in our series, only two patients received post-OAC EBRT as salvage therapy, both of whom were treated with OAC early in this series, and both of whom received EBRT upon returning to their original referring institution. Interestingly, EBRT was not able to salvage the globe successfully in either of these two patients, and both required subsequent enucleation.…”

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

“…There is presently no consensus regarding the need of consolidation focal treatments following intra-arterial chemotherapy and their potential role in preventing recurrence as observed post chemoreduction (Table 11). Finally, although successful treatment of localized intravitreal seeding has been occasionally reported with brachytherapy (Abouzeid et al, 2008;Francis et al, 2013b) or cryotherapy (Abramson and Schefler, 2004a), these treatment modalities are not, however, primarily aimed at the control of vitreous disease.…”

“…Secondary neovascularization can develop during the conservative management of retinoblastoma and affect both posterior and anterior segments of the eye. Its occurrence has been associated with retinal ischemia secondary to chronic retinal detachment (Stathopoulos et al, 2018a;Tawansy et al, 2006), focal treatments (Ghassemi and Amoli, 2014;Kase et al, 2008;Schefler et al, 2007), external irradiation (Archer et al, 1993;Hwang et al, 2017), plaque radiotherapy (Abouzeid et al, 2008;Albert, 1987;Francis et al, 2013b;Murakami et al, 2012), intra-arterial chemotherapy (Bianciotto et al, 2012;Stathopoulos et al, 2018a) as well as active tumor progression (Stathopoulos et al, 2018a) or recurrence (Kiratli et al, 2017;Stathopoulos et al, 2018a).…”

Reassessing the Role of Intra-Arterial Drug Delivery for Glioblastoma Multiforme Treatment

“…Today, IA chemotherapy is widely used as a treatment for this tumor. Data demonstrates that IA chemotherapy extends organ survival, avoids disfiguring ablative surgery, and may promote functional recovery [ 32 , 69 – 71 ]. Sullivan et al introduced hepatic artery (HA) chemotherapy in 1964 [ 72 ].…”