The Role of Intra-Arterial Chemotherapy in the Manegment of Advanced Retinoblastoma; Group D & E

Abstract
Background: The treatment modalities for managing retinoblastoma have evolved in the past decade. While globe-salvage still relies heavily on intravenous chemotherapy, tumors in advanced stages D and E that failed chemotherapy are now referred for intra-arterial chemotherapy (IAC) to avoid enucleation.
Aim of the Study: To evaluate the effectiveness and com-plications of intra-arterial chemotherapy (IAC) for treating advanced refractory group D and E retinoblastoma (RB).
Material and Methods: 30 intro-ocular advanced refractory retinoblastoma of 26 consecutive patients who received IAC were included in the study during the period between Novem-ber 2013 and January 2017. These patients failed to respond adequately to a standard systemic chemotherapy (i.e., carbo-platin, vincristine, and etoposide) with or without local therapy. Clinical outcomes and complications of these patients were reviewed.
Results: All our patients received IAC with injection of melphalan. The mean follow-up period was 14.2 months after final IAC (ranged from 6 to 20 months). The rate of overall globe salvage was 95% in Group D and 30% in Group E of this study. Short-term ocular adverse events included eyelid edema (n=15, 50%), bulbar conjunctiva congestion (n=7, 23.3%), mild ptosis (n=5, 16.7%) and long-term complications included ophthalmic artery spasm with reperfusion (n=2, 6.7%) retinal atrophy (n=1, 3.3%). Fever was observed after IAC in 10 patients and transient vomiting was observed in 16 patients.
Conclusion: IAC can be an evolving optional treatment to save Group D RB that failed in systemic chemotherapy and were destined for enucleation. However, it should be cautioned for Group E. Both the ocular and systemic toxicities of IAC were within tolerance.