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Technique of Ophthalmic Artery Chemosurgery for Retinoblastoma

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Recent Advances in Retinoblastoma Treatment

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Intra-arterial chemotherapy (IAC) has become an essential technique in the treatment of advanced intra-ocular retinoblastoma. In this chapter, we describe our experience with 1000 intra-arterial infusions for treating 290 eyes with retinoblastoma in 229 children, median age 15 month. According to the Reese-Ellsworth classification, 83 % eyes were Group V; according to the International classification, 70 % eyes were Group D and 13 % eyes were Group E. Catheterizations were successful in 98.8 %. The average number of IACs per eye was 3.4 (range 1–9). Three IAC techniques were used: direct ophthalmic artery infusion (77 %), infusion through the orbital branch of the middle meningeal artery (8 %), and balloon-assisted intracarotid infusion (14 %). The drug(s) were dosed according to age (which provides an estimate of the ocular size) and the angioanatomy of the ophthalmic artery and its branches. Body weight was taken into account only for limiting the total systemic dose. Three drugs were used: melphalan, topotecan, and carboplatin, usually in association. There were few complications. One patient died from a trilateral retinoblastoma, two patients who developed metastasis were treated with intensive chemotherapy and are doing well. The Kaplan–Meyer estimate of ocular survival was 85 % at 2 years, 77 % at 5 years, and 71 % at 7 years. In conclusion, IAC is a safe and effective technique that is used as first line therapy for advanced intra-ocular retinoblastoma.

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Compliance with Ethical Requirements

Y. Pierre Gobin declares that he has no conflict of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA

    Y. Pierre Gobin M.D.

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  1. Y. Pierre Gobin M.D.
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Correspondence to Y. Pierre Gobin M.D. .

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Editors and Affiliations

  1. Department of Ophthalmic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    Jasmine H. Francis

  2. Department of Ophthalmic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    David H. Abramson

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Gobin, Y.P. (2015). Technique of Ophthalmic Artery Chemosurgery for Retinoblastoma. In: Francis, J., Abramson, D. (eds) Recent Advances in Retinoblastoma Treatment. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-19467-7_3

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  • DOI: https://doi.org/10.1007/978-3-319-19467-7_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19466-0

  • Online ISBN: 978-3-319-19467-7

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