Intra-Arterial Chemotherapy for Retinoblastoma in Infants ≤10 kg: 74 Treated Eyes with 222 IAC Sessions

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Intra-arterial chemotherapy (IAC) for retinoblastoma (Rb) has dramatically altered the natural history of the disease. Cure rates, globe salvage, and vision preservation have dramatically increased. This retrospective chart review evaluated 207 Rb tumors of 207 eyes in 196 consecutive patients who underwent 658 IAC infusions overall. Patient weights were ≤10 kg in 69 (35.2%) and >10 kg in 127 (64.8%) patients. Comparison (≤10 kg versus >10 kg) revealed that the total number of IAC infusions was 222 versus 436. Periprocedural complications were not significantly different. The authors conclude that intra-arterial chemotherapy in patients weighing ≤10 kg is a safe and effective treatment.

Abstract

BACKGROUND AND PURPOSE

Figure 2 from Sweid et al
Retinoblastoma (A and B) before and (C and D) 9 months after treatment with intra-arterial chemotherapy (IAC). A, An infant presented with left eye leukocoria and unilateral group E retinoblastoma with no view of the optic nerve. B, B-scan ultrasonography demonstrated a calcified intraocular mass with overlying retinal detachment and no optic nerve involvement. C, After 4 IAC infusions using melphalan 5 mg and topotecan 1 mg, the tumor showed complete response with type III regression to a partially calcified mass in the macular region (D) confirmed by B-scan ultrasonography.

Intra-arterial chemotherapy for retinoblastoma has dramatically altered the natural history of the disease. The remarkable outcomes associated with a high safety profile have pushed the envelope to offer treatment for patients weighing ≤10 kg. The purpose was to determine the efficacy and safety of IAC infusions performed in infants weighing ≤10 kg with intraocular retinoblastoma.

MATERIALS AND METHODS

A retrospective chart review was performed for patients diagnosed with retinoblastoma and managed with intra-arterial chemotherapy.

RESULTS

The total study cohort included 207 retinoblastoma tumors of 207 eyes in 196 consecutive patients who underwent 658 intra-arterial chemotherapy infusions overall. Of these, patient weights were ≤10 kg in 69 (35.2%) and >10 kg in 127 (64.8%) patients. Comparison (≤10 kg versus >10 kg) revealed that the total number of intra-arterial chemotherapy infusions was 222 versus 436. Periprocedural complications were not significantly different (2 [0.9%] versus 2 [0.5%]; P = .49). Cumulative radiation exposure per eye was significantly lower in infants weighing ≤10 kg (5.0 Gym2 versus 7.7 Gym2P = .01). Patients weighing ≤10 kg had a greater frequency of complete tumor regression (82.6% versus 60.9%; P = .02). Mean fluoroscopy time was not significantly different (7.5 versus 7.2; P = .71). There was a significant difference in the frequency of enucleation (16 [21.6%] versus 52 [39.1%]; P = .01). Patients weighing ≤10 kg had greater number of aborted procedures (12 [5.4%] versus 7 [1.6%]; P = .01). On multivariate analysis, weight ≤10 kg was not an independent predictor of complications or procedure failure.

CONCLUSIONS

Intra-arterial chemotherapy in patients weighing ≤10 kg is a safe and effective treatment.

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Intra-Arterial Chemotherapy for Retinoblastoma in Infants ≤10 kg: 74 Treated Eyes with 222 IAC Sessions
Jeffrey Ross
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