Chemosurgery goes directly to tumor.

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