July 12, 2011 In a study examining eight eyes that were removed following intra-arterial chemotherapy (IAC) for treatment of retinoblastoma (a tumor of the retina of the eye), there was variable response of the tumor to therapy but also evidence of ocular complications, according to a report published Online First by Archives of Ophthalmology, one of the JAMA/Archives journals.
According to background information in the article, a new but somewhat controversial treatment for retinoblastoma (Rb) is IAC. In this type of therapy, chemotherapy is delivered directly to the eye and the surrounding area by administering the medication through the ophthalmic artery. "The main goal of this approach is to provide sufficient chemotherapy to eradicate the Rb and avoid the toxicities of systemic chemotherapy," explain the authors.
Ralph C. Eagle, Jr., M.D., from the Wills Eye Institute, Philadelphia, and colleagues examined eight eyes that had been treated with IAC but were later removed (enucleated). The enucleations were performed because the tumors were not responsive to therapy, or because other medical problems, such as a certain type of glaucoma, developed. An ophthalmic pathologist dissected and studied the eyes.
This examination demonstrated that the response to treatment ranged from minimal (one eye), to moderate (one eye), to extensive (four eyes) to complete regression (two eyes). However, a majority of the eyes also showed evidence of complications, including ischemia and atrophy of the retina, blood clots in blood vessels and foreign material within those clots.
"In summary, histopathology of eyes with Rb following IAC showed evidence of complete tumor regression in eyes in which there was clinical tumor regression and also confirmed viable tumor in those in which tumor was suspected clinically," report the authors. However, the authors also emphasize the importance of the discovery of blood vessel blockages and foreign material in the clots within those vessels. The researchers conclude, "We suggest that IAC for Rb be used with caution."
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- R. C. Eagle, C. L. Shields, C. Bianciotto, P. Jabbour, J. A. Shields. Histopathologic Observations After Intra-arterial Chemotherapy for Retinoblastoma. Archives of Ophthalmology, 2011; DOI: 10.1001/archophthalmol.2011.223
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