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Chemosurgery Goes Directly To Tumors- Inquirer Article

July 25, 2011 by   Leave a Comment

Chemosurgery Goes Directly To Tumors

From the: Philadelphia Inquirer Digital Edition- Article By Marie McCullough, Inquirer Staff Writer

Emily Sanzone watched her son in his bouncy seat. As Tyler looked toward the ceiling light, there it was again, a whiteness in his right pupil, like a cataract. He looked down, and it disappeared.

It’s probably nothing, Emily and her husband, Mike, agreed. The Old Bridge, N.J., couple marveled that their thriving 4-month-old was already wearing clothes for a 9-month-old. Even so, when Emily took Tyler for a routine pediatrician visit, she mentioned the whiteness.

That casual observation would transform her infant into a cancer patient, research subject, and pint-size pioneer in ocular oncology.

Tyler’s right eye appeared white because light was reflecting off a tumor. It was growing in his retina, the sensitive membrane at the back of the eye that converts light rays into signals the brain interprets as images.

In early March, he became one of about 300 children diagnosed annually in the United States with a malignancy called retinoblastoma, or RB.

The tumor, tests showed, was the size of a grape, nearly filling Tyler’s eyeball. It had forced the retina to peel away from its nourishing support tissue, leaving the eye blind. Untreated, such tumors typically invade the optic nerve and then, with ferocious lethality, the brain.

Fortunately, Tyler’s cancer was still confined to the globe, and his left eye was fine. Removing the diseased eye would give him a 98 percent chance of survival, explained ocular oncologist Carol L. Shields, a renowned retinoblastoma expert at Wills Eye Institute and Thomas Jefferson University.

Not many years ago, the discussion would have ended there. Standard therapies – eye radiation or whole-body intravenous chemotherapy – could not save such a “hopeless eye.”

But in March, Shields laid out a novel option: squirting chemotherapy directly into the eye through the tiny ophthalmic artery, the only vessel that feeds into the organ. It might save the eyeball so Tyler wouldn’t need a prosthesis. It might even restore some vision.

Shields stressed that there were risks. Maneuvering a catheter through the baby’s vessels could cause a stroke, hemorrhage, loss of a limb, even death. The chemo might scar the artery, foiling repeated catheterizations. And if three infusions, one a month, didn’t kill the cancer, it would all be for nothing.

Tyler’s eye would then have to be enucleated. Removed.


 Evolving Treatment

In poor countries with little health care, retinoblastoma is usually diagnosed too late. Death rates are 75 percent in some parts of Africa.

In developed countries, early detection is the norm. Because RB is so curable if the cancer is inside the eyeball, survival rates are more than 95 percent. Tyler’s white eye, called leukocoria, was the classic warning sign. Parents may first notice it in a flash photograph because the healthy eye appears red – the spooky but normal effect of the flash’s reflecting off blood vessels.

With survival almost certain, treatment has evolved to try to salvage eyes and, if possible, vision. This is vital for children with tumors in both eyes. They have the heritable form of RB, so the mutation is in every bodily cell, not just cells in one eye.

At Wills, which treats about half the nation’s cases and many from overseas, most eyes wind up being saved, yet deaths due to metastatic RB have been vanishingly rare in recent decades, Shields said.

Still, history has shown that today’s RB advance may be tomorrow’s anguish.

Eye radiation was long the mainstay of therapy – until it became clear in the 1990s that it could cause secondary cancers in the head and neck.

The next big step was IV chemotherapy. It cured many children but had moderate effectiveness within the eyeball and often had to be followed by laser, heat, or freezing treatments. What’s more, pumping toxic chemicals into babies – two-thirds of RB cases are diagnosed by age 2 – left some with hearing loss and a few with leukemia, a deadly blood cancer.

What doctors needed was a way to deliver the power of chemo with the precision of surgery.


Weighing the options

Sitting in the conference room after Shields presented their options, Mike and Emily Sanzone grappled with the implications. Tyler, meanwhile, was so exhausted from being poked and prodded that he had fallen asleep in the arms of Emily’s mother, Diana Gabardi of Pottsville.

Married just two years, the Sanzones felt torn.

Mike, 48, an apartment-complex manager with mechanical prowess, was pragmatic and, by nature, a bit pessimistic.

“To me, it was weighing the benefits and risks,” he recalled. “Dr. Shields didn’t feel enucleation was not the route to go. She said he’d probably be blind in that eye, although he might get back some peripheral vision or shapes. But he could suffer a stroke! And they might have to take the eye out anyway.”


Note: This article was posted in interest with a recent interview with Dr Sandra Hollander. We discussed new chemotherapy treatments and chemosurgery techniques now available South Jersey and all of NJ, Philadelphia and through out the Tri-state area. Consultations and appointments can be made from Atlantic Hematology and Oncology’s interactive website at: . Additional links, resources and information about Dr. Hollander can be found at



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