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