Causes of chemoreduction failure in retinoblastoma and analysis of associated factors leading to eventual treatment with external beam radiotherapy and enucleation

Occurrence of Sectoral Choroidal Occlusive Vasculopathy and Retinal Arteriolar Embolization After Superselective Ophthalmic Artery Chemotherapy for Advanced Intraocular Retinoblastoma

“…This approach has enabled globe preservation with no external radiotherapy in the large majority of less advanced tumors (Groups A-C of the International Classification of Intraocular Retinoblastoma 1 ) and in around 19% to 60% of more advanced tumors (Group D). [2][3][4][5][6][7][8][9][10][11][12] Vitreous and subretinal seeds characterizing Group D eyes constitute a major concern for globe salvage. Treatment techniques used up to now, such as external beam radiotherapy (EBR), 13 brachytherapy using radioactive plaques, 14-16 a combination of systemic chemotherapy and EBR, 3 or systemic chemotherapy with or without cyclosporine A or cryorupture of the hematoretinal barrier before chemotherapy, 2-11 may provide temporary control of seeding, but enucleation has often proven necessary even after last-resort external beam radiation.…”

The Treatment of Retinoblastoma with Four-Drug Regimen Including Cisplatin, Etoposide, Vincristine, and Cyclophosphamide

“…Enucleation is the most widely preferable method in these centers for the RE V tumors with no prospect for vision. Some of the authors [2,3,17] report, EnFS was 65% for the CRD group. We could not find any significant difference in EnFS for the RE V and RE I-IV tumors in the CRD group.…”

“…With the tumor shrinkage, supplemental therapies including transpupillary thermotherapy and cryotherapy, usually become more effective. Several studies indicate that most of the early stages and some of the advanced stages of intraocular RBLs may benefit significantly from this type of treatment [17][18][19][20][21][22][23][24].…”

Secondary and tertiary intra-arterial chemotherapy for massive persistent or recurrent subretinal retinoblastoma seeds following previous chemotherapy exposure: long-term tumor control and globe salvage in 30 eyes

“…Recurrent seeding, both vitreous and subretinal, is an important cause of chemotherapy failure, occasionally necessitating enucleation. [1][2][3] In the era of systemic intravenous chemotherapy (chemoreduction), Shields and colleagues 1 reported recurrence of subretinal seeds (SRS) in 53% of eyes within 1 year after intravenous chemotherapy and 62% after 3 years. When SRS are limited, local treatment measures, such as transpupillary thermotherapy, laser photocoagulation, cryotherapy, or plaque radiotherapy can suffice; however, extensive SRS require external beam radiation therapy (EBRT), enucleation, or, most recently, intra-arterial chemotherapy.…”

“…Additionally, incomplete response of SRS can be attributed to chemotherapy resistance, especially in eyes where IAC is a third-line therapy following previous year, and recurrences are generally all manifest within 3 years, thus emphasizing that close follow-up is needed despite initial good results. 3 Previous exposure to chemotherapy is important for IAC success. Abramson and colleagues 22 analyzed IAC in chemotherapy-naïve versus chemotherapy-nonnaïve eyes and found that the former showed 2-year globe salvage in 83% of those with solid tumor and SRS and 80% for those with solid tumor, SRS, and VS; in the nonnaïve eyes these rates were 50% and 54%, respectively.…”