Jesse L Berry1, Mercy Bechtold2, Sona Shah2, Emily Zolfaghari3, Mark Reid3, Rima Jubran4, Jonathan W Kim2. 1. USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California; The Vision Center at Children's Hospital Los Angeles, Los Angeles, California. Electronic address: jesse.berry@med.usc.edu. 2. USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California; The Vision Center at Children's Hospital Los Angeles, Los Angeles, California. 3. The Vision Center at Children's Hospital Los Angeles, Los Angeles, California. 4. The Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.
Abstract
OBJECTIVE: Intravitreal chemotherapy has emerged as an important modality for treating vitreous seeding in retinoblastoma. A classification system has been described as predictive of response to intravitreal melphalan (IVM) in patients treated predominantly with primary intra-arterial chemotherapy. The objective of this study is to evaluate the outcomes of retinoblastoma treated with intravenous chemotherapy and IVM as salvage for vitreous seeding, and further to determine whether vitreous seed classification (dust, spheres, cloud) is predictive of the total number and dose of IVM injections required for treatment in this cohort. DESIGN: A nonrandomized retrospective review. PARTICIPANTS: Retinoblastoma patients treated at a single center with intravenous chemotherapy and IVM. METHODS: Retrospective review of patients with vitreous seeding from retinoblastoma treated with intravenous chemotherapy and IVM from 2012 to 2016. MAIN OUTCOME MEASURES: Primary outcome measure was eradication of seeds and globe salvage. Secondary measures included IVM-associated toxicity and complications. RESULTS: Overall, 28 eyes of 25 patients were included, with a total of 110 IVM injections. By seed classification, eyes with dust (n = 15) required a median of 3 injections, spheres (n = 8) required 4 injections, and clouds (n = 5) required 6 injections. Spherical seeds were only seen in recurrent vitreous seeding. Of the 28 treated eyes, 9 were enucleated, 6 for recurrent retinal disease, resulting in an overall globe salvage rate of 68%. The salvage rate secondary to active retinoblastoma was 79%. Dust classification was the most prevalent seeding type of the 9 enucleated eyes. There was 100% regression of vitreous seeds after intravitreal injection and no eye was treated with radiation or enucleated for seeding. Twelve eyes demonstrated grade 3 or greater IVM-associated retinal or anterior segment toxicity post injection. Mean follow-up was 33 months (range, 9-51 months). CONCLUSIONS: IVM is an effective treatment for vitreous seeding after intravenous chemotherapy for retinoblastoma. As with eyes treated with intra-arterial chemotherapy, seed classification is predictive of the total number and dose of IVM injections in eyes treated with intravenous chemotherapy. Eyes with clouds required significantly more injections than eyes with dust or spheres.
OBJECTIVE: Intravitreal chemotherapy has emerged as an important modality for treating vitreous seeding in retinoblastoma. A classification system has been described as predictive of response to intravitreal melphalan (IVM) in patients treated predominantly with primary intra-arterial chemotherapy. The objective of this study is to evaluate the outcomes of retinoblastoma treated with intravenous chemotherapy and IVM as salvage for vitreous seeding, and further to determine whether vitreous seed classification (dust, spheres, cloud) is predictive of the total number and dose of IVM injections required for treatment in this cohort. DESIGN: A nonrandomized retrospective review. PARTICIPANTS: Retinoblastomapatients treated at a single center with intravenous chemotherapy and IVM. METHODS: Retrospective review of patients with vitreous seeding from retinoblastoma treated with intravenous chemotherapy and IVM from 2012 to 2016. MAIN OUTCOME MEASURES: Primary outcome measure was eradication of seeds and globe salvage. Secondary measures included IVM-associated toxicity and complications. RESULTS: Overall, 28 eyes of 25 patients were included, with a total of 110 IVM injections. By seed classification, eyes with dust (n = 15) required a median of 3 injections, spheres (n = 8) required 4 injections, and clouds (n = 5) required 6 injections. Spherical seeds were only seen in recurrent vitreous seeding. Of the 28 treated eyes, 9 were enucleated, 6 for recurrent retinal disease, resulting in an overall globe salvage rate of 68%. The salvage rate secondary to active retinoblastoma was 79%. Dust classification was the most prevalent seeding type of the 9 enucleated eyes. There was 100% regression of vitreous seeds after intravitreal injection and no eye was treated with radiation or enucleated for seeding. Twelve eyes demonstrated grade 3 or greater IVM-associated retinal or anterior segment toxicity post injection. Mean follow-up was 33 months (range, 9-51 months). CONCLUSIONS: IVM is an effective treatment for vitreous seeding after intravenous chemotherapy for retinoblastoma. As with eyes treated with intra-arterial chemotherapy, seed classification is predictive of the total number and dose of IVM injections in eyes treated with intravenous chemotherapy. Eyes with clouds required significantly more injections than eyes with dust or spheres.
Authors: Jesse L Berry; Liya Xu; Irsan Kooi; A Linn Murphree; Rishvanth K Prabakar; Mark Reid; Kevin Stachelek; Bao Han A Le; Lisa Welter; Bibiana J Reiser; Patricia Chévez-Barrios; Rima Jubran; Thomas C Lee; Jonathan W Kim; Peter Kuhn; David Cobrinik; James Hicks Journal: Mol Cancer Res Date: 2018-07-30 Impact factor: 5.852
Authors: Liya Xu; Ashley Polski; Rishvanth K Prabakar; Mark W Reid; Patricia Chevez-Barrios; Rima Jubran; Jonathan W Kim; Peter Kuhn; David Cobrinik; James Hicks; Jesse L Berry Journal: Mol Cancer Res Date: 2020-05-20 Impact factor: 5.852
Authors: Jesse L Berry; Francis L Munier; Brenda L Gallie; Ashley Polski; Sona Shah; Carol L Shields; Dan S Gombos; Kathleen Ruchalski; Christina Stathopoulos; Rachana Shah; Rima Jubran; Jonathan W Kim; Prithvi Mruthyunjaya; Brian P Marr; Matthew W Wilson; Rachel C Brennan; Guillermo L Chantada; Murali M Chintagumpala; A Linn Murphree Journal: Pediatr Blood Cancer Date: 2021-02-23 Impact factor: 3.167
Authors: Carley M Bogan; Janene M Pierce; Stephanie D Doss; Yuankai K Tao; Sheau-Chiann Chen; Kelli L Boyd; Albert Liao; Terry Hsieh; David H Abramson; Jasmine H Francis; Debra L Friedman; Ann Richmond; Anthony B Daniels Journal: Exp Eye Res Date: 2021-01-11 Impact factor: 3.467