The Role of Intra-Arterial Chemotherapy in the Manegment of Retinoblastoma in Comparison with Other Modalities

Abstract
Background: Retinoblastoma often presents with advanced intraocular disease and despite conventional treatment with intravenous chemotherapy (IVC) and external beam radiation therapy, may still require enucleation.
Aim of Study: To assess the efficacy of intra-arterial chemotherapy (IAC) in comparison with other modalities in the management of intraocular retinoblastoma.
Material and Methods: Twenty one patients with thirty intra ocular retinoblastomas were included in the study from November 2013 to September 2016. Chemo reduction followed by adjuvant consolidative treatment has replaced external beam radiotherapy as the primary modality of treatment for intraocular retinoblastoma. Patients failed to respond ade-quately to a standard systemic chemotherapy (i.e., carboplatin, vincristine, and etoposide) with or without other local therapies, are referred for intra-arterial chemotherapy (IAC) to avoid enucleation. The intervention was selective catheterization of the ophthalmic artery and injection of chemotherapy.
Results: The current commonly used treatments for retin-oblastoma in our study were IVC and IAC, along with con-solidated therapy based on tumor staging. For international classification of retinoblastoma (ICRB) grading, we found a significantly higher success rates for RTB cases treated with IAC as primary or adjuvant therapy compared to other treat-ment modalities which achieved 90% versus 73.6% for globe salvage, 80% vs 52.6 % for solid tumor control, 75% vs 66.6% for subretinal seeds control, 66.7% vs 62.5% for vitreous seeds control respectively.
Conclusion: IAC may be superior to IVC for the treatment of retinoblastoma, with a higher overall success rate and higher globe salvage especially in group D retinoblastoma that failed to respond to systemic chemotherapy and destined for enucleation.