Secondary intra-arterial chemotherapy and/or intravitreal chemotherapy as salvage treatment for retinoblastoma

Abstract

Purpose:

To evaluate the results of secondary intra-arterial chemotherapy (IAC) and/or intravitreal chemotherapy (IVC) as a salvage treatment for retinoblastoma (RB).

Materials and Methods:

The medical records of 31 (20 male, 11 female) cases (with 38 eyes) who underwent secondary IAC and/or IVC between February 2010 and June 2019 were retrospectively reviewed.

Results:

Thirteen (41.9%) cases had unilateral and 18 (58.1%) had bilateral RB. According to the International Classification of RB, 6 (15.8%) eyes had group B, 9 (23.7%) eyes had group C, 16 (42.1%) eyes had group D, and 7 (18.4%) eyes had group E RB at diagnosis. All patients underwent six-cycle intravenous chemotherapy as primary treatment and 8 eyes received external radiotherapy before IAC/IVC. Secondary IAC was performed in 21 (55.3%) eyes, IVC in 10 (26.3%) eyes, and IAC + IVC in 7 (18.4%) eyes. External radiotherapy was applied in 2 (5.3%) eyes after IAC/IVC, one of which was later enucleated. In total, 17 (44.7%) eyes undergoing secondary IAC/IVC treatments were enucleated. Metastasis and death were not observed in any case during the mean follow-up period of 59.3 (median 61, range: 10–98) months.

Discussion:

Although 60.5% of the eyes undergoing IAC/IVC consisted of groups D and E RB, globe salvage and survival rates were 55.3% and 100.0%, respectively. External radiotherapy was required in 5.3% of the eyes after IAC/IVC. In conclusion, IAC and IVC are safe and effective treatment methods in eyes with RB unresponsive to other eye-preserving treatments and those demonstrating recurrence.

Keywords

Enucleation external beam radiotherapy chemoreduction intra-arterial chemotherapy intravitreal chemotherapy retinoblastoma

Get full access to this article

View all access options for this article.

References

Shields

JA.

Diagnosis and management of retinoblastoma. Cancer Control 2004; 11(5): 317-327.

Kivelä

The epidemiological challenge of the most frequent eye cancer: retinoblastoma, an issue of birth and death. Br J Ophthalmol 2009; 93(9): 1129–1131.

Seregard

Lundell

Svedberg

, et al. Incidence of retinoblastoma from 1958 to 1998 in Northern Europe: advantages of birth cohort analysis. Ophthalmology 2004; 111(6): 1228–1232.

Broaddus

Topham

Singh

AD.

Incidence of retinoblastoma in the USA: 1975–2004. Br J Ophthalmol 2009; 93(1): 21–23.

Reese

Hyman

Tapley

, et al. The treatment of retinoblastoma by x-ray and triethylene melamine. AMA Arch Ophthalmol 1958; 60(5): 897–906.

Yamane

Kaneko

Mohri

The technique of ophthalmic arterial infusion therapy for patients with intraocular retinoblastoma. Int J Clin Oncol 2004; 9: 69–73.

Abramson

Dunkel

Brodie

, et al. A phase I/II study of direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma: initial results. Ophthalmology 2008; 115(8): 1398–1404.

Ericson

Rosengren

BH.

Present therapeutic resources in retinoblastoma. Acta Ophthalmol 1961; 39: 569–576.

Inomata

Kaneko

Chemosensitivity profiles of primary and cultured retinoblastoma cells in a human tumor clonogenic assay. Jpn J Cancer Res 1987; 78(8): 858–868.

10.

Kaneko

Suzuki

Eye-preservation treatment of retinoblastoma with vitreous seeding. Jpn J Cancer Res 2003; 33(12): 601–607.

11.

Munier

Soliman

Moulin

, et al. Profiling safety of intravitreal injections for retinoblastoma using an anti-reflux procedure and sterilization of the needle track. Br J Ophthalmol 2012; 96(8): 1084–1087.

12.

Shields

Mashayekhi

, et al. The international classification of retinoblastoma predicts chemoreduction success. Ophthalmology 2006; 113(12): 2276–2280.

13.

Shields

Jorge

Say

, et al. Unilateral retinoblastoma managed with intravenous chemotherapy versus intra-arterial chemotherapy. Outcomes based on the International Classification of Retinoblastoma. Asia Pac J Ophthalmol (Phila) 2016; 5(2): 97–103.

14.

Benz

Scott

Murray

, et al. Complications of systemic chemotherapy as treatment of retinoblastoma. Arch Ophthalmol 2000; 118(4): 572–575.

15.

Marr

Gobin

Dunkel

, et al. Spontaneously resolving periocular erythema and ciliary madarosis following intra-arterial chemotherapy for retinoblastoma. Middle East Afr J Ophthalmol 2010; 17(3): 207–209.

16.

Gobin

Marr

Dunkel

, et al. Intra-arterial chemotherapy (chemosurgery) in the ophthalmic artery for the treatment of retinoblastoma in children: 3 year experience. J Neurointerv Surg 2009; 1(1): 77–78.

17.

Klumpp

Jorge

Aziz-Sultan

MA.

Hemodynamic instability induced by superselective angiography of the ophthalmic artery. Case Rep Anesthesiol 2013; 2013: 1–3.

18.

Shields

Manjandavida

Lally

, et al. Intra-arterial chemotherapy for retinoblastoma in 70 eyes: outcomes based on the international classification of retinoblastoma. Ophthalmology 2014; 121: 1453–1460.

19.

Tsimpida

Thompson

Liasis

, et al. Visual outcomes following intraophthalmic artery melphalan for patients with refractory retinoblastoma and age appropriate vision. Br J Ophthalmol 2013; 97: 1464–1470.

20.

Suzuki

Aihara

Fujiwara

, et al. Intravitreal injection of melphalan for intraocular retinoblastoma. Jpn J Ophthalmol 2015; 59(3): 164–172.

21.

Xue

Ren

Meng

, et al. Ocular toxicity of intravitreal melphalan for retinoblastoma in Chinese patients. BMC Ophthalmol 2019; 19(1): 61.

22.

Abramson

Francis

, et al. Intravitreal chemotherapy in retinoblastoma: expanded use beyond intravitreal seeds. Br J Ophthalmol 2019; 103(4): 488–493.

23.

Dalvin

Kumari

Essuman

, et al. Primary intra-arterial chemotherapy for retinoblastoma in the intravitreal chemotherapy era: five years of experience. Ocul Oncol Pathol 2019; 5(2): 139–146.

24.

Chen

Zhang

Dong

, et al. Intra-arterial chemotherapy as primary or secondary treatment for infants diagnosed with advanced retinoblastoma before 3 months of age. BMC Cancer 2019; 19(1): 693.

25.

Rojanaporn

Chanthanaphak

Boonyaopas

, et al. Intra-arterial chemotherapy for retinoblastoma: 8-year experience from a tertiary referral institute in Thailand. Asia Pac J Ophthalmol (Phila) 2019; 8(3): 211–217.

26.

Shields

Kaliki

Al-Dahmash

, et al. Management of advanced retinoblastoma with intravenous chemotherapy then intra-arterial chemotherapy as alternative to enucleation. Retina 2013; 33(10): 2103–2109.

27.

Ghassemi

Shields

Ghadimi

, et al. Combined intravitreal melphalan and topotecan for refractory or recurrent vitreous seeding from retinoblastoma. JAMA Ophthalmol 2014; 132(8): 936–941.

28.

Abramson

Marr

Dunkel

, et al. Intra-arterial chemotherapy for retinoblastoma in eyes with vitreous and/or subretinal seeding: 2-year results. Br J Ophthalmol 2012; 96(4): 499–502.

29.

Munier

Gaillard

Balmer

, et al. Intravitreal chemotherapy for vitreous disease in retinoblastoma revisited: from prohibition to conditional indications. Br J Ophthalmol 2012; 96(8): 1078–1083.

30.

Francis

Iyer

Gobin

, et al. Retinoblastoma vitreous seed clouds (class 3): a comparison of treatment with ophthalmic artery chemosurgery with or without intravitreous and periocular chemotherapy. Ophthalmology 2017; 124(10): 1548–1555.

31.

Eagle

Jr Shields

Bianciotto

, et al. Histopathologic observations after intra-arterial chemotherapy for retinoblastoma. Arch Ophthalmol 2011; 129(11): 1416–1421.

32.

Abramson

Shields

Jabbour

, et al. Metastatic deaths in retinoblastoma patients treated with intraarterial chemotherapy (ophthalmic artery chemosurgery) worldwide. Int J Retina Vitreous 2017; 3(1): 40.