Comparison between intravenous chemotherapy and intra-arterial chemotherapy for retinoblastoma: a meta-analysis

Abstract

Background: Intravenous chemotherapy (IVC) and intra-arterial chemotherapy (IAC) have become the primary treatments for retinoblastoma; however, some controversy remains over which method is more effective. We conducted a meta-analysis to compare the clinical efficacy of IVC and IAC.

Methods: We systematically searched literature published on PubMed, Embase, and Cochrane Library up to May 2017. Studies containing either IAC or IVC that reported on efficacy were included. The effects estimate was expressed as a pooled rate with 95% confidence interval (CI), using a fixed-effects or random-effects model.

Results: Twenty-six studies were identified which included 1541 eyes (IAC: 11 trials, 445 eyes; IVC: 16 trials, 1096 eyes). The mean follow-up times were 49.4 months (range, 13.0-105.3 months) for IVC and 21.7 months (range, 8.8-38.7 months) for IAC. For the International Classification of Intraocular Retinoblastoma (ICRB) grading, the overall success rate was higher with IAC than with IVC (75.7% [95%CI: 65.7%-83.6%] vs. 69.5% [95%CI: 51.9%-82.8%], P < 0.001). The globe salvage with IAC was higher than with IVC in group D eyes (79.5% [95%CI: 71.8%-85.4%] vs. 55.1% [95%CI: 45.6%-64.2%], P < 0.001), but not in groups B (95.8% [95%CI: 57.5%-99.7%] vs. 82.5% [95%CI: 58.9%-94.0%], P = 0.163), C (91.3% [95%CI: 65.9%-98.3%] vs. 89.0% [95%CI: 69.0%-96.7%], P = 0.212), and E eyes (51.2% [95%CI: 37.0%-65.2%] vs. 43.2% [95%CI: 18.3%-72.1%], P = 0.578). IAC and IVC were not significantly different regarding the recurrence and metastasis rates (15.0% vs. 15.4%, P = 0.148 and 2.7% vs. 0.6%, P = 0.194, respectively). For Reese-Ellsworth (RE) grading, IAC had a higher globe salvage in groups IV (90.9% [95%CI: 56.0%-98.7%] vs. 66.3% [95%CI: 32.4%-89.0%], P = 0.047) and V eyes (83.2% [95%CI: 72.0%-90.5%] vs. 59.9% [95%CI: 43.1%-74.6%], P = 0.003), but not in group I-III eyes (88.6% [95%CI: 58.3%-97.7%] vs. 88.1% [95%CI: 76.6%-94.4%], P = 0.244). The overall success rate was higher in IAC than in IVC (87.1% [95%CI: 78.1%-92.7%] vs. 77.3% [95%CI: 68.1%-84.4%], P = 0.033).

Conclusions: IAC may be superior to IVC for the treatment of retinoblastoma, with a higher overall success rate and higher globe salvage in group D or groups IV and V eyes.

Keywords: Intra-arterial chemotherapy; Intravenous chemotherapy; Meta-analysis; Retinoblastoma.

Fig. 1

The technique of intra-arterial chemotherapy (IAC) treatment. a: An arteriogram was performed to indicate the takeoff of the ophthalmic artery from the internal carotid artery. b: Using fluoroscopy and roadmap guidance, the microcatheter selectively catheterized the ophthalmic artery. c: As soon as the microcatheter was in a stable position at the ostium of the ophthalmic artery, then pulse-inject drugs

Fig. 2

The fundus photographs of group A-E eyes of retinoblastoma. Group A: Eyes with small discrete tumors away from critical structures; Group B: Eyes with no vitreous or subretinal seeding and discrete retinal tumor of any size or location; Group C: Eyes with only focal vitreous or subretinal seeding and discrete retinal tumors of any size and location; Group D: Eyes with diffuse vitreous or subretinal seeding and/or massive, nondiscrete endophytic or exophytic disease; Group E: Eyes that have been destroyed anatomically or functionally by the tumor

Fig. 3

The literature screening flowchart