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Combined intravitreal melphalan and intravenous/intra-arterial chemotherapy for retinoblastoma with vitreous seeds

 Ji Hwan Lee  ;  Jung Woo Han  ;  Seung Min Hahn  ;  Chuhl Joo Lyu  ;  Dong Joon Kim  ;  Sung Chul Lee 
 Graefes Archive for Clinical and Experimental Ophthalmology, Vol.254(2) : 391-394, 2016 
Journal Title
 Graefes Archive for Clinical and Experimental Ophthalmology 
Issue Date
Antineoplastic Agents, Alkylating/administration & dosage* ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage ; Child, Preschool ; Combined Modality Therapy ; Female ; Humans ; Infusions, Intra-Arterial ; Infusions, Intravenous ; Intravitreal Injections ; Male ; Melphalan/administration & dosage* ; Neoplasm Seeding* ; Retinal Neoplasms/drug therapy* ; Retinal Neoplasms/pathology ; Retinoblastoma/drug therapy* ; Retinoblastoma/secondary ; Retrospective Studies ; Vitreous Body/pathology*
Combined modality therapy ; Intravitreal injections ; Melphalan ; Neoplasm seeding ; Retinoblastoma
PURPOSE: We aimed to evaluate the therapeutic effect and complications of combined intravitreal melphalan and intravenous/intra-arterial chemotherapy as a primary approach for retinoblastoma with vitreous seeds. METHODS: In this retrospective case series, eight eyes from eight retinoblastoma patients with vitreous seeds were included. All eyes received 20-30 μg of intravitreal melphalan accompanied by intravenous and intra-arterial chemotherapy. Triple freeze-thaw cryotherapy was performed when withdrawing the needle from the eye to prevent tumor dissemination. RESULTS: Tumors and vitreous seeds regressed in all eyes. The mean number of intravitreal melphalan injections was 3.25 (median 3.50, range 2-4). Globe salvage was attained in seven of eight eyes (87.5 %). Enucleation was performed in one case, in which the pathologic section showed no residual tumor and tumor-free resection margins. Serous retinal detachment was observed in four eyes (50 %), and vitreous hemorrhage developed in two (25 %). Retinal pigment epithelium atrophy or mottling was found in three eyes (37.5 %). There were no cases of extraocular tumor extension or remote metastasis. CONCLUSIONS: Combined intravitreal melphalan and intravenous/intra-arterial chemotherapy was effective for tumor and vitreous seeding control, but vision-threatening complications such as vitreous hemorrhage or serous retinal detachment occurred in half the cases.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Lyu, Chuhl Joo(유철주) ORCID logo https://orcid.org/0000-0001-7124-7818
Lee, Sung Chul(이성철) ORCID logo https://orcid.org/0000-0001-9438-2385
Lee, Ji Hwan(이지환)
Hahn, Seung Min(한승민) ORCID logo https://orcid.org/0000-0001-9832-6380
Han, Jung Woo(한정우) ORCID logo https://orcid.org/0000-0001-8936-1205
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