Ocular survival after intra‐arterial chemotherapy for retinoblastoma improves with accrual of experience and programmatic evolution

Abstract

Background: Intra-arterial chemotherapy (IAC) for the treatment of intraocular retinoblastoma has gained recognition as a method to improve ocular salvage; however, there is a paucity of evidence supporting treatment factors prognosticating ocular survival. Methods: All patients with retinoblastoma treated with IAC at a single institution between December 2008 and December 2019 were evaluated. Patient demographics, tumor classification, prior treatments, procedural data, other non-IAC therapies, adverse reactions, procedural complications, ocular outcomes, and overall survival were assessed via retrospective chart review. Factors suggestive of increased ocular survival were identified via univariate and multivariate analyses. The impact of accrued treatment experience was evaluated by grouping eyes by the respective year, IAC treatment was initiated.Results: Forty-nine eyes of 43 patients were treated for retinoblastoma with IAC (256 total procedures). At least grade 3 neutropenia was observed following 19% of IAC procedures. The risk of neutropenia was not statistically different between single or multidrug IAC. Comparing those who received balloon-assisted intra-arterial chemotherapy (bIAC) in more than two-thirds of cycles to those who did not, the risk of arterial access site complications was not statistically different. Multivariate analysis revealed a significantly lower risk of enucleation associated with treatment era in years (hazard ratio [HR] = 0.52-1.00, p < .05) and laser therapies (HR = 0.02-0.60, p < .05).Conclusions: Ocular survival rates in patients treated with IAC for retinoblastoma at our institution have increased over time. Accrued treatment experience and programmatic changes have likely contributed. Larger, prospective series may lead to a better understanding of factors that consistently contribute to better ocular salvage.

A multi‐institutional feasibility study of intra‐arterial chemotherapy in children with retinoblastoma. A Children's Oncology Group study (COG ARET12P1)

“…This highlights the importance of limiting the delivery of this complex treatment in high‐volume centers with technical expertise. Retinoblastoma is a rare disease and one individual institution will not see a substantial number of patients to acquire the required experience with the delivery technique in a short period of time; extensive training and programmatic focus are needed for success 29 . This study was initiated in 2014 and therefore the results reported here need to be interpreted in its due historical context as one can expect greater experience with IA therapy at the current time.…”

Epidemiological aspect of retinoblastoma in the world: a review of recent advance studies

“…Treatment Treatment modalities for Rb have changed rapidly over the past decade [40] . and the survival of many Rb cases that used to die in the past has improved in recent years [3,[57][58][59] . In general, the available treatment options for Rb include surgery (including enucleation and pars plana vitrectomy); focal therapies (including cryotherapy, laser photocoagulation, and transpupillary thermotherapy); chemotherapy (including intravenous chemotherapy, intra-arterial chemotherapy, and intravitreal chemotherapy), and radiotherapy (including plaque brachytherapy and external beam technique) [16] .…”