Comparison of intravitreal melphalan with and without topotecan in the management of vitreous disease in retinoblastoma
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CLINICAL INVESTIGATION
Comparison of intravitreal melphalan with and without topotecan in the management of vitreous disease in retinoblastoma Hayyam Kiratli1 · Irem Koç1 · Ebru Öztürk2 · Ali Varan3 · Canan Akyüz3 Received: 3 June 2019 / Accepted: 21 April 2020 © Japanese Ophthalmological Society 2020
Abstract Purpose To evaluate clinical outcomes and enucleation rates after intravitreal melphalan (IVM) alone and after IVM combined with intravitreal topotecan (IVT) for the treatment of vitreous disease, and to a lesser extent subretinal and retrohyaloid seeds, in patients with retinoblastoma. Study design A retrospective analysis of 77 eyes of 72 consecutive patients. Methods Demographic data, classification of tumors, seed type (dust, sphere or cloud) before injection and at the end of follow-up, injection type (IVM or IVM+IVT), doses of IVM and IVT, number of injections, follow-up time, enucleation status and side effects were recorded. Cox regression analysis and log-rank test for Kaplan-Meier curves were performed. Results Of 77 eyes, 40 received IVM alone (group 1) and 37 received IVM+IVT (group 2). Enucleation rates were 62.5% (n=25) in group 1 and 10.8% (n=4) in group 2 (p=0.001). Median eye survival was 23.6 months in group 1 and 25.6 months in group 2. Mantel-Cox test revealed statistically significant differences between Kaplan-Meier curves of group 1 and 2 (p=0.022). Multiple Cox regression analysis showed a significantly elevated enucleation rate associated with: IVM only treatment group (p=0.019) and pre-injection cloud type of seeding (p=0.014). Conclusion The combined use of intravitreal melphalan and topotecan provides significantly better results in terms of avoiding enucleation and vitreal and subretinal seed control. Keywords Retinoblastoma · Seeding · Melphalan · Topotecan · Intravitreal injection
Introduction The earliest documented descriptions of clinical and histopathological features of vitreous seeding in retinoblastoma can be traced in the seminal work of Hugo Wintersteiner published in 1897. In his book, Wintersteiner alluded in great details to cases reported by Da Gama Pinto, Iwanoff, Treitel, Grolmann, Bock, Agnew and Eno, and Wolff but Corresponding Author: Hayyam Kiratli * Hayyam Kiratli [email protected] 1
Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Sihhiye, 06100 Ankara, Turkey
2
Department of Biostatistics, Hacettepe University School of Medicine, Ankara, Turkey
3
Department of Pediatric Oncology, Hacettepe University School of Medicine, Ankara, Turkey
cited Franz Rompe as the first to have ever reported “retinal gliomas metastasizing to the vitreous body” [1]. Rompe described a 1-year-old girl whose left eye had a large number of white, small glioma clumps in the vitreous. The eye was enucleated and 2/3 of the vitreous was found to be filled with friable retinal tumor [2]. The girl was followed for 2.5 years without any recurrence [2]. In the modern era, the interest in vitreous seeds was rekindle
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