The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Issue 2, March/April 2016 Original Study - Clinical

Unilateral Retinoblastoma Managed With Intravenous Chemotherapy Versus Intra-Arterial Chemotherapy. Outcomes Based on the International Classification of Retinoblastoma

Shields, Carol L.; Jorge, Rodrigo; Say, Emil Anthony T.; Magrath, George; Alset, Adel; Caywood, Emi; Leahey, Ann M.; Jabbour, Pascal; Shields, Jerry A.



Author Information


From the *Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA; †Ribeirão Preto Medical School, University of São Paulo, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, São Paulo, Brazil; ‡Nemours Center for Cancer and Blood Disorders, Nemours/Alfred I. DuPont Hospital for Children at Thomas Jefferson University; §Pediatric Oncology Department, The Children's Hospital of Philadelphia, University of Pennsylvania; and ¶Department of Neurovascular and Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA.


Reprints: Carol L. Shields, MD, Ocular Oncology Service, Suite 1440, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA 19107. E-mail: carolshields@gmail.com.



Abstract


Purpose: The objective of this study was to compare outcomes after intravenous chemotherapy (IVC) versus intra-arterial chemotherapy (IAC) for unilateral retinoblastoma.


Design: A retrospective comparative interventional case series.


Methods: Patients with unilateral retinoblastoma managed with either IVC using vincristine, etoposide, and carboplatin or IAC using melphalan with or without topotecan with a minimum of 1-year follow-up were compared. The primary outcome measure was globe salvage.


Results: Of 91 patients with unilateral retinoblastoma, IVC was employed in 42 (46%) cases and IAC in 49 (54%). By comparison (IVC vs IAC), patients in the IAC group had greater mean tumor diameter (14 vs 18 mm, P < 0.001) and thickness (7 vs 10 mm, P = 0.001), greater percentage with active vitreous seeds (29% vs 55%, P = 0.01), and greater total retinal detachment (10% vs 43%, P < 0.001). There were no cases of group A in either treatment arm. Globe salvage was not significantly different in groups B, C, or E, but there was significantly improved globe salvage with IAC for group D (48% vs 91%, P = 0.004). Control was significantly better with IAC for solid tumor (62% vs 92%, P = 0.002), subretinal seeds (31% vs 86%, P = 0.006), and vitreous seeds (25% vs 74%, P = 0.006). There were no patients with pinealoblastoma, second cancer, metastasis, or death in either group.


Conclusions: For unilateral retinoblastoma, IAC provided significantly superior globe salvage compared with IVC for group D eyes. In addition, IAC provided significantly superior control for solid tumor, subretinal seeds, and vitreous seeds.




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