Abstract
Background: Intra-arterial chemotherapy (IAC) is increasingly used in
managing patients with retinoblastoma. In Australia, IAC is primarily
used as a globe-salvage treatment when primary treatment has failed.
Methods: A retrospective, single-institution study conducted on
consecutive children treated with IAC at the Royal Children’s Hospital,
Victoria, Australia between September 2009 to January 2021. Results:
Using the Intraocular Classification of Retinoblastoma (ICRB), 16 eyes
of 14 children classified as group A (n=1), Group B (n=3), Group D
(n=10), or Group E (n=2) were treated with IAC. All but one child
received IAC as secondary treatment for relapsed or refractory disease.
Successful catheterisation of the ophthalmic artery was achieved in
37/46 (80.4%) procedures. A systemic complication occurred in one child
(n=1): radiological evidence of a watershed infarct. Local complications
of IAC included conjunctival injection (n=1), forehead rash (n=1), sixth
cranial nerve palsy (n=2), ptosis (n=2), hemi-retinal ischaemia (n=1),
choroidal ischaemia (n=1), retinal detachment (n=2), and choroidal
neovascularisation (n=1). Regional extra-ocular disease occurred in one
child. No child had distant metastatic disease and no child died. The
overall globe salvage rate was 8/16 (50%): Group A (n=1, 100%), group
B (n=2, 66.6%), Group D (n=5, 50%), group E (n=0, 0%). Kaplan Meier
analysis of ocular survival following treatment with IAC was 75%, 68%
and 53% for 6 months, 1 year and 2 years, respectively. Conclusions:
Our experience demonstrates that IAC can be a useful treatment modality
for refractory retinoblastoma in globe salvage, with an acceptable
side-effect profile.