Electroretinogram monitoring of dose-dependent toxicity after ophthalmic artery chemosurgery in retinoblastoma eyes: six year review

Jasmine H Francis, David H Abramson, Y Pierre Gobin, Brian P Marr, Ira J Dunkel, Elyn R Riedel, Scott E Brodie, Jasmine H Francis, David H Abramson, Y Pierre Gobin, Brian P Marr, Ira J Dunkel, Elyn R Riedel, Scott E Brodie

Abstract

Purpose: To report electroretinogram responses of retinoblastoma children under anesthesia before and after treatment with chemotherapeutic drugs (melphalan, topotecan, carboplatin) delivery by ophthalmic artery chemosurgery (OAC).

Methods: A cohort study of 81 patients with retinoblastoma treated with OAC. All patients treated with OAC at our center through May 2012 for whom the requisite ERG data were available are included in the analysis. This study recorded the ERG 30 Hz flicker amplitude response changes from baseline, at 3 and 12 months following OAC treatment completion. Both univariate and multivariate linear regression models were evaluated, with generalized estimating equations to correct for correlations within patients. Independent numerical variables included maximum doses and cumulative doses of melphalan, topotecan and carboplatin.

Results: By univariate analysis, both melphalan and topotecan appear to be associated with changes in ERG amplitude at both 3 and 12 months; but for the most part, these changes are minimal and likely clinically insignificant. By multivariate analysis, maximum and cumulative melphalan have a modest, temporary effect on the ERG amplitude change, which is apparent at 3 months but no longer evident at 12 months after completing treatment. By multivariate analysis, topotecan and carboplatin do not appear to adversely effect the change in ERG response.

Conclusion: Melphalan has the strongest, and carboplatin the weakest association with reduction in ERG response amplitudes; but for the most part, these changes are minimal and likely clinically insignificant. These conclusions apply only over the dose ranges used here, and should be applied with caution.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Scatterplot demonstrating change in ERG…
Figure 1. Scatterplot demonstrating change in ERG response to cumulative dose of melphalan over all data.
Although a cutpoint of 14(p-value = 0.01), there remains variability above and below this dose.
Figure 2. Scatterplot demonstrating change in ERG…
Figure 2. Scatterplot demonstrating change in ERG response to cumulative dose of melphalan after excluding patients with alterations in retinal architecture.
A cutpoint of 10(p-value = 0.05); however, there is variability above and below this dose.

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