The value of MRI in evaluating the efficacy and complications with the treatment of intra-arterial chemotherapy for retinoblastoma.

Shuxian Chen,Zhengrong Xia,Ming Liu,Yuhua Li,Hui Zheng,He Wang,Qiufeng Yin,Xunda Ji

doi:10.18632/oncotarget.16423

Abstract

Retinoblastoma is the most common intraocular malignant tumor of childhood. Intra-arterial chemotherapy (IAC) is a recently popularized technique used for the treatment of retinoblastoma, to decrease mortality, increase preservation of the eye, and prevent blindness. Along with the extensive use of IAC, it is important to apply noninvasive examination methods to assess the activity of the tumor and the risk factors for disease dissemination without histopathological confirmation. There are few studies that have assessed the value of magnetic resonance imaging (MRI) in evaluating the efficacy and complications of IAC for retinoblastoma. We retrospectively analyzed the MRI features of 60 patients with unilateral retinoblastoma given the primary treatment of IAC from January 2014 to February 2016 in our hospital. Our study showed that MRI could well assess the decreased activity of the tumor after IAC, presenting with diminished tumor size, increased apparent diffusion coefficient (ADC) values (from 0.94 ± 0.24 × 10−3 mm2/s to 2.24 ± 0.40 × 10−3 mm2/s), and a reduced degree of enhancement of the tumor. Our study also showed that MRI can monitor the risk factors of abnormal enhancement of the postlaminar optic nerve, to avoid unnecessary enucleation. Meanwhile, the results showed that the main late complications after IAC included affected eyeball volume reduction, subretinal hemorrhage, vitreous hemorrhage, vitreous opacity, cataractous len, and choroidal vascular ischemia.

Highlights

Retinoblastoma is the most common intraocular malignant tumor of childhood, with a prevalence of one in 15,000–20,000 livebirths [1,2,3,4,5]
Of the 60 patients, 26 were right unilateral and 34 were left, and all patients were classified according to the International Classification of Retinoblastoma [4] (ICRB) as group D (n = 50; 83.3%) and group E (n = 10; 16.7%)
The Intra-arterial chemotherapy (IAC) was delivered as the primary therapy in all patients and the secondary therapy of enucleation was performed in six patients

Summary

Introduction

Retinoblastoma is the most common intraocular malignant tumor of childhood, with a prevalence of one in 15,000–20,000 livebirths [1,2,3,4,5]. In the past 10 years, the management of intraocular retinoblastoma has changed dramatically due to the use of intraarterial chemotherapy (IAC) and intravitreous chemotherapy, contributing to decreased mortality, preservation of the eye, and prevention of blindness [2, 7, 8]. IAC is believed to result in an increased concentration of drug to the tumor, saving the eye and reducing systemic side effects [8, 9]. The treatment was associated with significant local side effects [10]

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