Skip to main content

Advertisement

SpringerLink
Log in

Combined intravitreal melphalan and intravenous/intra-arterial chemotherapy for retinoblastoma with vitreous seeds

  • Oncology
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

We aimed to evaluate the therapeutic effect and complications of combined intravitreal melphalan and intravenous/intra-arterial chemotherapy as a primary approach for retinoblastoma with vitreous seeds.

Methods

In this retrospective case series, eight eyes from eight retinoblastoma patients with vitreous seeds were included. All eyes received 20–30 μg of intravitreal melphalan accompanied by intravenous and intra-arterial chemotherapy. Triple freeze-thaw cryotherapy was performed when withdrawing the needle from the eye to prevent tumor dissemination.

Results

Tumors and vitreous seeds regressed in all eyes. The mean number of intravitreal melphalan injections was 3.25 (median 3.50, range 2–4). Globe salvage was attained in seven of eight eyes (87.5 %). Enucleation was performed in one case, in which the pathologic section showed no residual tumor and tumor-free resection margins. Serous retinal detachment was observed in four eyes (50 %), and vitreous hemorrhage developed in two (25 %). Retinal pigment epithelium atrophy or mottling was found in three eyes (37.5 %). There were no cases of extraocular tumor extension or remote metastasis.

Conclusions

Combined intravitreal melphalan and intravenous/intra-arterial chemotherapy was effective for tumor and vitreous seeding control, but vision-threatening complications such as vitreous hemorrhage or serous retinal detachment occurred in half the cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig 1

Similar content being viewed by others

References

  1. Shields CL, Mashayekhi A, Au AK, Czyz C, Leahey A, Meadows AT, Shields JA (2006) The international classification of retinoblastoma predicts chemoreduction success. Ophthalmology 113:2276–2280

    Article  PubMed  Google Scholar 

  2. Shields CL, Ramasubramanian A, Thangappan A, Hartzell K, Leahey A, Meadows AT, Shields JA (2009) Chemoreduction for group E retinoblastoma: comparison of chemoreduction alone versus chemoreduction plus low-dose external radiotherapy in 76 eyes. Ophthalmology 116:544–551, e541

    Article  PubMed  Google Scholar 

  3. Shields CL, Bianciotto CG, Jabbour P, Ramasubramanian A, Lally SE, Griffin GC, Rosenwasser R, Shields JA (2011) Intra-arterial chemotherapy for retinoblastoma: report No. 1, control of retinal tumors, subretinal seeds, and vitreous seeds. Arch Ophthalmol 129:1399–1406

    Article  PubMed  Google Scholar 

  4. Abramson DH, Marr BP, Dunkel IJ, Brodie S, Zabor EC, Driscoll SJ, Gobin YP (2012) Intra-arterial chemotherapy for retinoblastoma in eyes with vitreous and/or subretinal seeding: 2-year results. Br J Ophthalmol 96:499–502

    Article  PubMed  Google Scholar 

  5. Munier FL, Gaillard MC, Balmer A, Soliman S, Podilsky G, Moulin AP, Beck-Popovic M (2012) Intravitreal chemotherapy for vitreous disease in retinoblastoma revisited: from prohibition to conditional indications. Br J Ophthalmol 96:1078–1083

    Article  PubMed  Google Scholar 

  6. Ghassemi F, Shields CL (2012) Intravitreal melphalan for refractory or recurrent vitreous seeding from retinoblastoma. Arch Ophthalmol 130:1268–1271

    Article  PubMed  Google Scholar 

  7. Shields CL, Manjandavida FP, Arepalli S, Kaliki S, Lally SE, Shields JA (2014) Intravitreal melphalan for persistent or recurrent retinoblastoma vitreous seeds: preliminary results. JAMA Ophthalmol 132:319–325

    Article  PubMed  Google Scholar 

  8. Munier FL, Soliman S, Moulin AP, Gaillard MC, Balmer A, Beck-Popovic M (2012) Profiling safety of intravitreal injections for retinoblastoma using an anti-reflux procedure and sterilisation of the needle track. Br J Ophthalmol 96:1084–1087

    Article  PubMed  Google Scholar 

  9. Smith SJ, Smith BD, Mohney BG (2014) Ocular side effects following intravitreal injection therapy for retinoblastoma: a systematic review. Br J Ophthalmol 98:292–297

    Article  PubMed  Google Scholar 

  10. Ghassemi F, Shields CL, Ghadimi H, Khodabandeh A, Roohipoor R (2014) Combined intravitreal melphalan and topotecan for refractory or recurrent vitreous seeding from retinoblastoma. JAMA Ophthalmol 132:936–941

    Article  PubMed  Google Scholar 

  11. Shields CL, Bianciotto CG, Jabbour P, Griffin GC, Ramasubramanian A, Rosenwasser R, Shields JA (2011) Intra-arterial chemotherapy for retinoblastoma: report No. 2, treatment complications. Arch Ophthalmol 129:1407–1415

    Article  PubMed  CAS  Google Scholar 

  12. Muen WJ, Kingston JE, Robertson F, Brew S, Sagoo MS, Reddy MA (2012) Efficacy and complications of super-selective intra-ophthalmic artery melphalan for the treatment of refractory retinoblastoma. Ophthalmology 119:611–616

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea

    Ji Hwan Lee & Sung Chul Lee

  2. Department of Pediatric Hematology and Oncology, Yonsei University College of Medicine, Seoul, Korea

    Jung Woo Han, Seung Min Hahn & Chuhl Joo Lyu

  3. Department of Radiology, Yonsei University College of Medicine, Seoul, Korea

    Dong Joon Kim

Authors
  1. Ji Hwan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jung Woo Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seung Min Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chuhl Joo Lyu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dong Joon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sung Chul Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sung Chul Lee.

Ethics declarations

Funding

None.

Conflicts of interest

The authors declare that they have no conflict of interest. All authors certify that we have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.H., Han, J.W., Hahn, S.M. et al. Combined intravitreal melphalan and intravenous/intra-arterial chemotherapy for retinoblastoma with vitreous seeds. Graefes Arch Clin Exp Ophthalmol 254, 391–394 (2016). https://doi.org/10.1007/s00417-015-3202-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-015-3202-0

Keywords

Search

Navigation