July 25, 2011
A New Approach to Treating Rare Eye Cancer in Children
By Josh Goldstein
Intra-arterial Chemotherapy for Retinoblastoma
Chujin Yu clung to her mother in the exam room at Jefferson Hospital for Neuroscience.
To the small girl from Zhejiang province in China, this was indeed a strange place with strange people crowding around. The 3-year-old girl had arrived in Philadelphia with her parents the previous night from China for the treatment of a recurrence of rare cancer affecting her eye.
Chujin has retinoblastoma, a cancer that develops in the ophthalmic arteries of babies and young children. She had already been treated in China with systemic chemotherapy, but the tumor returned and her parents had brought her to the U.S. in hopes of saving the eye.
She was at Jefferson because of a collaboration between Jefferson and Wills Eye Institute on a clinical trial to develop a new treatment regimen for children with this condition.
Traditionally, children with retinoblastoma had two treatment options – having the eye surgically removed and/or systemic chemotherapy delivered through an IV with high enough doses to reach and destroy the tumors in the eye.
Working in collaboration with Carol Shields, MD, an eye cancer specialist at Wills Eye, Jefferson vascular neurosurgeons Robert H. Rosenwasser, MD, and Pascal Jabbour, MD, have been using a new approach with remarkable success.
This new treatment, called intra-arterial chemotherapy, involves delivering the cancer-killing drugs directly into the artery – the ophthalmic artery – behind the affected eye. The key is getting a catheter into the miniscule artery of the babies and small children with this cancer.
That’s where Jefferson’s experienced neurosurgeons come in.
Using a minimally invasive technique that involved threading a microcatheter from an artery in the child’s thigh through the body into the head and then into the ophthalmic artery – a process that would be challenging in an adult and requires an especially experienced, steady hand in small children – where the chemo agent is injected over the course of 30 minutes.
A small amount of this powerful drug used in treatment – “a small dose that would fit in a thimble” – helps minimize the side effects, Dr. Shields said. And because the technique appears to benefit even children who have had their retinoblastoma recur, the Jefferson-Wills Eye collaboration is attracting patients like Chujin from all over this country and the world, including Malaya Zacara from Virginia Beach, Va. and Dania Alhorani from Jordan.
Tyler Sanzone with his parents Emily and Mike Sanzone
In addition to such toddlers and preschoolers, the team here is also treating the smallest babies diagnosed with retinoblastoma – children like five-month-old Tyler Sanzone whose case was recently featured in
The Philadelphia Inquirer. In these littlest babies, the ability to minimize the amount of chemotherapy and reduce the number of treatments from six to three is a great benefit of the intra-arterial approach, according to Dr. Jabbour.
Even more importantly, it has helped prevent the surgical removal of the eyes of many of these kids and in some cases even improved their vision.
“Preliminary results are promising,” Dr. Jabbour said. “We were able to save the eye in approximately 70 to 80 percent of the cases and sometimes in cases where IV chemotherapy failed, we were able to cure the tumor.”
In the U.S. about 300 children a year, the vast majority under five years of age, are diagnosed with retinoblastoma. Often parents are the first to see the problem – even if they don’t recognize it for what it is. In photographs where a flash is used instead of ready eye, the affected eye of children appears white or yellow.
Early that spring morning in Philadelphia, an exhausted Chujin didn’t want to open her eyes as she snuggled in her mother’s protective embrace.
She couldn’t have known that her parents had taken extraordinary measures in their effort to save her eye and cure the cancer that had returned to it. After the doctors in China had exhausted their treatment options, they felt there was still a chance to save the eye and recommended Chujin’s parents bring her to the U.S. for treatment by the unique team of experts at Jefferson and Wills Eye.