Eye Salvage with Intra-Arterial and Intra-Vitreal Chemotherapy in Patients with Retinoblastoma: 8-Year Single-Institution Experience in Colombia

Abstract

<b><i>Introduction:</i></b> Intra-arterial chemotherapy (IAC) is useful for eye preservation in advanced retinoblastoma (Rb). Intra-vitreal chemotherapy (IvitC) is the latest treatment for vitreous seeds. <b><i>Methods:</i></b> The present study is a retrospective assessment of 100 eyes, treated with primary or secondary IAC alone or with IvitC. We evaluated demographic and clinical variables, eye salvage, associated adverse events, and patient survival. Data were analyzed using descriptive statistics. Kaplan-Meier survival curves and Cox hazard ratios were utilized to assess the effect of demographic and clinical variables over eye salvage. <b><i>Results:</i></b> Bilateral Rb was observed in 61% of patients, and 57% of eyes received secondary treatment. Forty eyes needed intra-arterial plus IvitC and 62 presented advanced disease (group D and E). Three- and 5-year ocular survival probabilities were 75 and 68%. We found a higher risk in group D and E eyes and those requiring 2 or more routes for ophthalmic artery catheterization. Patients coming from other countries also showed increased risk. Using primary or secondary treatment, or IvitC, did not affect this risk. Overall rates of survival and eye salvages were 98.8 and 73%, and we had a 100% catheterization success and none ophthalmic arterial occlusions. <b><i>Conclusions:</i></b> In an upper middle-income country such as Colombia, a specialized institution counting with therapeutic alternatives and a multidisciplinary team can reach rates of patient survival and eye salvage similar to those of high-income countries.

How We Approach Conservative Treatment of Retinoblastoma in South America in the Era of Local Ocular Treatments. A Consensus of the Grupo America Latina De Oncologia Pediatrica (Galop)

“…However, as opposed to the North American experience, in Argentina (and later in other Latin American countries), OAC was mostly used for the treatment of relapsed or advanced bilateral disease and less frequently for patients with unilateral disease 9,10 . Later, this treatment was gradually introduced in other countries included in this consensus document 9,11,16 .…”

“…As opposed to other pediatric malignancies, these outstanding results were not achieved by international cooperative groups performing prospective studies. Therefore, most referral centers for retinoblastoma in South America also moved from systemic to ocular delivery of chemotherapy for the conservative treatment resulting in unprecedented ocular salvage rates and near total elimination of EBRT [9][10][11] . This document is the result of a consensus of the current management in institutions participating in the GALOP group, which included collaborating institutions in Spain and Portugal.…”

“…Juan Pablo Lopez Garin 1 , Claudia Sampor 2 , Nathalia Grigorovski 3 , Alejandro Ceciliano 4 , Adriana Fandiño 2 , Diego Ossandon 5,6 , Veronica Perez 6 , Rafaela Caixeta 7 , Joaquim Caetano Aguirre Neto 7 , Sandra Alarcon 8 , Sonia Silva 9 , Luiz Teixeira 10 , Celia Gianotti Antoneli 11 , Clarissa Matosinho 3 , Carlos Leal-Leal, 12 Guilherme Castella 9 , Flavio Requejo 2 , Jaume Catala 13 , Carla Macedo 11 , Guillermo L Chantada 4,13,14 1: Universidad de Chile. Santiago, Chile 2: Hospital de Pediatría SAMIC Juan P Garrahan, Buenos Aires, Argentina The Grupo de America Latina de Oncologia Pediatrica (GALOP developed a consensus document for the management of conservative therapy for retinoblastoma.…”

Quimioterapia intra-arterial para el manejo del retinoblastoma

“…Respecto al ámbito de costoefectividad, las estrategias de tratamiento de menor a mayor costo por episodio de atención son: la enucleación, seguida de la terapia focal con láser, la QMT sistémica sola, la QMT sistémica con enucleación planificada y, por último, QIA con melfalán, la cual aumenta su costo para casos bilaterales (51). González et al (52) presentaron la experiencia de 8 años de un centro en Colombia en el manejo de Rb con QIA y evidenciaron que al contar con una institución especializada y un equipo multidisciplinario, es posible alcanzar tasas de sobrevida y salvamento ocular similares a aquellas encontradas en países de mayor nivel socioeconómico.…”

How we approach conservative treatment of retinoblastoma in South America in the era of local ocular treatments: A consensus of the Grupo America Latina de Oncologia Pediatrica (GALOP)

“…The results of this treatment in eyes with vitreous or subretinal seeding were modest; therefore, several major institutions in high‐income countries have implemented ocular chemotherapy techniques such as ophthalmic artery intra‐arterial (OAC) and intra‐vitreal chemotherapy in order to allow greater delivery of chemotherapy to the eye with fewer systemic effects 8 . Most referral centers for retinoblastoma in South America also moved from systemic to ocular delivery of chemotherapy for conservative treatment, resulting in increased ocular salvage rates and near‐total elimination of EBRT 9–11 . Despite there is a relative paucity of evidence coming from prospective studies in retinoblastoma, the participants of this group elaborated this consensus report on the current management of retinoblastoma at institutions participating in the GALOP group, which also included collaborating institutions in Spain and Portugal.…”