Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 28;13(4):527-534.
doi: 10.4103/tjo.TJO-D-22-00162. eCollection 2023 Oct-Dec.

Intra-arterial chemotherapy for retinoblastoma: Experience from the pediatric ophthalmology referral center in Malaysia with literature review

Yong Zheng Wai  1   2 , Dhanya Menon Radhakrishnan  2 , Ganeshwara Lingam  3 , Norhafizah Hamzah  2 , Jamalia Rahmat  2
Affiliations

Intra-arterial chemotherapy for retinoblastoma: Experience from the pediatric ophthalmology referral center in Malaysia with literature review

Yong Zheng Wai et al. Taiwan J Ophthalmol. .

Abstract

Purpose: We aimed to analyze our 4-year experience of intra-arterial chemotherapy (IAC) for retinoblastoma (RB) and to examine the tumor response, globe salvage, mortality, and safety profile of IAC in the Malaysian profile.

Materials and methods: This was a retrospective, interventional case series. A total of 22 eyes of 20 patients with RB who underwent IAC using melphalan and topotecan from January 2018 to December 2021 in Hospital Kuala Lumpur were retrospectively reviewed. Tumor response, globe salvage, mortality, and safety profile of IAC were compared based on the International Classification of Retinoblastoma.

Results: The mean patient age at IAC was 21.3 months. An overall globe salvage rate of 63.6% was observed: more specifically, 100% for Group A, 75% for Groups B and C, 66.7% for Group D, and 42.9% for Group E. Poor tumor response after IAC was significantly associated with a lesser chance of globe salvage (P = 0.045). The overall rate of good tumor response following IAC was 77.3%. Specifically, rates of good tumor response in each group were 100%, 75%, 75%, 83.3% and 71.4% in group A, B, C, D and E, respectively. The mortality rate was 5%. Complications (per-catheterization) included cerebral infarct (2.2%), oxygen desaturation (2.2%), vomiting (26.1%), periorbital edema (8.8%), ptosis (6.5%), fever, femoral hematoma, and hyperpigmentation over lid (4.4% each).

Conclusion: Four-year experience showed that IAC is a safe and effective method for RB management. Patients with a poor response after IAC may have a lower chance of globe salvage. Careful patient selection is of utmost importance to achieve the best outcome in a setting of limited health-care resources.

Keywords: Developing nation; globe salvage; intra-arterial chemotherapy; retinoblastoma.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there are no conflicts of interests of this paper.

Figures

Figure 1
Figure 1
(a) Angiogram was performed with the catheter at the internal carotid artery, demonstrating its branches including the ophthalmic artery. (b) Superselective ophthalmic artery angiogram. These images were done with digital subtraction angiography, in which all the other structures were extracted and only the contrast within the blood vessel was shown
Figure 2
Figure 2
(a) Unilateral Group D intraocular retinoblastoma appearance during the first EUA, large calcified mass with vitreous seeding. (b) After 1 cycle of IAC, the calcified mass reduced in size with vitreous seeding. (c) After 3 cycles of IAC, the tumor shrank further with optic disc exposed and less vitreous seeding. (d) After 5 cycles of IAC, mass reduced to 4-disc diameter in size with vitreous veil anteriorly. EUA: Examination under anesthesia. IAC: Intra-arterial chemotherapy
Figure 3
Figure 3
Bar chart showing good response (combination of complete response and partial response) and globe salvage rate after IAC therapy according to the ICRB group. IAC: Intra-arterial chemotherapy, ICRB: International Classification of Retinoblastoma
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Yamane T, Kaneko A, Mohri M. The technique of ophthalmic arterial infusion therapy for patients with intraocular retinoblastoma. Int J Clin Oncol. 2004;9:69–73. - PubMed
    1. Abramson DH, Marr BP, Dunkel IJ, Brodie S, Zabor EC, Driscoll SJ, et al. Intra-arterial chemotherapy for retinoblastoma in eyes with vitreous and/or subretinal seeding: 2-year results. Br J Ophthalmol. 2012;96:499–502. - PubMed
    1. Shields CL, Manjandavida FP, Lally SE, Pieretti G, Arepalli SA, Caywood EH, et al. Intra-arterial chemotherapy for retinoblastoma in 70 eyes: Outcomes based on the international classification of retinoblastoma. Ophthalmology. 2014;121:1453–60. - PubMed
    1. Shields CL, Dockery PW, Yaghy A, Duffner ER, Levin HJ, Taylor OS, et al. Intra-arterial chemotherapy for retinoblastoma in 341 consecutive eyes (1,292 infusions): Comparative analysis of outcomes based on patient age, race, and sex. J AAPOS. 2021;25:150.e1–150.e9. - PubMed
    1. Liu CC, Mohmood A, Hamzah N, Lau JH, Khaliddin N, Rahmat J. Intra-arterial chemotherapy for retinoblastoma: Our first three-and-a-half years'experience in Malaysia. PLoS One. 2020;15:e0232249. - PMC - PubMed