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. 2013 Aug 21;8(8):e72441.
doi: 10.1371/journal.pone.0072441. eCollection 2013.

Carboplatin +/- topotecan ophthalmic artery chemosurgery for intraocular retinoblastoma

Jasmine H Francis  1 , Y Pierre Gobin, Ira J Dunkel, Brian P Marr, Scott E Brodie, Gowtham Jonna, David H Abramson
Affiliations

Carboplatin +/- topotecan ophthalmic artery chemosurgery for intraocular retinoblastoma

Jasmine H Francis et al. PLoS One. .

Abstract

Purpose: Carboplatin administered systemically or periocularly can result in dramatic and prompt regression of retinoblastoma. However, both routes are rarely curative alone and have undesirable side effects. We aimed to assess the efficacy and toxicity of carboplatin +/- topotecan delivered by ophthalmic artery chemosurgery whereby chemotherapy is infused into the eye via the ophthalmic artery.

Methods: This retrospective, IRB-approved study investigated retinoblastoma patients whom received carboplatin +/- topotecan ophthalmic artery chemosurgery. Patient survival, ocular survival, hematologic toxicity, ocular toxicity, second cancer development and electroretinogram response were all evaluated.

Results: 57 carboplatin +/- topotecan infusions (of 111 total) were performed in 31 eyes of 24 patients. The remaining infusions were melphalan-containing. All patients were alive and no patient developed a second malignancy at a median follow up of 25 months. The Kaplan-Meier estimate of ocular survival at two years was 89.9% (95% confidence interval [CI], 82.1-97.9%) for all eyes. Grade 3 or 4 neutropenia developed in two patients and one patient developed metastatic disease. By univariate analysis, neither increasing maximum carboplatin/topotecan dose nor cumulative carboplatin/topotecan dose was associated with statistically significant reduction in the electroretinogram responses.

Conclusion: Carboplatin +/- topotecan infusions are effective for ophthalmic artery chemosurgery in retinoblastoma: they demonstrate low hematologic and ocular toxicity and no statistically significant influence on electroretinogram responses, and used in conjunction with melphalan-containing OAC, demonstrate excellent patient survival and satisfactory ocular survival.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Response to carboplatin +/− topotecan-containing ophthalmic artery chemosurgery (OAC).
Representative case. Left: Reese-Ellsworth Group VB (IC D) left eye prior to treatment Right: Same eye following three OAC cycles consisting of carboplatin and topotecan. Note dramatic response of tumors following carboplatin/topotecan therapy.
Figure 2
Figure 2. Kaplan-Meier ocular survival curve of all eyes.
Figure 3
Figure 3. Electroretinogram categories before and after carboplatin +/− topotecan containing Ophthalmic Artery Chemosurgery.
OAC = ophthalmic artery chemosurgery, ERG =  electroretinogram.
See this image and copyright information in PMC

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