The value of MRI in evaluating the efficacy and complications with the treatment of intra-arterial chemotherapy for retinoblastoma

Abstract

Retinoblastoma is the most common intraocular malignant tumor of childhood. Intra-arterial chemotherapy (IAC) is a recently popularized technique used for the treatment of retinoblastoma, to decrease mortality, increase preservation of the eye, and prevent blindness. Along with the extensive use of IAC, it is important to apply noninvasive examination methods to assess the activity of the tumor and the risk factors for disease dissemination without histopathological confirmation. There are few studies that have assessed the value of magnetic resonance imaging (MRI) in evaluating the efficacy and complications of IAC for retinoblastoma. We retrospectively analyzed the MRI features of 60 patients with unilateral retinoblastoma given the primary treatment of IAC from January 2014 to February 2016 in our hospital. Our study showed that MRI could well assess the decreased activity of the tumor after IAC, presenting with diminished tumor size, increased apparent diffusion coefficient (ADC) values (from 0.94 ± 0.24 × 10−3 mm2/s to 2.24 ± 0.40 × 10−3 mm2/s), and a reduced degree of enhancement of the tumor. Our study also showed that MRI can monitor the risk factors of abnormal enhancement of the postlaminar optic nerve, to avoid unnecessary enucleation. Meanwhile, the results showed that the main late complications after IAC included affected eyeball volume reduction, subretinal hemorrhage, vitreous hemorrhage, vitreous opacity, cataractous len, and choroidal vascular ischemia.

Risk factors for cataract in retinoblastoma management

“…20 Three years later, Chen et al reported a cataract incidence of 6.7% after IAC and concluded that cataract was one of the main late complications. 21 There are more reports about cataract occurrence after IvitC treatment. Francis et al reported lens opacity as a common toxic effect in intravitreous melphalan injection.…”

Signal enhancement ratio of CE-MRI: a potential biomarker of survival after hepatic arterial infusion chemotherapy in biliary tract cancers

“…Enhancement is considered one factor in the evaluation of the treatment response according to the modified RECIST for HCC [31]. However, in 2017, Chen et al found that retinoblastoma with decreased activation after the treatment of HAIC presented with lower enhancement in MRI [32]. Another recently published study also proved that the enhancement of tumors decreased after the effective chemotherapy [33].…”

Clinical spectrum and treatment outcome of retinoblastoma with Group D and E diseases

“…With the intended use of chemoreduction and local therapy, patients can be treated without histopathological confirmation for assessment of risk factors for disease dissemination and prognosis. [ 7 ] The ICRB and Reese–Ellsworth (RE) classifications had been found to be rationally concordant when the classifications were further subdivided into A–B–C vs D–E for the ICRB classification and I through IV vs V for the RE classification. [ 8 ] The overall survival and event-free survival in both groups were parallel.…”