Abstract
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. A retrospective chart review was performed for patients diagnosed with retinoblastoma and managed with intra-arterial chemotherapy. 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 Gym2; P = .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. Intra-arterial chemotherapy in patients weighing ≤10 kg is a safe and effective treatment.
Highlights
BACKGROUND AND PURPOSEIntra-arterial chemotherapy for retinoblastoma has dramatically altered the natural history of the disease
The remarkable outcomes associated with an acceptable safety profile—despite the risks—and advancement in catheter techniques have pushed the envelope to offer treatment for patients weighing #10 kg
We describe our efficacy and safety outcomes in a large series of Intra-arterial chemotherapy (IAC) infusions performed in infants weighing #10 kg
Summary
A retrospective chart review was performed for patients diagnosed with retinoblastoma and managed with intra-arterial chemotherapy. The study subjects included patients with unilateral or bilateral intraocular Rb undergoing IAC from February 2008 to June 2016. The population was dichotomized according to weight, #10 kg or .10 kg. The study protocol was reviewed and approved by the institutional review board. Informed consent was waived because of the retrospective design of this study. Ocular exclusion criteria were vitreous hemorrhage, secondary glaucoma, and extension of tumor into the optic nerve, uvea, anterior segment, or extrascleral compartments. Systemic exclusion criteria were history of blood dyscrasia or thrombotic events
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