Selective ophthalmic artery infusion of chemotherapy for @entity995 : initial experience with 17 XXXX .

@entity1 @entity548 @entity5 @entity3601 @entity1442 @entity2093 @entity995
OBJECT: @entity995 is the most common @entity2093 in @entity1 . Left untreated it spreads to the brain via the optic nerve. Traditional therapy is enucleation, and while this procedure is still the most common treatment worldwide, modern eye-preserving therapies can often spare the globe. However, @entity1 with @entity995 often present in advanced stages of the disease when these globe-preserving strategies are often insufficient to prevent enucleation. In these challenging cases, direct infusion of chemotherapy into the ophthalmic artery has been attempted to achieve @entity5 control. The authors' aim in this study was to report on their initial experience with and clinical results for this approach. METHODS: The authors prospectively collected data on all cases of @entity995 treated with selective intraophthalmic melphalan at Bascom Palmer Eye Institute. All cases were classified as International Intraocular @entity995 Classification (IIRC) Group D or Reese-Ellsworth Group Vb, had not responded to aggressive multimodal therapy consisting of chemotherapy and focal consolidating laser therapy, and were pending enucleation. Using digital subtraction angiography, a microcatheter was navigated under roadmap guidance into the ophthalmic artery, and melphalan was infused over 40 minutes. Early in the series, @entity1 were treated with 3 or 5 mg of melphalan, but after low response rates occurred all eyes were treated with 7.5 mg of @entity3601 . All @entity1 were examined with funduscopy while under anesthesia 3 weeks after treatment and every 3 months thereafter. @entity1 with persistent disease were retreated with repeat infusions of melphalan. RESULTS: Twenty-six procedures were performed to treat 17 @entity5 in 15 @entity1 . Successful cannulation of the ophthalmic artery was achieved in all cases. The follow-up ranged from 3 to 12 months, with a mean of 8.6 months. Overall, 76% of the @entity5 responded to therapy and these cases were spared enucleation. The average number of treatments was 1.5 per @entity5 . Of the responders, 54% responded to a single dose of melphalan. Treatment with the higher dose of 7.5 mg up front was associated with a lower enucleation rate (0% vs 36%) as compared with the lower starting dose. Delayed @entity548 occurred after 4 (15%) of 26 treatments, and these cases were treated with enucleation. CONCLUSIONS: In this challenging group of advanced @entity995 refractory to aggressive multimodal therapy, virtually 100% of eyes are generally enucleated. In contrast, the authors' protocol of infusing melphalan directly into the ophthalmic artery led to a dramatic decrease in the enucleation rate to 23.5%. While it is now the treatment of choice for refractory @entity995 at their center, its role in less @entity1442 remains to be elucidated.
