Intra-arterial chemotherapy

with melphalan for intraocular retinoblastoma BACKGROUND Recently, this journal published a paper from Marr et al1 concerning multi-drug intra-arterial chemotherapy (IAC) for intraocular retinoblastoma. In many centres IAC has quickly garnered exciting interest, emerging as a promising, highly effective alternative for globe conserving treatment.2–4 In our institution, IAC with melphalan (IACM) has been performed since June 2008, and topotecan was added in June 2011. Fifty-nine patients have at least 1 year follow-up. Here we report our results obtained with IACM. METHODS Forty-seven patients (table 1) for a total of 52 eyes with 22 newly diagnosed intraocu-lar retinoblastomas (ND-RTBs) and 30 intraocular retinoblastomas after partial remission and/or relapses after other ther-apies (PR/R-RTBs) underwent IACM after a multidisciplinary group approval.5 The range of follow-up time is 19–61 months (median 39.6 months). RESULTS Two patients did not receive IACM for technical failure, two patients have been lost to follow-up, and 43 patients under-went a total of 176 session treatments in 48 eyes (table 1). During or after IACM, 27 eyes in 25 patients underwent other therapies including cryotherapy (n=13), laser ablation (n=13), intravitreal melpha-lan (n=6), periocular topotecan (n=6), subretinal carboplatin (n=6), brachitherapy (n=3), and systemic chemotherapy (n=2). Twenty-one eyes in 18 patients underwent only IACM. All these 43 patients are alive and free of metastases. Eighteen (35%) out of 48 eyes underwent enucleation— that is, 12 with ND-RTBs (Reese–Ellsworth stages Vb and International Intraocular Retinoblastoma Classification stage D, with vitreal seeding and total retinal detachment; 7/12 were late RTBs), and six with PR/ R-RTBs. Most recent follow-up examin-ation under general anaesthesia showed ophthalmoscopic remission in 28 (58%) eyes. Two year Kaplan–Meier eye enucle-ation-free rates (figure 1) were 48