Intravitreal chemotherapy for vitreous disease in retinoblastoma revisited: from prohibition to conditional indications

Abstract

This study reports the first clinically documented case series of patients with retinoblastoma treated with IViC. Despite a possible confounding effect of concomitant chemotherapy prescription using other routes of administration in four of the successfully treated eyes (20%), IViC achieved an unprecedented success rate of tumour control in the presence of vitreous seeding. Of note, none of the treated eyes required external beam irradiation to control the vitreous seeding. Further studies are required to assess IViC retinal toxicity and to better delineate its role in the management of retinoblastoma.

Conservative treatment of retinoblastoma: a prospective phase II randomized trial of neoadjuvant chemotherapy followed by local treatments and chemothermotherapy

“…15 The last data on intraarterial chemotherapy seem to show satisfactory eye preservation for first-line as well as second-line treatments. 30,31 Short-term ocular toxicity may be seen with ischemic short-term complications being described.…”

“…Intravitreal injection of chemotherapy may be an interesting tool in the management of selected cases with active vitreous seeding. 15 All these techniques can be combined to obtain the best tumor control, especially in the more advanced D group cases, these patients needing more treatments. Since the end of the study bilateral group D patients are treated by an association of six courses of three drugs chemotherapy regimen and local adjuvant therapies.…”

“…These last modalities were developed during the study period. [13][14][15] The current conservative strategy often needs the combination of several of the therapeutic modalities indicated above. Our team published, in 2008, a phase II prospective study on the efficacy of a treatment combining local therapies or chemothermotherapy after chemoreduction by etoposide and carboplatin (2 cycles) whenever the tumors are not directly treatable by local treatments.…”

Managing the consequences of aggressive conservative treatment for refractory retinoblastoma with vitreous seeding

“…These new eye-preserving therapies are particularly relevant to 40% of the RB cases that are bilateral (3) . Periocular chemotherapy, selective ophthalmic artery infusion chemotherapy (SOAIC), and intravitreal (IVit) chemotherapy are relatively recent therapeutic options that have shown potential for eye-preservation (4)(5)(6) . The ultimate goal of these therapies is to deliver a locally toxic dose of chemotherapeutic agent while avoiding the systemic side effects seen in intravenous chemotherapy (7) .…”

“…Its side effects include orbital inflammation and diffuse chorioretinal atrophy, among others (9) . The IVit chemotherapy is the most recent modality developed to deliver the chemotherapeutic agent directly into the vitreous (6,10) . Studies have shown clearing of the vitreous seeding and avoidance of enucleation in the majority of cases (6) .…”