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Purpose To report 4 late retinoblastoma cases treated with supraselective injection of intraarterial melphalan as the primary treatment. In advanced retinoblastoma in older children enucleation remains the most common treatment option although some eyes can be salvaged with combinations of systemic chemotherapy, focal techniques and external beam radiotherapy. Direct infusion of chemotherapy into the ophthalmic artery has be attempted to achieve tumor control and avoid enucleation. Methods The authors prospectively collected data of all retinoblastoma cases treated with selective intra‐ophthalmic melphalan at the Referral Center for Retinoblastoma of Siena, Italy, from 2008 to 2011. Four out of 43 cases (4 eyes out of 49 eyes) of late unilateral advanced retinoblastoma received intraarterial melphalan infusion therapy as the primary treatment. Results Complete remission was obtained in 1 out of 4 cases. Conclusion The role of intraarterial chemotherapy as primary treatment for advanced retinoblastoma in older children remains to be elucidated. [ABSTRACT FROM AUTHOR]

Purpose To report the preliminary results of the conservative treatment of advanced retinoblastoma (Stage Va e Vb) obtained with the melphalan protocol (direct intraarterial‐ophthalmic artery infusion). Methods 33 children (35 eyes) with advanced retinoblastoma who were eligible for enucleation were entered in phase two of one center open study‐approved protocol of ophthalmic artery infusion of Melphalan to avoid enucleation (Italian Melphalan protocol, approved by the Ethic Commettee – University Hospital of Siena). Two cases have been treated bilaterally. 15 eyes were first diagnosis and 18 were relapses following chemo and/or radiotherapy. In two cases has not been possible to conclude the procedure due to haemodynamic problems. Results The ophthalmic artery was successfully cannulated in 35 eyes (total, 121 procedures). In 2 attempts was impossible to successfully conclude the procedure due to hemodynamic problems. Cannulation of the ophthalmic artery was performed by a femoral artery approach using microcatheters (magic 1.5) while the children were under general anesthesia and anticoagulated. Melphalan was infused into the artery over a 30‐minute period (dose of 3‐7 mg according to the age and size of the globe). Local and systemic toxicity have been evaluated and documented. Conclusion 33 children (35 eyes) with advanced retinoblastoma (Stage Va and Vb Reese classification) were eligible for the Melphalan Italian Protocol. The 78.7% of treated eyes is in complete remission. Superselective chemotherapy delivered through the ophthalmic artery can avoid enucleation, primary radiation or abuse of systemic chemotherapy. [ABSTRACT FROM AUTHOR]