The remarkable procedure saving children from eye cancer
Ophthalmic artery chemosurgery delivers a strong dose of chemotherapy without negative side effects. In this video, HealthMaker David Abramson, MD, explains the origins of this revolutionary surgery to treat retinoblastoma.
Transcript
[DELICATE PIANO MUSIC PLAYING] One of the big challenges in treating retinoblastoma is to try to retain an eye with vision
and cure the cancer removing the eye is always an option-- again, retinoblastomas in both eyes.
I've done it many times, but I can't think of a worse operation that you want to do than removing both eyes of a child.
In 1903, it was first recognized that you could cure this cancer with radiation alone.
And in fact, it remains one of the very few solid cancers-- meaning not leukemia or lymphoma-- that can be cured with radiation alone.
Thousands of children were treated, and thousands of lives were saved and eyes saved. But as the children got older, it was recognized that some
of those children went on and developed a different kind of cancer-- usually a bone cancer-- which killed them.
As a result of that, beginning in the 1990s, physicians switched from using radiation
to using chemotherapy-- intravenous chemotherapy. These are very young children. The chemotherapy works in the sense that the tumors shrink,
but the chemotherapy never cures it. The chemotherapy had many side effects, including causing cancer, including
causing hearing problems. There were no treatments invented that really, to me,
had a satisfactory profile of safety and toxicity. So it occurred to me the only way
you could ever cure retinoblastoma with systemic chemotherapy would be if you gave such a high dose
that it killed the patient. And if it killed the patient, of course, it would kill the cancer. But any dose less than that, you would
have the cancer cells surviving and the normal cells not surviving. So I thought, how can we go about getting
a dose of chemotherapy so high that we killed the cancer, but to the patients so low that they didn't have
these horrible side effects? So in 1986, Dr. Pierre Goban and I
got together for the first time, and I proposed to him a way to do this. And the way to do this is to feet
a little catheter-- a tube taller than me but thinner than angel hair pasta.
We put it in the blood vessel and the groin of young babies and then pass it through the blood vessels of the belly,
through the blood vessels of the chest, into the blood vessels of the neck, and put it directly into the one blood vessel that
goes to the human eye. There's only one blood vessel that goes to the eye. That's both good and bad. That blood vessel is the size of angel hair
pasta, which is 900 microns. And our catheter is 450 microns, so our catheter
is half the thickness of angel hair pasta. When you do that, you need to only inject a few drops of chemotherapy.
The dose that you get to the eye is 100 to 1,000 times the dose you get intravenously, but the dose that leaks
into the bloodstream is less than 1% of what the children normally get with intravenous chemotherapy.
In May of 2006, we did our first patient. That patient was scheduled to have her eye removed.
They agreed to this protocol. The eye was blind. We did it.
We waited three weeks and had the child come back. And when the child came back, the cancer was about 95% gone.
That began us on the treatment for children. We then recognized if we could do one eye,
we could do both eyes, simply by going up one side of the neck and treating the eye, coming down, going across, up
the other side of the neck to the other blood vessel, coming down. It's an outpatient procedure. It takes an hour.
The children go home with a Band-Aid. Because the dose of chemotherapy is so low, only about 1%
of these children ever require blood transfusions. So the children don't require blood transfusions. They don't get sick.
They don't lose their hair. They don't have any of the complications of chemotherapy. And, it worked.
cancer
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