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. 2018 Apr 26;13(4):e0195395.
doi: 10.1371/journal.pone.0195395. eCollection 2018.

Total retinal detachments due to retinoblastoma: Outcomes following intra-arterial chemotherapy/ophthalmic artery chemosurgery

Megan A Rowlands  1 , Ijah Mondesire-Crump  2 , Ariana Levin  2 , Audrey Mauguen  3 , Jasmine H Francis  2   4 , Ira J Dunkel  5   6 , Scott E Brodie  7 , Y Pierre Gobin  2   8 , David H Abramson  2   4
Affiliations

Total retinal detachments due to retinoblastoma: Outcomes following intra-arterial chemotherapy/ophthalmic artery chemosurgery

Megan A Rowlands et al. PLoS One. .

Abstract

Purpose: To report on the rate and timing of retinal reattachment and outcomes for retinoblastoma children who have total retinal detachments at presentation to our center and were treated with intra-arterial chemotherapy (ophthalmic artery chemosurgery, OAC).

Patients and methods: Single-center retrospective review of retinoblastoma patients who presented with total retinal detachments and were subsequently treated with OAC at MSKCC between May 2006 and July 2016. Endpoints were retinal detachment resolution, visual function, ERG amplitude, ocular survival, and patient survival from metastases.

Results: 87 eyes of 84 retinoblastoma patients were included. Using a survival multistate model, by 36 months of follow-up, there was a 54% cumulative probability of complete retinal reattachment and a 76% probability of partial reattachment. 24% of eyes that completely reattached received only OAC without any prior or adjuvant treatments. Eyes that completely reattached were significantly more likely to have been diagnosed at a younger age (p<0.0001) and to have greater initial ERG values (p = 0.006). At final follow-up, 14% of eyes had gained at least 25 μV of ERG activity, and 8.0% had achieved hand motion vision or better, including one to 20/60. 13% of eyes were enucleated. No patient died from metastatic disease, and only one developed metastases.

Conclusion: OAC can successfully treat previously considered "non-salvageable" retinoblastoma eyes with total retinal detachments, promote retinal reattachment in the majority of eyes, and preserve ocular and patient survival.

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Conflict of interest statement

Competing Interests: I have read the journal's policy, and the authors of this manuscript have the following competing interests: Ira Dunkel had competing interests as follows: - Consultant (paid or unpaid) within the past 5 years: Apexigen, Bayer, Bristol-Myers Squibb, Celgene, Eisai, Ipsen, Pfizer. - Relationships with funding bodies: Medical advisory board member for Beez foundation, Matthew Larson foundation, Kamen brain tumor foundation; Grant reviewer for the German Research foundation, Alex’s Lemonade Stand foundation. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Frequency of drug treatment combinations per eye by OAC treatment.
A combination of Melphalan, Topotecan, and Carboplatin was most commonly used across all OAC treatments. M: Melphalan, T: Topotecan, C: Carboplatin.
Fig 2
Fig 2. Cumulative incidence of retinal reattachment by time (months).
Fig 3
Fig 3. Electroretinogram (ERG) improvement after OAC.
Fig 4
Fig 4. Kaplan-Meier curve of the ocular survival in OAC-treated total retinal detachment eyes, among all 87 eyes, 21 eyes treated within the first 5 years (2006–2011), and 66 eyes treated within the most recent 5 years (2012–2016).
The dotted lines represent the 95% confidence interval for the survival curves.
See this image and copyright information in PMC

References

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