The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma

Abstract

Introduction. Retinoblastoma is the most common primary intraocular neoplasm in children. With the advances in medicine, the armamentarium of available treatment modalities has grown. Intraarterial chemotherapy is a relatively new treatment method with promising outcomes. The purpose of this literature review is to evaluate its role in the management of retinoblastoma. Methods. A systematic online search was conducted using Ovid Embase and Ovid Medline. The final results included 23 studies. The studies were published between 2011 and 2019. The studies evaluated the technical success rate of IAC, globe salvage rate, and ocular and systemic complications, as well as the occurrence of deaths, metastasis, and secondary neoplasms. In total, 1827 eyes with retinoblastoma were analysed. The follow-up was between 0 and 252 months. Results. Overall globe retention rate ranged from 30% to 100%. Sixteen out of 23 studies reported ocular salvage between 60 and 80%. Eyelid oedema and erythema were the most commonly reported ocular complications following IAC. The most common systemic complications included nausea, vomiting, and neutropenia. Metastases and deaths were reported in 6 out of 23 studies. Three studies reported the development of secondary neoplasms. The technical success rate of IAC procedure ranged from 91% to 100%. Discussion. The studies have shown that IAC is a safe and effective treatment for advanced retinoblastoma, especially group D. It allows to save the globe without compromising patients’ survival. Local and systemic complications are acceptable. The role of IAC in less advanced tumours is yet to be established. Future work should focus on conducting larger prospective studies with longer follow-up. Multiple novel therapies for the management of retinoblastoma are currently being tested, including angiogenic inhibitors and targeted agents. The results seem to be promising. Future advances require a further in-depth understanding of unique genetics of retinoblastoma and complex interactions between tumour cells and their microenvironment.

Intraarterial Chemotherapy for Retinoblastoma – Initial Experiences of a German Reference Centre

“…The bulbus preservation rates here were 60 %/92 %. A comparison of studies published to date, summarized in 2020 in a systematic review by Pekacka et al, reveals a bulbus preservation rate between 60 % and 80 % in the majority of studies [8]. In our patient collective as well, 68.1 % of eyes were preserved by using IAC as primary or recurrence therapy in the long term course, whereby the follow-up analysed in our study tended to be long at 38 months.…”

“…In the late 2000s, the method was technically refined by Abramson et al, whereby the ophthalmic artery was directly cannulated and the chemotherapeutic agent was administered supraselectively [6]. IAC is now considered a widely used and established therapeutic method [7,8] that has resulted in a substantial increase in bulbus preservation, especially in cases of advanced group D and E eye disease according to the International Classification of Retinoblastoma (ICRB) [9], central unifocal tumours and recurrences with difficult therapeutic regimens. It must nonetheless be kept in mind that IAC itself is a complex interventional procedure.…”

“…It must nonetheless be kept in mind that IAC itself is a complex interventional procedure. The success rates reported by various publications and centres vary widely [8] Schlussfolgerung Zusammenfassend stellt die IAC ein potentes Therapieverfahren zur Behandlung des Retinoblastoms dar, das auch bei fortgeschrittenen und vorbehandelten Befunden zum Bulbuserhalt eingesetzt werden kann. Dennoch sollten die okulären Komplikationen, insbesondere bei funktioneller Unicussituation, nicht außer Acht gelassen werden.…”

“…addition to ocular adverse effects, mild systemic complications such as post-intervention nausea and vomiting and transient neutropenia have been reported as well as severe complications, i.e. allergic reactions up to and including anaphylactic shock, bronchospasms and arterial occlusive spasms [8]. The severity of ocular adverse effects ranges from self-limiting upper lid erythema, chemosis and ptosis to severe complications such as vitreous body haemorrhage, vascular occlusions and chorioretinal atrophies.…”

Eye Salvage with Intra-Arterial and Intra-Vitreal Chemotherapy in Patients with Retinoblastoma: 8-Year Single-Institution Experience in Colombia

“…Retinoblastoma (Rb) is the primary-malignant-intraocular tumor most frequently diagnosed during childhood [1]. The treatment of these tumors has gone from using enucleation and external beam radiation (EBR) as only alternatives to the use of intravenous chemotherapy (IVC), and finally, intra-arterial chemotherapy (IAC) [2][3][4].…”