Variable response and
ocular complications found after use of intra-arterial chemotherapy
for retinoblastoma
In a study examining eight eyes that were
removed following intra-arterial chemotherapy (IAC) for treatment
of retinoblastoma, there was variable response of the tumor to therapy
but also evidence of ocular complications, according to a report
published Online First in the Archives of Ophthalmology, one of
the JAMA/Archives journals.
According to background information in the article, a new but somewhat
controversial treatment for retinoblastoma (Rb) is IAC. In this
type of therapy, chemotherapy is delivered directly to the eye and
the surrounding area by administering the medication through the
ophthalmic artery. "The main goal of this approach is to provide
sufficient chemotherapy to eradicate the Rb and avoid the toxicities
of systemic chemotherapy," explain the authors.
Ralph C. Eagle, Jr., M.D., from the Wills Eye Institute, Philadelphia,
and colleagues examined eight eyes that had been treated with IAC
but were later enucleated. The enucleations were performed because
the tumors were not responsive to therapy, or because other medical
problems, such as a certain type of glaucoma, developed. An ophthalmic
pathologist dissected and studied the eyes.
This examination demonstrated that the response to treatment ranged
from minimal (one eye), to moderate (one eye), to extensive (four
eyes) to complete regression (two eyes). However, a majority of
the eyes also showed evidence of complications, including ischemia
and atrophy of the retina, blood clots in blood vessels and foreign
material within those clots.
"In summary, histopathology of eyes with Rb following IAC
showed evidence of complete tumor regression in eyes in which there
was clinical tumor regression and also confirmed viable tumor in
those in which tumor was suspected clinically," report the
authors. However, the authors also emphasize the importance of the
discovery of blood vessel blockages and foreign material in the
clots within those vessels. The researchers conclude, "We suggest
that IAC for Rb be used with caution."
This study was supported by the Noel T. and Sara L. Simmonds Endowment
for Ophthalmic Pathology, Wills Eye Institute, and the Eye Tumor
Research Foundation, Philadelphia. Please see the article for additional
information, including other authors, author contributions and affiliations,
financial disclosures, funding and support, etc.
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