A team of doctors at Children’s Health use a state-of-the-art treatment to save a patient’s life and his vision.
As an infant, Miguel couldn't tell his parents that he couldn't see very well. They noticed that he sometimes missed things he was reaching for, but they figured it was just part of his development. But when Miguel's pediatrician examined his eyes at a 9-month-old well-child visit, they realized something was very wrong.
"Two specialists later, we were being admitted to Children's Health," says Miguel's mom Berenice.
The diagnosis was life-changing: Miguel had two tumors in each eye, caused by a cancer called retinoblastoma. Berenice remembers the diagnosis like it was yesterday — she felt sick to her stomach, then the tears came.
"He had all of these doctors working together," Berenice says. "If one treatment didn't work, they tried the next. They would not stop until my son was healed."
Tackling a rare childhood cancer
Retinoblastoma is very rare and typically affects children under 5. It was 100% fatal 100 years ago. Then doctors learned that you can save a child's life by removing their eye when the cancer is caught early enough. But this would limit their vision or take it away completely if the cancer was in both eyes.
"In the 1990s, chemotherapy started being used in an attempt to salvage the eye. Still, well over half of children needed their eye removed at that time. Now that number is much lower, around 5%," says James William Harbour, M.D., ocular oncologist and world leader in eye cancer, who led Miguel's care.
Miguel's first treatment was systemic chemotherapy, which means using chemotherapy medicines that travel throughout the body. That worked well for one eye. But in the other, the cancer came back after a short time and started growing within the retina (a layer of tissue at the back of the eye).
That left his team with two options: removing that eye or intra-arterial chemotherapy (IAC), a new treatment approach, only offered at a handful of hospitals in the country. Dr. Harbour had administered IAC with a different team at his previous hospital. But this would be the first time it was performed at Children's Health.
"We were a little scared because it was so new, but through the whole process we saw how all of the staff loved our son and wanted to take care of him," Berenice says. "We knew they wanted him to be cured as much as we did, so they had our trust."
A team of experts
Unlike systemic chemotherapy that travels through the whole body, IAC sends a high dose of chemotherapy directly to the eye tumors. Doctors feed a long, skinny tube through a vein, then direct the medicine to tiny vessels that supply blood to the retina. This delivers the medicine directly to the tumor in the eye.
It's no simple procedure. Miguel needed a team of eye doctors with special expertise in retinal diseases, cancer, and brain surgery with special training in blood vessels of the brain — and all of them need extensive experience in treating babies and children. Children's Health pediatric retina specialists Yu-Guang He, M.D. and Angeline Wang, M.D., and pediatric neurosurgeon Rafael Sillero, M.D. were ready.
"We basically met this stream of doctors," Berenice says. "It was like 'this is who you have next, this is who you have next, and this is how they'll work together to heal your son.'"
Miguel had four treatments over the course of a few months. One striking difference between IAC and the initial systemic chemotherapy was the side effects. With systemic chemotherapy, Miguel lost all of his hair, his nails were yellow and he was vomiting all the time.
"With IAC, there was nothing," Berenice says. "No scar, he was not sick, his eyes did not hurt. He was at home that night and playing the next day."
Giving Miguel the best chance and every opportunity
The lack of side effects was great, but the final treatment results were incredible: No signs of cancer and better vision than ever.
"A few years ago, when retinoblastoma recurred after therapy and spread into the retina, it would have meant removing the eye for sure," Dr. Harbour says. "But instead, we were able to treat this with IAC, and he responded beautifully. The cancer is completely gone, and we were able to save the eye. In fact, that's now the better seeing eye."
Miguel's family can see a notable difference in how he moves through the world now that the tumors are gone. They're grateful that he was able to benefit from a treatment on the leading edge of medicine.
"It's amazing how well the treatment worked and we hope it can be used all the time for other kids with this cancer," Berenice says. "We really appreciate how Miguel's treatment was not only about saving his life, but about giving him the best chance and every opportunity in the future."
At Children's Health, we strive to not only cure a child's disease, but use treatments that will give them the best quality of life as they grow up. We provide comprehensive care for children with retinoblastoma, tailored to each child's unique needs. Learn more about this rare eye cancer and treatment options.