Intra-arterial chemotherapy for unilateral advanced intraocular retinoblastoma

Abstract

Intra-arterial chemotherapy (IAC) has become an essential technique for the management of advanced intraocular retinoblastoma (RB). In this study, the aim of this article is to describe the clinical results and the short-term complications of IAC performed in our hospital.We retrospectively analyzed patients with newly diagnosed unilateral advanced intraocular (group D or E) RB undergoing IAC from October 2016 to December 2017 in our hospital. We recorded the data including age, gender, cycles of IAC, pathway of arteries approached (ophthalmic artery or middle meningeal artery), ocular and systematic complications, globe salvage.Sixty-one patients underwent IAC performing 189 procedures with a median of 3.1 sessions per eye (range, 1–5 sessions). The overall globe salvage rate is 78.7% (Group D (84.2%), and Group E (69.6%) and followed-up. Short-term ocular complications include eyelid edema (15 cases), ptosis (5 cases), forehead congestion (3 cases), retina hemorrhage (5 cases), choroid atrophy (2 cases), phthisis bulbi (1 case), bradycardia and hypotension during the procedure (7cases), myelosuppressions (6 cases), and nausea and vomiting (5cases).IAC is safe and effective for the treatment of unilateral advanced intraocular RB with a very low complication rate.

The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma

“…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.…”

“…No data Mean 42 (20-90) Reddy et al [38] 9 No data Median 21 (4-35) Francis et al [24] 436 No data Median 27 (0-120) Funes et al [39] 97 99 Median 49 (12-79) Hua et al [25] 84 94.5 Mean 14 (3-28) Wang et al [40] 61 100 No data Dalvin et al [41] 54 No data 27 therapeutic target.…”

Retrograde Approach for Intra-arterial Chemotherapy Delivery in Retinoblastoma

“…15 Advanced Rbs (grades D and E) have variable ocular salvage rates, ranging from 35 to 78.7%. 5,8,16 This heterogeneity of results is explained due to the adjunctive treatment that many patients receive.…”

“…It can be used as primary or salvage treatment, achieving cure in 100% of groups B and C, 94% for group D, and 25% for group E. 1,7 It also allows the preservation of the ocular globe and visual function, especially in advanced cases. 3,5,8 This treatment has demonstrated more advantages in advanced cases and refractory cases compared with systemic chemotherapy. 3 Moreover, for groups D and E, intravitreal chemotherapy has increased the cure rates successfully.…”

“…1,2 Currently, IAC is the first-line treatment for Rbs, achieving cure in low-grade cases (International Classification of Retinoblastoma grades A, B, and C), advanced cases (International Classification of Retinoblastoma grades D and E), and refractory cases. [3][4][5] The aim of this treatment is the successful catheterization of the OA to deliver a high concentration of chemotherapeutic agents directly, avoiding systemic toxicity, and achieving cure while preserving the visual function and the ocular globe. 1,6…”