Reduction of severe visual loss and complications following intra-arterial chemotherapy (IAC) for refractory retinoblastoma

Abstract

The proportion of visual and ocular motility complications may be reduced by providing age-adjusted doses of melphalan. Dose rather than complications from catheterisation is the most important risk factor for ocular injury.

The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma

“…Small sample size may significantly affect the reliability of the outcomes. Sample size in the analysed studies ranged from 9 eyes as in the study by Reddy et al [38] to 436 eyes as reported by Francis et al [24]. It has to be emphasized that the number of eyes was less than 40 in at least half of the analysed studies.…”

“…e potential risk of other severe complications such as vascular occlusions, chorioretinal atrophy, retinal detachment, neovascular glaucoma, and cranial nerve palsies should not be neglected. Reddy et al suggested in their recent study that adjusting the dose of the intraarterial chemotherapeutic agent according to the patient's age may significantly decrease ocular adverse events and still maintain excellent globe salvage rates [38]. Figure 6 illustrates ocular 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.…”

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

“…Its incidence varies substantially in the literature ranging from 7% (Dalvin et al, 2018) (Bianciotto et al, 2012) to 47% (Muen et al, 2012). This variability may be explained at least in part by a learning curve (Dalvin et al, 2018;Reddy et al, 2017), and/or by the fact that not all grades of the complication are necessarily reported (see Table 16). According to the Lausanne data collected over the last 10 years, this complication was observed in 21 of 560 injection procedures (3.8%) administered to 213 eyes (9.8%), and typically occurred after a mean number of 2.4 injections (range 1-5), distributed in 10% grade 1, 52% grade 3, 10% grade 4, and 28% grade 5.…”

“…A dose-related ocular toxicity of melphalan was hypothesized by the London group (Reddy et al, 2017), who reported that visual complications may be minimized with age-adjusted melphalan dosages. However, such a dosage effect, at least within the published dose range, could not be demonstrated in a subsequent study from Philadelphia (Dalvin et al, 2018).…”