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