Treatment of Eye Cancer in Children With Chemosurgery

1. 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

2. 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

3. 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

4. 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).

5. Why a new treatment for Retinoblastoma? • Avoid removing the eye (enucleation) • Avoid toxicity of current treatments by radiation and chemotherapy

6. 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

7. 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

8. 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

9. Before After

10. 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

11. 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

12. Before After

13. 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