treatment of eye cancer in children with chemosurgery
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Treatment of Eye Cancer in Children
With Chemosurgery
Pierre Gobin (1), David Abramson (2) , Ira Dunkel (3)
1: Interventional Neuroradiology, Weill Cornell Medical College
2: Ophthalmic Oncology, Memorial Sloan Kettering Cancer Center
3: Pediatric Oncology, Memorial Sloan Kettering Cancer Center
Disclosures: none
Retinoblastoma- Definition:
-Cancer of the eye: precisely cancer of the retina, the light sensitive layer which enables the eye to see
- Frequency:- 7th most common pediatric cancer- 80% diagnosed < 3 year-old- 75% unilateral, 25% bilateral
- Prognosis:- 5 year-survival in the U.S: 98%
- Genetic: - 40% patients have the genetic form
Clinical signs- Presenting signs:
- leukocoria (white pupillary reflexion): 60%
- Cross-eyes: 25%
- Late diagnosis: leukocoria means the tumor is already filling the eye
- Diagnostic: ophthalmoscopy, ultrasound
Treatment for Intraocular disease
• Wide array of treatment including:– Photocoagulation and Cryotherapy – Radiation– Chemotherapy
• Problem:– Most children present with advanced disease for which local control is impossible: the only treatment is enucleation (removing the eye).
Why a new treatment for Retinoblastoma?
• Avoid removing the eye (enucleation)
• Avoid toxicity of current treatments by radiation and chemotherapy
Treatment protocol
• General anesthesia, outpatient• Puncture the artery in the groin • Placement of a catheter in the artery of the eye
• Inject chemotherapy drugs in the artery of the eye.
• Three treatments at 3 weeks interval
Patient population• 22 patients recruited since May 2006
– Age: 1 month to 10 years (median: 2 year)
– Bilateral: 11/22• Previous treatments:
– Contralateral Enucleation: 5– Others: 11
• All patients (except one) had advanced eye cancer normally treated by enucleation
Results
• Patient enrolled: 22 (23 eyes)• Treatment completed in 20 patients– Treatment possible: 18/20 patients (90%)
– Procedures failed in 2• Most patients had 3 treatments
Before After
Complications:
• No procedure related complications (64 procedures)
• Toxicity: – General:
• None of the usual complications of chemotherapy (readmission, infection, transfusion, hair loss)
– Local:• Two transient skin discoloration• Four retinopathy
– Dose too high in the beginning
Results• Patients treated: 22
– Treatment impossible: 2– Under treatment: 2– Treatment completed: 18 patients
• Tumor control:– Tumor cured: 16/18
• 14 have kept their eye• 2 enucleations: no tumor
– Failures: 2 including one growth
• Vision result of 14 cured eyes– Eye with vision: 9 cases (improved in 4)
– no vision: 5
Before After
Conclusion: Chemosurgery for retinoblastoma
• Accomplishment: In advanced eye cancer formerly treated by removing the eye, chemosurgery saved 78% of eyes and preserved vision in 50%.
• Future directions: – Using existing protocol, extend indications to less severe tumors
– Develop new protocols to entirely replace intravenous chemotherapy and radiation therapy
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