Program Book

1. Department of Ophthalmology, Royal Children’s Hospital, Melbourne
2. Department of Paediatrics, University of Melbourne
3. Children’s Cancer Centre, Royal Children’s Hospital, Melbourne
4. Centre for Eye Research Australia, University of Melbourne
Purpose. To demonstrate the utility of utilising systemic chemotherapy
as adjunctive therapy for the management of retinoblastoma.
Methods. Nine consecutive patients treated with systemic
chemotherapy are described. All have presented with differing
classification of retinoblastoma (according to International
Classification or Retinoblastoma) including 3 with optic nerve
involvement at presentation. No patients had bone marrow infiltration
or CSF involvement.
Results. Each case will be presented individually. Chemotherapy
regimes varied according to “aggressiveness” of tumour and whether
optic nerve invasion was evident. The number of cycles of chemotherapy
changed according to the clinical response as evident on serial EUA’s.
Conclusions. Systemic chemotherapy has revolutionised the
management of retinoblastoma, providing excellent tumour regression
allowing focal therapy to be applied. This therapy frequently avoids
the previously “gold standard” of enucleation.
Financial disclosure. None
2225 RBp117
COMPARISON BETWEEN OPHTHALMIC ARTERIAL
INJECTION THERAPY AND CHEMOREDUCTION AS
PRIMARY THERAPY FOR INTRAOCULAR RETINOBLAS-
TOMA
Takashi Yamane, Nobuyuki Suzuki, Makoto Mohri (joecool777jp@
yahoo.co.jp)
Saiseikai Yokohamashi Tobu Hospital
Purpose. For retinoblastoma patients, we have performed ophthalmic
arterior injection therapy (OPAI) by using melphalan from 1988. We
compared OPAI as primary therapy with OPAI after chemoreduction
retrospectively, and examined the validity of OPAI.
Methods. 128 eyes were treated by chemoreduction (VEC 2-6 course)
before OPAI. ICRB A: 2, B: 45 C: 22 D: 46 E: 13 eyes
49 eyes were treated by OPAI from start of therapy. A: 2, B: 30, C: 5, D:
9, E: 3 eyes
Each eye preservation rate was examined. Most of OPAI were combined
with laser therapy.
Results. Eye preservation rate was as follows:
OPAI after chemoreduction, A: 100%, B: 82% C: 59% D: 41% E: 31%.
OPAI as primary therapy, A: 100%, B: 93% C: 40% D: 78% E: 33%
Conclusions. Ophthalmic arterial injection chemotherapy using
melphalan can expect eye preservation more than an equivalence
compared with chemoreduction following OPAI. We would like to add
statistically examination furthermore.
Financial disclosure. None
942 RBp118
INTRA-ARTERIAL CHEMOTHERAPY FOR RETINOBLAS-
TOMA: FIRST AUSTRALIAN EXPERIENCE
John D. McKenzie1, Nisha Sachdev1, Sandra Staffieri1,4, James E. Elder1,2, John
Heath2,3, Peter Downie3, Peter J Mitchell5,6 (jdmckenzieonline@gmail.com)
RETINOBLASTOMA
Posters
53
1. Department of Ophthalmology, Royal Children’s Hospital; 2. Department
of Paediatrics, University of Melbourne; 3. Children’s Cancer Centre, Royal
Children’s Hospital;
4. Centre for Eye Research Australia, University of Melbourne; 5.
Department of Radiology, Royal Melbourne Hospital, Parkville; 6.
Neurointervention Service, University of Melbourne, Melbourne
Purpose. To present the first Australian case of using intra-arterial
chemotherapy for primary treatment of Retinoblastoma
Methods. A child was referred with leukocoria to Royal Children’s Hospital in
Melbourne. Examination revealed a large lobulated posterior segment mass
occupying more than 50% of the globe. IOP and anterior examination was
normal. MRI showed no extrascleral extension, no optic nerve involvement.
LP, Bone Marrow Aspirate and trephine biopsy was normal.
Standard treatment of primary enucleation was offered to the parents,
which was denied. Globe preservation was strongly desired by the parents
due to the child’s previous history of self-induced wound dehiscence.
It was decided that intra-arterial chemotherapy could be offered as
primary therapy for this large retinoblastoma. Clinical Ethics Committee
approval was obtained to offer this treatment.
Results. Four cycles of intra-arterial chemotherapy (Melphalan 5mg,30
min infusion) were administered monthly. Serial EUA’s and MRI’s were
arranged during this time period. Apart from significant sterile orbital
cellulitis after the inital treatment the intra-arterial chemotherapy was
well tolerated. MRI following the fourth cycle revealed an inferotemporal
orbital mass on the revealed a retinoblastoma deposit. Bone marrow
aspirate and trephine biopsy showed bone marrow infiltration. He
has subsequently had 4 cycles of quadruple systemic chemotherapy
(Vincristine, Etoposide, Carboplatin, Cyclophosphamide).
Conclusions. Intra-arterial chemotherapy for retinoblastoma is an
emerging treatment modality as primary therapy for retinoblastoma;
however, as this case illustrated, further study into the precise
chemotherapeutic agents that should be used and frequency for these
require to be established.
Financial disclosure. None
817 RBp119
OUTCOMES OF GROUP D RETINOBLASTOMA EYES
J.L. Berry1, H. Almarzouki2, S.R. Bababeygy1, T.H. Lee1, 2, R. Jubran2,
A.L. Murphree1, 2 (jesse.berrymd@gmail.com)
1. Doheny Eye Institute, Los Angeles, CA
2. Childrens Hospital of Los Angeles, Los Angeles, CA
Purpose. To determine treatment outcomes of Group D retinoblastoma eyes.
Methods. Retrospective chart review.
Results. All patients diagnosed with retinoblastoma and classified as
Group D in at least one eye during a ten-year period from January 1, 2000
to December 31, 2009 at Childrens Hospital Los Angeles were included.
107 eyes of 94 patients were included in the study; 44 patients had
unilateral disease and 50 had bilateral disease, 13 of which had bilateral
Group D disease. 50 of 107 Group D eyes were enucleated primarily. 57
eyes were treated with systemic and local chemotherapy, as well as local
consolidation. 27 of 57 eyes (47%) were salvaged with chemotherapy and
consolidation therapy. 30 eyes had recurrences; 5 eyes were enucleated
and 25 eyes were treated with 36 Gy intensity modulated radiotherapy
(IMRT). Of the 25 irradiated eyes, 20 (80%) were salvaged. 5 eyes were
enucleated after IMRT treatment. Two patients died from retinoblastoma,
1 from a midline primitive neuroectodermal tumor and the other from CNS
metastases without ocular recurrence. Final visual acuity ranged from
20/20 to light perception with 10 eyes having 20/80 vision or better. 4
eyes had 20/200 vision. Mean length of follow up was 42.6 months.