New method of salvage retinoblastoma treatment

Abstract

Purpose. Elaboration of the new method of salvage retinoblastoma (RB) treatment, combining local and systemic chemotherapy. Material and methods. Salvage treatment using the new method was carried out in 71 children aged 2 months – 7 years on 102 eyes with RB in T1–T3 stages. At the Department of Pediatric Ophthalmopathology of SI «The Filatov Institute of Eye Diseases and Tissue Therapy of NAMS of Ukraine» the method of combined polychemotherapy (CPCT) was developed in 2010: primary IViC – injection of 0,01 µg (0,1 µg) Melphalan through pars plana; a course of CEV-protocol (drugs combination: Carboplatin + Etoposide Phosphate + Vincristine Sulfate) chemoreduction the next day after injection; monitoring the state of the tumor with repeated courses of SPHT every 3 weeks; addition of CPCT by focal destruction methods according to indications. In order to increase the ablasticity of IVi injections, we have developed the antireflux method of their implementation: to reduce IOP the diuretic injection is preliminarily performed in age-related dosage; puncture of the conjunctiva at the distance of 1–1,5 mm from the intended sclera puncture and its displacement above the IVi injection site; puncture of the sclera with obliquely perpendicular injection channel formation; IViC by cytostatic Melphalan in a volume of 0,1 ml in various dilutions depending on the indications; in repeated IViC – in different meridians; removing the needle with one-step tamponade of the injection site by cotton swab, antibiotic solution injecting under the conjunctiva with roller formation. Results. Ten-year experience of using the developed algorithm of salvage RB treatment by combined polychemotherapy, based on primary intravitreal melphalan chemotherapy (using the proposed antireflux injection method) with simultaneous systemic chemoreduction, proves its safety and effectivity – 77.5% regression of the tumors. Conclusion. Simultaneous action on the tumor of various cytostatics – one (melphalan) intraocular directly on the tumor and its vitreal clones, others – (carboplatin, etoposide, vincristine) – from the peripheral blood – creates the effect of «double blow» on RB cells. Key words: retinoblastoma, salvage treatment, combined polychemotherapy.