Abstract
Purpose :
Intra-arterial chemotherapy (IAC) has emerged as an effective treatment for retinoblastoma (RB), but little information exists regarding its use in older patients (>5 years). We evaluate the use of IAC (2008-2018) for RB in older patients and compare outcomes to those in the pre-chemotherapy (<1994) and intravenous chemotherapy (IVC) (1994-2007) eras.
Methods :
We performed a retrospective analysis of all patients older than 5 years who were treated with IAC for RB from 2008-2018 on the Ocular Oncology Service at the Wills Eye Hospital, Philadelphia, PA, USA. Comparisons were made to 26 active RB cases in older children treated in the pre-chemotherapy era and to 12 active RB cases in a series treated with IVC. Comparisons were evaluated using Fisher’s exact test.
Results :
A total of 13 eyes from 13 patients were analyzed and classified as Group D (n=9) or E (n=4) using the International Classification of Retinoblastoma. IAC was the primary treatment (n=8) or secondary treatment (n=5) following failed IVC (n=4), plaque radiotherapy (n=1), intravitreal chemotherapy (n=1), and/or external beam radiation therapy (EBRT) (n=1). Median visual acuity at presentation was 20/100 (mean 20/400, range 20/20-light perception (LP)). At the time of IAC, median patient age was 6.8 years (mean 10.1, range 5.2-32.3). The median number of IAC cycles was 3 (mean 3.6, range 2-7) with 8 eyes receiving additional intravitreal chemotherapy. Tumor response was achieved in all 13 eyes at a median interval of 1.13 months (mean 1.18, range 0-2.33) from first IAC. Globe salvage was achieved in 8 eyes with 5 requiring enucleation. At last follow-up, median visual acuity was hand motions (mean 20/400, range 20/30-LP). There was no instance of metastasis or death at a median follow-up of 15 months. Compared to the pre-chemotherapy era, these patients demonstrated significant reduction in need for enucleation (p=0.0007) and EBRT or enucleation (<0.0001). Compared to the IVC era, there was significant reduction in need for EBRT (p=0.02) and EBRT or enucleation (p=.03) and similar avoidance of metastasis (p=1.00) and death (p=1.00).
Conclusions :
IAC is effective for management of RB in patients older than 5 years, even those with advanced Groups D or E, with globe salvage in 62% cases, avoidance of EBRT in 100% cases, and no instance of metastasis or death.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.