Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Combined chemotherapy and intra-arterial chemotherapy of retinoblastoma

  • Choi, Saerom (Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System) ;
  • Han, Jung Woo (Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System) ;
  • Kim, Hyosun (Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System) ;
  • Kim, Beom Sik (Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System) ;
  • Kim, Dong Joon (Department of Radiology, Yonsei University Health System) ;
  • Lee, Sung Chul (Department of Ophthalmology, Yonsei University Health System) ;
  • Lyu, Chuhl Joo (Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System)
  • Received : 2012.09.11
  • Accepted : 2012.10.25
  • Published : 2013.06.15
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Abstract

Purpose: Retinoblastoma (RB) is the most common primary malignant intraocular tumor in children. Although systemic chemotherapy has been the primary treatment, intra-arterial chemotherapy (IAC) represents a new treatment option. Here, we performed alternate systemic chemotherapy and IAC and retrospectively reviewed the efficacy and safety of this approach. Methods: Patients diagnosed with intraocular RB between January 2000 and December 2011 at Severance Children's Hospital, Yonsei University, were reviewed. Before February 2010, the primary treatment for RB was chemotherapy (non-IAC/CTX). Since February 2010, the primary treatment for RB has been IAC (IAC/CTX). External beam radiotherapy or high-dose chemotherapy were used as "last resort" treatments just prior to enucleation at the time of progression or recurrence during primary treatment. Enucleation-free survival (EFS) and progression-free survival were assessed. Results: We examined 19 patients (median age, 11.9 months; range, 1.4 to 75.6 months) with a sum of 25 eyes, of which, 60.0% were at advanced Reese Ellsworth (RE) stages. The enucleation rate was 33.3% at early RE stages and 81.8% at advanced RE stages (P=0.028). At 36 months, EFS was significantly higher in the IAC/CTX group than in the non-IAC/CTX group (100% vs. 40.0%, P=0.016). All 5 patients treated with IAC achieved eye preservation, although most patients were at advanced RE stages (IV-V). Conclusion: Despite the limitation of a small sample size, our work shows that an alternative combined approach using IAC and CTX may be safe and effective for eye preservation in advanced RB.

Keywords

References

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