Berry Jesse L, Shah Sona, Kim Fiona, Jubran Rima, Kim Jonathan W
USC Roski Eye Institute, Los Angeles, California, USA.
The Vision Center at Children's Hospital Los Angeles, Los Angeles, California, USA.
Ocul Oncol Pathol. 2018 Nov;4(6):335-340. doi: 10.1159/000486098. Epub 2018 Jun 13.
Intravitreal injection of melphalan (IVM) is safe and effective for the treatment of seeding in retinoblastoma. Current protocols require weekly injections during examination under anesthesia (EUA). To avoid additional anesthesia exposure for these children, IVM was initiated at the EUA concurrent with the 4th cycle of systemic chemoreduction in a series of 6 patients with persistent seeding.
A retrospective review was completed to assess treatment response compared to all patients at our center treated with IVM and systemic chemotherapy. Overall, 6 eyes of 6 patients were included; salvage therapy included systemic chemoreduction with vincristine, etoposide, and carboplatin and IVM for persistent seeding.
IVM was initiated in all eyes at cycle 4 of their chemotherapy. Success in eradicating vitreous seeds was 100%; overall salvage rate was 67%. Anterior toxicity was observed in 2 out of 6 eyes and posterior toxicity in 4 out of 6 eyes.
The concurrent chemoreduction and IVM protocol demonstrated a similar efficacy of globe salvage while sparing children additional EUAs. However, the increased rates of observed melphalan-related toxicities for concurrent therapy are concerning. Further clinical experience is necessary to define the best initiation time and dosing schedule for IVM.
玻璃体内注射美法仑（IVM）治疗视网膜母细胞瘤的播散安全有效。目前的方案要求在麻醉下检查（EUA）期间每周注射一次。为避免这些儿童额外暴露于麻醉，在一系列6例持续性播散的患者中，于EUA时同时在全身化疗第4周期开始使用IVM。
完成一项回顾性研究，以评估与本中心所有接受IVM和全身化疗的患者相比的治疗反应。总共纳入6例患者的6只眼；挽救治疗包括使用长春新碱、依托泊苷和卡铂进行全身化疗减积以及对持续性播散使用IVM。
所有眼均在化疗第4周期开始使用IVM。根除玻璃体播散的成功率为100%；总体挽救率为67%。6眼中有2眼观察到前部毒性，6眼中有4眼观察到后部毒性。
化疗减积与IVM联合方案在挽救眼球方面显示出相似的疗效，同时使儿童免于额外的EUA。然而，联合治疗中观察到的美法仑相关毒性发生率增加令人担忧。需要进一步的临床经验来确定IVM的最佳起始时间和给药方案。
