Transcript Mechanical Revascularization and Hypothermia: Potential

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