Intra-Arterial Chemotherapy for Retinoblastoma: A Single-Center Experience

Abstract

Background: Studies conducted in recent years have reported promising results regarding the treatment of retinoblastoma with the intra-arterial use of melphalan. In the present study, we intended to report the results of intra-arterial chemotherapy with melphalan (IACT) in the treatment of newly diagnosed or relapsed-refractory retinoblastoma patients at the Department of Pediatric Oncology of Hacettepe University, Ankara, Turkey. Materials and Methods: This was a retrospective study of patients with intraocular retinoblastoma who were treated with IACT from December 2011 to May 2014. A total of 56 eyes of 46 consecutive patients (30 males and 16 females) were included in the study. Forty-four eyes received systemic chemotherapy upon diagnosis (systemic chemotherapy group, SCG), and 12 eyes were those of newly diagnosed patients (primary intra-arterial melphalan group, PIAG). The choice of the IACT dose was based on age. Tumor control and globe salvage with IACT were analyzed. Complete blood counts were examined 7 days after the IACT for systemic toxicity. Ocular toxicities such as proptosis, eyelid edema, ocular motility, and retinal and optic atrophy were assessed by an ocular oncologist with regular ophthalmologic examinations. Results: Enucleation was avoided overall in 66% (37/56) of the eyes, including 75% (9/12) in the PIAG and 64% (28/44) in the SCG patients. The 1-year enucleation-free survival rate was 56.7% at a median follow-up time of 11.9 months (range 0.27-27.6). IACT was administered in a total of 124 cycles (ranging from 1 to 7 cycles, mean 2.3). The responses were as follows: regression of the retinal tumor in 27 eyes and improvements in vitreous seeding in 5 of 15 eyes. The further treatment requirements after IACT were as follows: enucleation in 19 eyes (10 with vitreous seeding), radiotherapy in 3 eyes, systemic chemotherapy in 1 eye, and local therapy in 1 eye. No severe systemic side effects occurred. Transient swelling of the eyelids (22 patients), conjunctival chemosis (12 patients), upper eyelid ptosis (5 patients), redness over the frontal area (3 patients), limitation of ocular motility (3 patients) and mild proptosis (1 patient) were detected. Retinal pigment epithelial alterations (30 patients) and optic atrophy (3 patients) were seen in the late follow-up. Conclusions: Globe salvage and avoidance of radiotherapy may be achieved by IACT with limited toxicity. This treatment is efficient, repeatable and safe.

The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma

“…Apart from these, no other systemic adverse events were observed [21]. Interestingly, Akyuz et al did not detect any systemic side effects in their study [33] which is in agreement with findings published by Parareda et al [32]. Abramson et al found that bronchospasm was the most common systemic complication during intraarterial drug delivery and occurred in 44 patients [22].…”

“…Following enucleation, both patients died as the disease progressed despite intensive treatment with radiotherapy and chemotherapy [33]. One patient developed brain metastases [33]. In the other patient, metastatic spread was not specified by the authors [33].…”

“…Across all case series, the anaphylactoid reaction was noted in 2 patients [28,36] Other, 12% Figure 6: Ocular complications following IAC. [26] 76 76% D Suzuki et al [20] 60 100% A, 88% B, 65% C, 45% D, 30% E Marr et al [27] 88 No data Muen et al [28] 80 80% secondary ampi et al [29] 70 86% A-C, 38% D and E, 58.3% primary, 87.5% secondary Venturi et al [30] 79 57% primary, 95.5% secondary Ghassemi et al [31] 62.5 67.5% D-E, 84% primary, 56% secondary Shields et al [21] 67 100% B, 100% C, 94% D, 36% E of primary treatments, 72% primary, 62% secondary Parareda et al [32] 58 58% D Akyüz et al [33] 66 75% primary, 64% secondary…”

“…Unfortunately, none of them survived [20]. Akyuz et al reported 2 cases of metastases [33]. Both patients belonged to the group that failed initial systemic chemotherapy and therefore received secondary IAC.…”

“…Eventually, they had their eyes enucleated as they failed to respond to IAC. Following enucleation, both patients died as the disease progressed despite intensive treatment with radiotherapy and chemotherapy [33]. One patient developed brain metastases [33].…”