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Comparative Study
. 2017 Aug;101(8):1086-1093.
doi: 10.1136/bjophthalmol-2016-309298. Epub 2016 Dec 7.

First-line intra-arterial versus intravenous chemotherapy in unilateral sporadic group D retinoblastoma: evidence of better visual outcomes, ocular survival and shorter time to success with intra-arterial delivery from retrospective review of 20 years of treatment

Francis L Munier  1 , Pascal Mosimann  2 , Francesco Puccinelli  2 , Marie-Claire Gaillard  1 , Christina Stathopoulos  1 , Susan Houghton  1 , Ciara Bergin  1 , Maja Beck-Popovic  3
Affiliations
Comparative Study

First-line intra-arterial versus intravenous chemotherapy in unilateral sporadic group D retinoblastoma: evidence of better visual outcomes, ocular survival and shorter time to success with intra-arterial delivery from retrospective review of 20 years of treatment

Francis L Munier et al. Br J Ophthalmol. 2017 Aug.

Abstract

Purpose: The introduction of intra-arterial chemotherapy (IAC) as salvage treatment has improved the prognosis for eye conservation in group D retinoblastoma. The aim of this study was to compare the outcomes of consecutive patients with advanced unilateral disease treated with either first-line intravenous chemotherapy (IVC) or first-line IAC.

Design: This is a retrospective mono-centric comparative review of consecutive patients.

Patients: Sporadic unilateral retinoblastoma group D cases treated conservatively at Jules-Gonin Eye Hospital and CHUV between 1997 and 2014. From January 1997 to August 2008, IVC, combined with focal treatments, was the primary treatment approach. From September 2008 to October 2014, IAC replaced IVC as first-line therapy.

Methods: 48 patients met the inclusion criteria, receiving only either IAC or IVC as primary treatment modality.

Results: Outcomes of 23 patients treated by IVC were compared with those of 25 treated by IAC; mean follow-up was 105.3 months (range 29.2-218.6) and 41.7 months (range 19.6-89.5), respectively. Treatment duration was significantly shorter in the IAC group (p<0.001). Ten eyes in the IVC group underwent enucleation. Recordable visual acuity of the salvaged eyes was significantly better in the IAC group (0.9 vs 1.4 logarithm of the minimum angle of resolution, p<0.01). No extraocular disease, metastases or long-term systemic complications were observed in either group.

Conclusions: The difference in the time frame between treatment groups had an impact on the availability of intravitreal chemotherapy treatment. Despite this, the results reported here imply that eyes treated with first-line IAC will have shorter treatment period, better ocular survival and visual acuity than first-line IVC.

Keywords: Child health (paediatrics); Neoplasia; Retina; Treatment Medical.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Kaplan-Meier curves showing the time to treatment success for the intra-arterial chemotherapy (IAC) and intravenous chemotherapy (IVC). The log-rank statistic indicates that there is a significant difference between the curves p<0.001.
Figure 2
Figure 2
Kaplan-Meier curves showing the eye retention rates with respect to time for the intra-arterial chemotherapy (IAC) and intravenous chemotherapy (IVC). The log-rank statistic indicates that there is a significant difference between the curves p<0.001.
Figure 3
Figure 3
A bar chart summarising the number of lines lost in treated eye in comparison to contralateral healthy eye for intra-arterial chemotherapy (IAC) (black) and intravenous chemotherapy (IVC) (grey) treated eyes.
See this image and copyright information in PMC

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