Cancer Res Treat.  2023 Jan;55(1):270-278. 10.4143/crt.2021.1537.

The Efficacy of Alternate Systemic Intravenous Chemotherapy and Intra-arterial Chemotherapy Approach for Eye Globe Salvage in Retinoblastoma

• Han JW
• Lee CS
• Hahn SM
• Ahn WK
• Kim HS
• Yun H
• Lee SC
• Kim BM
• Kim DJ
• Lyu CJ

• KMID: 2538010
• DOI: http://doi.org/10.4143/crt.2021.1537

Abstract

Purpose
The advances in the treatment of retinoblastoma have enabled salvaging the globe in advanced stages with intra-arterial chemotherapy (IAC). We developed a strategy of alternate application of systemic intravenous chemotherapy (IVC) and IAC (referred to as alternate systemic IVC and IAC; ASIAC) to reduce central nervous metastases during IAC and examined its efficacy and safety in eye globe salvage in this study.
Materials and Methods
Between January 2010 and February 2021, 43 eyes of 40 patients received ASIAC treatment for retinoblastoma at the Yonsei Cancer Center, Yonsei University Health System. Their medical records were reviewed retrospectively to evaluate the eye salvage rate (ESR), defined from diagnosis to enucleation. High-risk retinoblastoma was defined as group D or E by the International Classification of Retinoblastoma.
Results
The study enrolled 38 and five cases of high-risk and low-risk retinoblastoma, respectively. In total, 178 IAC and 410 IVC courses were administered, with a median of 4 (interquartile range [IQR], 3.0 to 5.0) IAC and 9 (IQR, 6.0 to 11) IVC courses per eye, respectively. The 5-year ESR was 60.4%±8.7% for the whole cohort, 100% for low-risk retinoblastoma, and 53.6%±9.8% for high-risk retinoblastoma. Among those diagnosed since 2015, the 5-year ESR for high-risk retinoblastoma was 63.5%±14.0%. Fifteen eyes underwent enucleation; no viable tumor was found in three enucleated eyes. There were no deaths in this cohort.
Conclusion
Primary IAC-IVC (i.e., ASIAC) for patients with retinoblastoma was tolerable and effective in salvaging the eye and maintaining survival.

Keyword

Retinoblastoma; Eye globe salvage; Intra-arterial chemotherapy; Intravenous chemotherapy

Figure

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  Fig. 1 One cycle of Alternate Systemic and Intraarterial Chemotherapy (ASIAC). One course of ASIAC comprises combination systemic intravenous chemotherapy and intra-arterial chemotherapy (IAC). Each course is delivered to the patient 2–3 weeks apart. A maximum of 6–8 courses are planned for the primary aim of salvaging the eye with the newly developed retinoblastoma.

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  Fig. 2 The number of intra-arterial (IA) chemotherapy procedures per an eye.

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  Fig. 3 Eye salvage rate (ESR). (A) The ESR of the whole cohort is shown. (B) The ESR according to the international classification of retinoblastoma (ICRB) is shown. (C) The ESRs of the low- and high-risk groups, as defined by the ICRB, are shown. (D) The ESR according to the year at diagnosis is shown. Patients diagnosed before and after January 2015 were compared. (E) The ESR of the cohort diagnosed after January 2015. ICRB high-risk vs. low-risk. (F) The ESR of the high-risk group according to the intraarterial chemotherapy regimen (melphalan/topotecan vs. melphalan alone).

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  Fig. 4 Progression-free salvage rate. (A) The progression-free salvage rate of the whole cohort is shown. (B) The progression-free salvage rates of the high- and low-risk groups, as defined by the international classification of retinoblastoma, are shown.

Reference

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