Combined high‐dose intra‐arterial and intrathecal chemotherapy for the treatment of a case of extraocular retinoblastoma

Intra-arterial chemotherapy (IAC), also known as superselective ophthalmic artery chemotherapy or chemosurgery, is currently widely accepted as one of the primary treatment modalities for intraocular retinoblastoma worldwide. Following the introduction of the technique in 1998, IAC has evolved over the past decades to be safer and more effective. Accumulated evidence shows that IAC is more effective in providing eye salvage in group D and E retinoblastoma as compared to conventional systemic intravenous chemotherapy (IVC). In contrast to IVC, IAC has the added benefits of reduced overall treatment duration and minimal systemic toxicity. This review provides a comprehensive update on the history, technique, indications, contraindications, and outcome of IAC. We have also identified the strengths, weaknesses, opportunities and threats (SWOT analysis) of the technique in this review.

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“…Thereafter, the child was lost to follow-up and further status was not known on stability or recurrence or metastasis or death. [76]…”

Section: Treatment Outcomesmentioning

confidence: 99%

Intra-arterial chemotherapy in retinoblastoma – A paradigm change

Manjandavida

Stathopoulos

Zhang

et al. 2019

Indian J Ophthalmol

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“…However, the only survivor in the initial diagnosis group had positive MDD in the CSF at diagnosis, suggesting that intensive treatments may rescue these patients, as we reported in cases with high‐risk pathology features . Intra‐arterial chemotherapy may be considered as a way to achieve higher chemotherapy exposure to the optic nerve compared to systemic chemotherapy . Since a high proportion of our patients have MDD, in case intra‐arterial is used to treat orbital retinoblastoma, it should be combined with other systemic and CNS‐directed therapies.…”

Section: Discussionmentioning

confidence: 72%

“…11 Intra-arterial chemotherapy may be considered as a way to achieve higher chemotherapy exposure to the optic nerve compared to systemic chemotherapy. 15,16 Since a high proportion of our patients have MDD, in case intra-arterial is used to treat orbital retinoblastoma, it should be combined with other systemic and CNS-directed therapies.…”

Section: Discussionmentioning

confidence: 99%

Minimally disseminated disease and outcome in overt orbital retinoblastoma

Aschero

Torbidoni

Sampor

et al. 2019

Pediatric Blood & Cancer

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In this retrospective study of patients with overt orbital retinoblastoma, we evaluated minimally disseminated disease (MDD) in bone marrow and cerebrospinal fluid (CSF) using CRX and/or GD2 synthase as markers. Ten patients were evaluated—five (50%) at diagnosis and five upon relapse. MDD was detected in four cases (one in the bone marrow, two in the CSF, and in one case in both sites). All patients received chemotherapy and four received orbital radiotherapy. Seven patients relapsed or progressed and all of them died. Three patients remain in complete remission. There was no apparent correlation between MDD and the outcome.

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“…While neural invasion predominantly lead to CNS metastases; non-neural invasion have higher propensity to metastasize to other systemic sites 21 . It has been reported that CNS metastases have worse prognosis compared to other systemic metastases due to the blood-brain barrier which does not permeate the systemic chemotherapy 19 and may warrant adjuvant intrathecal or intraventricular chemotherapy 22,23 . B7H3 expression showed a significant increase in the RB tumor invading non-neural tissues compared to neural tissues.…”

Section: Discussionmentioning

confidence: 99%

Clinical relevance of B7H3 expression in retinoblastoma

Ganesan

Parameswaran²,

Sharma

et al. 2020

Sci Rep

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Retinoblastoma (RB) is the most common paediatric intraocular tumour. currently, chemotherapy is widely used to reduce the chance of metastasis as well as for vision salvage. the limitations of chemotherapy for RB include chemoresistance and cytotoxicity. Recently, immunotherapy is considered for treating chemoresistant cancers. Although, several molecular targets are available for immunotherapy in different cancers, we were interested in B7H3, as it was differentially expressed between retinoblastoma and retina in our earlier proteomics study. Hence, in this study we validated the previous finding by Western blotting and immunohistochemistry on primary RB tumor samples. The results suggest significantly increased expression of B7H3 in RB tumor samples compared to retina by western blotting. immunohistochemistry revealed spatial, inter and intratumoral heterogeneity in the primary RB tumor sections. Correlation of the B7H3 expression with clinical and histopathological data revealed significantly increased expression of B7H3 in poorly differentiated, non-neural invasive tumors and lower expression in neural invasion and severe anaplastic areas of the tumors. B7H3 expression did not significantly vary between low-risk and high-risk tumors. The study also revealed considerably reduced infiltration of T lymphocytes in RB. We conclude that B7H3 is prominently expressed in primary RB tumors and could be used for targeted therapy.

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Combined high‐dose intra‐arterial and intrathecal chemotherapy for the treatment of a case of extraocular retinoblastoma

Cited by 13 publications

References 17 publications

Intra-arterial chemotherapy in retinoblastoma – A paradigm change

Intra-arterial chemotherapy in retinoblastoma – A paradigm change

Minimally disseminated disease and outcome in overt orbital retinoblastoma

Clinical relevance of B7H3 expression in retinoblastoma

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