Intra-Arterial Chemotherapy for Retinoblastoma in Infants ≤10 kg: 74 Treated Eyes with 222 IAC Sessions

Abstract

BACKGROUND AND PURPOSE: Intra-arterial chemotherapy for retinoblastoma has dramatically altered the natural history of the disease. The remarkable outcomes associated with a high safety profile have pushed the envelope to offer treatment for patients weighing #10 kg. The purpose was to determine the efficacy and safety of IAC infusions performed in infants weighing #10 kg with intraocular retinoblastoma. MATERIALS AND METHODS:A retrospective chart review was performed for patients diagnosed with retinoblastoma and managed with intra-arterial chemotherapy. RESULTS:The total study cohort included 207 retinoblastoma tumors of 207 eyes in 196 consecutive patients who underwent 658 intra-arterial chemotherapy infusions overall. Of these, patient weights were 10 kg in 69 (35.2%) and .10 kg in 127 (64.8%) patients. Comparison (#10 kg versus .10 kg) revealed that the total number of intra-arterial chemotherapy infusions was 222 versus 436. Periprocedural complications were not significantly different (2 [0.9%] versus 2 [0.5%]; P ¼ .49). Cumulative radiation exposure per eye was significantly lower in infants weighing #10 kg (5.0 Gym 2 versus 7.7 Gym 2 ; P ¼ .01). Patients weighing 10 kg had a greater frequency of complete tumor regression (82.6% versus 60.9%; P ¼ .02). Mean fluoroscopy time was not significantly different (7.5 versus 7.2; P ¼ .71). There was a significant difference in the frequency of enucleation (16 [21.6%] versus 52 [39.1%]; P ¼ .01). Patients weighing 10 kg had greater number of aborted procedures (12 [5.4%] versus 7 [1.6%]; P ¼ .01). On multivariate analysis, weight #10 kg was not an independent predictor of complications or procedure failure.CONCLUSIONS: Intra-arterial chemotherapy in patients weighing #10 kg is a safe and effective treatment.

Recent advancements in the management of retinoblastoma and uveal melanoma

“…This convention is to minimize procedure-related complications in small infants, such as catheterization site hematoma and limb ischemia. However, more studies are demonstrating that IAC can be safely administered in infants weighing less than 10 kg, with the youngest reported patient only 35 days of age when receiving the first cycle of IAC 34 – 38 . Sweid et al .…”

“…Sweid et al . published a comparative study in which patients weighing less than 10 kg experienced fewer total IAC cycles as well as less exposure to radiation during fluoroscopy, which can help minimize procedure-related adverse effects in the long term 34 . As a result, there is increasing understanding that younger patients undergoing IAC as primary therapy may attain better outcomes in a shorter treatment duration 29 , 34 , 39 .…”