Alternated intra‐arterial and intravitreal chemotherapy: successes and failures of advanced intraocular retinoblastoma treated without systemic chemotherapy

Abstract

PurposeTo report the efficacy of combined intravitreal chemotherapy (IViC) and intra‐arterial chemotherapy (IAC) for the treatment of advanced stage retinoblastoma.MethodsThe medical records of twenty patients affected by unilateral advanced retinoblastoma (Reese‐Ellsworth stage Vb/D of ABC classification). After clinical and ophthalmoscopic evaluation, they underwent MRI to exclude local and CNS dissemination. The IAC was given to treat retinal masses and intravitreal injections to treat vitreous seeding. Patients had received two cycles (six infusions) of IAC, and from six up to ten melphalan injections into the vitreous, with an interval of 7–10 days between them.ResultsAll patients underwent to bimonthly MRI examination, during treatment and every 3 months for 1 year after last injection, to exclude orbital dissemination. Successful control (57.8%) of tumor masses and vitreous seeds was achieved in all cases at 12 up to 60 months follow‐up. No permanent complications have been reported. Transient omplications disappeared throughout the months. No intraocular or orbital tumor recurrence or retinoblastoma metastases were observed.ConclusionsSequential IAC and intravitreal melphalan for advanced retinoblastoma is a good tool to provide retinal and vitreous seed control.