Intra‐arterial chemotherapy for retinoblastoma: Centralization of care is essential

Abstract

Retinoblastoma is highly curable in high-income settings, so most current treatments aim to increase the ocular preservation rate retaining vision, while reducing the treatment burden, especially in children with germline mutations of the RB1 gene who are at higher risk of treatment-induced secondary malignancies. In the mid-1990s, the use of systemic chemoreduction of intra-ocular tumors allowed for a decreased use of external-beam radiotherapy which has been associated with radiation-induced neoplasms in children with the RB1 gene germline mutation. 1 However, eyes with advanced disease, categorized as group D, had a lower preservation rate, and external-beam irradiation could not be avoided in many of them; moreover, some patients needed enucleation, sometimes having received prior external-beam radiotherapy. 1 In addition, rare but usually fatal cases of secondary leukemias associated with systemic exposure to chemotherapy were later reported. 2 In the late 2000s, the group at Memorial Sloan Kettering Cancer Center in New York published a modified technique for intra-ophthalmic artery administration of chemotherapy originally developed by Japanese investigators which allowed for a substantially increased eye preservation rate in advanced group D eyes, especially after the use of intravitreal chemotherapy, which was pioneered by the Lausanne's group in the mid-2010s. [3][4][5] However, there were concerns about the safety of intra-arterial chemotherapy, and questions about its wide implementation were posed. Nevertheless, intra-arterial chemotherapy is being used in an increasing number of centers, including in middle-income settings with reported successful results. 6 It was not until this year that the superiority of intra-arterial chemotherapy over systemic chemotherapy