Background

Intra-arterial chemotherapy has shown promising results and improved the prognosis of retinoblastoma in the developed countries. Here, we aim to report our initial experience, in Egypt, in the treatment of all stages of naïve retinoblastoma with ophthalmic artery chemosurgery (OAC), using melphalan.

Results

The technique was successful in 23 out of 26 eyes. Overall, a total of 63 treatment sessions were performed. Ophthalmic artery catheterization was performed in 59 treatment sessions, whereas middle meningeal artery catheterization was performed in 4 treatment sessions. Adequate tumor control was achieved in 95.6%. Progression has developed in one eye after the third OAC session. The mean follow-up period was 18.5 months. Recurrence of the main tumor as well as vitreous and subretinal seeds was reported in one eye after 19-month duration. A globe salvage rate of 91.3% was attained. No metastasis was recorded, and all patients were alive within the stated follow-up period.

Conclusion

A high globe salvage rate along with metastasis free survival and mild complications were achieved. Therefore, our initial experience with OAC in primary retinoblastoma proved to be safe and effective.

Background

Retinoblastoma is the most common pediatric intraocular neoplasm. It remains a significant health problem, particularly in the developing countries [1]. For both unilateral and bilateral diseases, enucleation used to be the main treatment strategy to cure patients and maintain their survival [2]. Yet, this was at the expense of the globe and vision salvage. In more advanced stages, external beam radiation was the alternative treatment procedure that provided globe salvage [3]. This was, however, associated with a high rate of second cancer which, in most cases, might have been more fatal than the retinoblastoma [4]. Therefore, systemic intravenous chemotherapy was proposed to reduce the harmful effect of radiotherapy [5] and was frequently used in combination with other focal therapies such as laser or cryotherapy. Some major systemic complications, however, were associated with systemic chemotherapy such as acute myeloid leukemia and neutropenia [6]. Intra-arterial chemotherapy through the carotid artery was introduced early to save the globe and to minimize the radiation exposure and the systemic side effects [7]. The regimen has been modified afterward, to include selective ophthalmic artery infusion chemotherapy, which has been developed by the Japanese [8, 9]. Eventually, the super-selective ophthalmic artery chemotherapy, which is also known as ophthalmic artery chemosurgery (OAC), has introduced by Abramson et al. [10].

The use of OAC has been increased, gradually, to be the first choice of retinoblastoma treatment in the developed countries. Consequently, the enucleation rate has been reduced from 95 to about 10% [11] with the estimated survival rate of retinoblastoma exceeds 95% in the developed countries [12]. OAC was implemented, however, in a small percent of low- and middle-income countries [1]. Thus, the enucleation rate, in such regions, remains high and ranges from 50 to 87.6%, with estimated survival rate of retinoblastoma reaches about 60% in Asia and about 30% in Africa [12].

Here, we introduce our OAC experience in Egypt. Namely, we report our 3 years initial experience for the treatment of early and advanced naive retinoblastoma with OAC, in two major referral centers in Egypt.