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. 2018 Dec;66(12):1833-1838.
doi: 10.4103/ijo.IJO_737_18.

Periocular topotecan for vitreous seeds in retinoblastoma

Purnima R Sthapit  1 , Raksha Rao  1 , Santosh G Honavar  1
Affiliations

Periocular topotecan for vitreous seeds in retinoblastoma

Purnima R Sthapit et al. Indian J Ophthalmol. 2018 Dec.

Abstract

Purpose: Refractory or recurrent vitreous seeds account for a large proportion of failure of eye salvage in retinoblastoma. The purpose of this study is to evaluate the efficacy of periocular topotecan (POT) in the management of vitreous seeds in retinoblastoma.

Methods: Retrospective, interventional study of patients with retinoblastoma with vitreous seeds who received POT concurrent with intravenous chemotherapy (IVC).

Results: Thirty-eight eyes of 35 patients received POT. Five eyes (13%) belonged to International Classification of Retinoblastoma group C, 23 eyes (61%) belonged to group D, and 10 eyes (26%) belonged to group E. Primary treatment included IVC with a combination of carboplatin, etoposide, and vincristine for a mean of 6 cycles (median 6; range 6-9). Concurrent to IVC from the fourth cycle onward, all patients received POT. Focal vitreous seeds were present in 20 eyes (53%) which received a mean of 3 injections (median 3; range 1-7). Diffuse vitreous seeds were present in 18 eyes (47%) which received a mean of 4 injections (median 5; range 1-7). At a mean follow-up of 8.5 months (median 5 months; range 1-15 months), regression of focal and diffuse vitreous seeds was achieved in 16 eyes (80%) and 8 eyes (44%), respectively. In all, 24 eyes (63%) had complete remission of vitreous seeds with POT given concurrently with IVC. Eye salvage was possible in 19 eyes (95%) with focal vitreous seeds and 12 eyes (68%) with diffuse VS. Enucleation was necessary for persistent vitreous seeds and viable tumor in five eyes (13%), viable tumor alone in one eye (0.02%), and recurrent vitreous seeds in one eye (0.02%). None of the patients developed systemic metastasis.

Conclusion: POT administered concurrent with IVC is safe and effective in the initial management of vitreous seeds.

Keywords: Periocular injection; retinoblastoma; topotecan; vitreous seeds.

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Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
(a) Left eye of a 11-month-old male with group C retinoblastoma with focal vitreous seeds. (b) Complete regression of the vitreous seeds following 2 doses of periocular topotecan (POT) with concurrent intravenous chemotherapy (IVC) given at 4 weeks interval which was maintained at 15-month follow-up
Figure 2
Figure 2
(a) Right eye of a 2-year-old female with group D retinoblastoma with diffuse vitreous seeds. (b) Total resolution of vitreous seeds following 3 doses of POT with concurrent IVC given at 4 weeks interval which was maintained at 11-month follow-up
Figure 3
Figure 3
(a) Vitreous cloud overlying a large tumor in group E retinoblastoma in a 16-month-old female. (b) Partially disappearance of the vitreous cloud with non-viable vitreous seeds after 5 doses of POT with concurrent IVC given at 4 weeks interval (IVC extended to 9 cycles in the patient to achieve maximum tumor volume reduction). The vitreous seed regression was maintained at 9-month follow-up
See this image and copyright information in PMC

Comment in

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