Intra-arterial Chemotherapy(Chemosurgery) for Retinoblastoma

14:07 EDT 21st September 2014 | BioPortfolio

Summary

Conventional treatments of retinoblastoma involves laser photocoagulation, cryotherapy (freezing of the tumor), plaque radiotherapy,external beam radiotherapy, and intravenous chemotherapy. Enucleation (removing of the eye)is the last option when the tumor cannot be controlled otherwise. However,many children with retinoblastoma present with advanced intraocular disease for which enucleation is the only option. Intra-arterial chemotherapy (Chemosurgery)delivers anti-tumor drug directly into the ophthalmic artery (the artery feeding the eye) in order to increase the dose of drug reaching the tumor while minimizing toxicity to the rest of the body.

Description

Present treatments for intraocular retinoblastoma cure 99% of children but have significant toxicity. Enucleation of the eye is effective but blinds the eye and leaves a lifelong cosmetic deformity. Radiation is associated with the subsequent development of fatal cancers. Systemic (intravenous)chemotherapy is used worldwide but experience with it has shown that the majority of eyes initially treated with chemotherapy still require additional treatments, such as radiation, laser, cryotherapy or even enucleation. In addition blood transfusions, secondary infections, insertion of ports and permanent hearing loss are now well reported. Three years ago we developed this technique of Chemosurgery for significantly increasing the dose of drug to the cancer while decreasing the dose of drug administered to children. This approach has decreased the need for enucleation in advanced eyes scheduled for enucleation with minimal systemic toxicity. We now offer treatment of both eyes simultaneously (in bilateral cases) and to eyes with less advanced disease and normal vision as an alternative to toxic systemic chemotherapy. In cases of very advanced ocular disease we will be using multiple drugs infused at the same session to increase tumor kill.

Chemosurgery interventions are performed under general anesthesia. The femoral artery (artery at the groin) is punctured and a catheter (a small plastic tube)is advanced into the opthalmic artery (the artery of the eye)using fluoroscopic (X-ray) guidance. The drugs are injected directly into the opthalmic artery over a period of 30-45 min.The catheter is then removed, manual compression exerted to the femoral artery, the child is awaken and goes to recovery for 6 hours. The procedure is repeated every 3-4 weeks for a total of 2 to 6 sessions according to tumor response. Since April 2006, our center has treated by chemosurgery 60 eyes in 52 patients with advanced intra-ocular retinoblastoma for which enucleation was considered.

Study Design

Control: Uncontrolled, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Conditions

Retinoblastoma

Intervention

Intra-arterial Chemotherapy

Location

Weill Medical College of Cornell University
New York
New York
United States
10065

Status

Completed

Source

Weill Medical College of Cornell University

Results (where available)

View Results

Links

Clinical Trials [363 Associated Clinical Trials listed on BioPortfolio]

Intra-arterial Chemotherapy for Advanced Intraocular Retinoblastoma

Phase II study of selective intra-arterial infusion of chemotherapy for intraocular retinoblastoma

Intra-arterial Chemotherapy for Children With Retinoblastoma

Retinoblastoma is a cancer of the eye that occurs exclusively in children. The treatment for retinoblastoma may include surgery, chemotherapy, radiation and local treatments to the eye suc...

Research on the Environment and Children's Health: Retinoblastoma

The purpose of the research study is to learn more about the causes of retinoblastoma and to identify possible risk factors in the parents of patients with retinoblastoma. This kind of stu...

Retinoblastoma Survivor Study: Assessment of General Health and Quality of Life

The purpose of this study is to find out about the quality of life and health in a group of adults who had retinoblastoma when they were children. By quality of life, we mean how you are f...

Trial Comparing Two Carboplatin Doses in Groups C and D Intraocular Retinoblastoma

The purpose of this study is to determine whether an increase in the dose of carboplatin in treatment of advanced intraocular (group C and D) retinoblastoma helps in avoiding radiotherapy ...

PubMed Articles [6466 Associated PubMed Articles listed on BioPortfolio]

Targeted retinoblastoma management: when to use intravenous, intra-arterial, periocular, and intravitreal chemotherapy.

The management of retinoblastoma is complex and involves strategically chosen methods of enucleation, radiotherapy, chemotherapy, laser photocoagulation, thermotherapy, and cryotherapy. Chemotherapy h...

Radiation dose reduction in intra-arterial chemotherapy infusion for intraocular retinoblastoma.

Retinoblastoma (RB) is a rare malignancy affecting the pediatric population. Intravenous chemotherapy is the longstanding delivery method, although intra-arterial (IA) chemotherapy is gaining populari...

Intra-arterial chemotherapy for retinoblastoma. Challenges of a prospective study.

To report the efficacy and complications of intra-ophthalmic artery melphalan (IAM) for treatment of patients with advanced intra-ocular retinoblastoma.

Neoadjuvant intra-arterial chemotherapy followed by total laparoscopic radical trachelectomy in stage IB1 cervical cancer.

To support the feasibility and safety of neoadjuvant intra-arterial chemotherapy followed by total laparoscopic radical trachelectomy in stage IB1 cervical cancer with tumor larger than 2 cm.

Advanced gastric cancer with brain metastasis effectively treated by arterial infusion chemotherapy: A case report.

The current report presents a case of advanced gastric cancer with brain metastasis effectively treated by intra-left gastric arterial and internal carotid arterial infusions of tegafur, epirubicin an...

Medical and Biotech [MESH] Definitions

Regional infusion of drugs via an arterial catheter. Often a pump is used to impel the drug through the catheter. Used in therapy of cancer, upper gastrointestinal hemorrhage, infection, and peripheral vascular disease.

Product of the retinoblastoma tumor suppressor gene. It is a nuclear phosphoprotein hypothesized to normally act as an inhibitor of cell proliferation. Rb protein is absent in retinoblastoma cell lines. It also has been shown to form complexes with the adenovirus E1A protein, the SV40 T antigen, and the human papilloma virus E7 protein.

A ubiquitously expressed regulatory protein that contains a retinoblastoma protein binding domain and an AT-rich interactive domain. The protein may play a role in recruiting HISTONE DEACETYLASES to the site of RETINOBLASTOMA PROTEIN-containing transcriptional repressor complexes.

A retinoblastoma-binding protein that is involved in CHROMATIN REMODELING, histone deacetylation, and transcription repression. Although initially discovered as a retinoblastoma binding protein it has an affinity for core HISTONES and is a subunit of chromatin assembly factor-1 where it plays a role in the deposition of NUCLEOSOMES on newly synthesized DNA.

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