Session Title: Quick Fire Free Paper 5
Session Date/Time: Sunday 14/09/2014 | 11:00-13:00
Paper Time: 12:00
Venue: Boulevard B
First Author: : F.Ghassemi IRAN
Co Author(s): : C. Shields A.R. Khodabandeh
To evaluate the efficacy and complications of combined intravitreal chemotherapy (melphalan and topotecan) for viable vitreous seeding from retinoblastoma.
Cross sectional retrospective case series.
Trans-pars plana intravitreal injection of melphalan (40 µg in 0.04 cc) and topotecan (8-20 µg in 0.04 cc) was performed, followed by injection site cryotherapy.
There were 9 eyes, initially classified as Group D (n=6) or E (n=3), treated with standard 6 cycles of intravenous chemotherapy, and subsequently developed recurrent viable vitreous seeds. Intravitreal melphalan/topotecan was delivered in each case with complete control of vitreous seeds in 9/9 eyes following mean 1.6 injections, (median 1.0, range 1-3 injections). In 5 (56%) cases, tumor control was achieved with a single injection, whereas in 4 (44%) cases, 2 or 3 injections were necessary. Two patients were enucleated because of recurrent tumor and persistent anterior chamber lesions. Over mean 11months follow up (median 12, range 3-21 months), there was no recurrence in the 7 eyes that responded. Complications included temporary hypotonia of 2 weeks or less (n=2), temporary epithelial defect (n=1), and mild vitreous hemorrhage (n=1). There was no case of episcleral or orbital retinoblastoma extension or remote retinoblastoma metastasis. There was no change in electrophysiologic signal.
Combined intravitreal melphalan and topotecan is safe and remarkably effective for resistant or recurrent vitreous seeds from retinoblastoma. In the majority of cases, tumor control was achieved with less than usual injections of single agent chemotherapy with melphalan.