Primary Intra-Arterial Chemotherapy for Retinoblastoma in the Intravitreal Chemotherapy Era: Five Years of Experience

Abstract

Purpose: To report our 5-year experience with intra-arterial chemotherapy (IAC) in the intravitreal chemotherapy (IvitC) era. Methods: Retrospective review of retinoblastoma treated with primary unilateral IAC in the IvitC era (2012–2017). Results: There were 34 eyes treated with IAC alone versus 20 eyes treated with IAC plus IvitC for vitreous seeds. IAC (IAC alone vs. IAC plus IvitC) consisted of melphalan (41 vs. 10%) or melphalan plus topotecan (59 vs. 90%, p = 0.03). IvitC consisted of melphalan (60%) or melphalan plus topotecan (40%). Tumor control and globe salvage were achieved in 100% of group B and C eyes without IvitC. Despite more extensive vitreous seeds in the IvitC group (p < 0.01), comparison of IAC alone versus IAC plus IvitC revealed no difference in tumor control for group D (88 vs. 69%, p = 0.36) or group E (67 vs. 100%, p = 0.25) and no difference in globe salvage for group D (88 vs. 69%, p = 0.36) or group E (58 vs. 57%, p = 0.39). Conclusions: IAC is effective as primary therapy for unilateral group B, C, D, and E retinoblastoma. IvitC is an important adjuvant therapy to achieve comparable globe salvage rates for group D and E eyes with persistent active vitreous seeds.

Intra-arterial chemotherapy in retinoblastoma – A paradigm change

“…In these eyes, enucleation or radiation was eliminated in 75% with IAC alone and 65% with combined IvitC. [66] Francis et al reported similar estimated 1-year ocular survival with IAC in the pre-IvitC era (96%) and IvitC era (96%). [67] In the review by Yousef et al , overall eye salvage was 66% in 502 eyes, 86% in groups A–C, and 57% in groups D and E.[39] Primary IAC had better eye salvage rate than secondary IAC.…”

“…[50] Our team has been fortunate to have used IAC for nearly 12 years in carefully selected hundreds of cases of retinoblastoma and we have had no incidence of metastasis or death. [20252729626566]…”

The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma

“…Fourteen patients developed fever, and 8 patients developed transient myelosuppression [25]. It should be noted that some of the studies did not comment on the systemic complications such as Francis et al [24] and Dalvin et al [41]. Figure 7 illustrates systemic and extraocular complications following IAC and their percentage share based on the analysed studies.…”

“…Ong et al [34] 59 75% B and C, 54% D and E, 67% primary, 55% secondary Abramson et al [22] 78.6 78.6% D, 85% primary, 74% secondary Michaels et al [35] 58 43% primary, 67% secondary Tuncer et al [36] 66.6 66.6% D, 66.6% primary Chen et al [37] 78.5 100% B, 100% C, 78.6% D, 62% E, 93.3% primary, 79% secondary Munier et al [23] 100 100% D Reddy et al [38] 66 66% secondary Francis et al [24] 92 No data Funes et al [39] 63 92% B-C, 40% D, 69% primary, 68% secondary Hua et al [25] 30 42% D, 21% E Wang et al [40] 78.7 84.2% D, 69.6% E, 78.7% primary Dalvin et al [41] 74 B 100%, C 100%, D 79%, E 58% IAC-related systemic side effects are mostly mild and transient; therefore, this treatment modality can be considered safe while performed by an experienced team of interventional neuroradiologists.…”

“…No data Mean 42 (20-90) Reddy et al [38] 9 No data Median 21 (4-35) Francis et al [24] 436 No data Median 27 (0-120) Funes et al [39] 97 99 Median 49 (12-79) Hua et al [25] 84 94.5 Mean 14 (3-28) Wang et al [40] 61 100 No data Dalvin et al [41] 54 No data 27 therapeutic target.…”