Metastatic deaths in retinoblastoma patients treated with intraarterial chemotherapy (ophthalmic artery chemosurgery) worldwide

Abstract

BackgroundOphthalmic artery chemosurgery [OAC, intra-arterial chemotherapy (IAC)] was introduced in 2006 as treatment modality for intraocular retinoblastoma. The purpose of this commentary is to retrospectively review the incidence of metastatic deaths in retinoblastoma patients treated with OAC worldwide over a 10 year period. Retrospective data regarding metastatic deaths was collected from six international retinoblastoma centers (New York City USA, Philadelphia USA, Sao Paulo Brazil, Siena Italy, Lausanne Switzerland and Buenos Aires Argentina). All retinoblastoma patients from these centers (naive and recurrent, unilateral and bilateral) treated with OAC/IAC since 2006 have been included in this study. Data regarding number of patients, number of OAC/IAC infusions, number unilateral and bilateral, number treated for naive disease or salvage and number of metastatic deaths have been assessed. Over a 10-year period of time 1139 patients received OAC/IAC for 4396 infusions. At last follow-up there were only three metastatic deaths (all treated in Buenos Aires).ConclusionThe current survey assessed the recorded risk of metastatic deaths in six retinoblastoma centers worldwide in children with retinoblastoma (unilateral or bilateral) treated with OAC/IAC as primary or secondary therapy. Overall, the observed risk for metastatic deaths from retinoblastoma was <1% in OAC/IAC treated children.

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

“…Neoadjuvant systemic chemotherapy may offer a less favorable coverage in patients with high risk for CNS involvement when compared to the unmatched chemotherapeutic optic nerve concentration achieved by intra-arterial drug delivery (Taich et al, 2016), while intravenous chemotherapy may be more efficient against distant minimally disseminated disease. Although the end result in terms of survival remains unknown to date, patient survival following the introduction of first line intra-arterial chemotherapy appears, however, unimpaired compared to previous treatment regimens, with no increase in the metastasis rate, ranging between 2 and 2.5% (Funes et al, 2018) and death rate from metastatic disease around 1% (Abramson et al, 2017b). Noteworthy, in all cases, the cause of metastases resulting in death was parental refusal of enucleation of a single remaining eye (Abramson et al, 2017b).…”

“…Although the end result in terms of survival remains unknown to date, patient survival following the introduction of first line intra-arterial chemotherapy appears, however, unimpaired compared to previous treatment regimens, with no increase in the metastasis rate, ranging between 2 and 2.5% (Funes et al, 2018) and death rate from metastatic disease around 1% (Abramson et al, 2017b). Noteworthy, in all cases, the cause of metastases resulting in death was parental refusal of enucleation of a single remaining eye (Abramson et al, 2017b).…”

An Overview of Retinoblastoma and Enucleation in Pediatric Patients

“…Patients with bilateral presentation, occurring in approximately one‐third of cases and presenting with the highest risk for vision loss, have historically been treated with bilateral enucleation, unilateral enucleation with chemotherapy or external beam radiation therapy management of the less affected eye, or systemic chemotherapy . Most recently, practitioners have been using bilateral ophthalmic artery chemosurgery (ie, intraoperative intra‐arterial chemotherapy), which offers ocular salvage, low toxicity, and a less than 1% risk for metastatic death, but may put children at risk for developing second cancers …”

Survival and ocular preservation in a long-term cohort of Japanese patients with retinoblastoma

“…In the 1990s, neoadjuvant systemic chemotherapy then emerged as an initial therapy for complete survival and better visual outcome [4]. Intra-ophthalmic artery chemotherapy (IAC) has been also introduced for effective globe salvage and reducing the risk of SPM [5][6][7][8].…”