Intra-arterial chemotherapy as secondly therapy for retinoblastoma_Chinese Journal of Ocular Fundus Diseases

Authors：

Jiang Hua , Fang Qian , Deng Hailang , Xia Jiejun , Luo Fang ,  Zhang Jing

Department of Interventional Radiology and Vascular Anomalies (Jiang Hua, Deng Hailang, Xia Jiejun, Luo Fang, Zhang Jing) , Department of ultrasound (Fang Qian), Guangzhou Women and Children’s Medical Center, Guangzhou 510120, China;

Corresponding author：

Zhang Jing, Email: fejr@foxmail.com

Keywords：

Retinoblastoma/drug therapy; Chemotherapy, cancer, regional perfusion; Treatment outcome

DOI：

10.3760/cma.j.issn.1005-1015.2017.06.014

Video：

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Objective To analyze the efficacy and safety of Intra-arterial chemotherapy (IAC) as secondly treatment in children with retinoblastoma (RB). Methods 42 eyes of 34 consecutive RB patients were enrolled in the study after intravenous chemotherapy (IVC), including 26 males and 8 females. The average age is 14.1 months. 21 cases were bilateral and 7 cases were unilateral. A total of 42 eyes of 34 patients were classified according to the International Intraocular Retinoblastoma Classification（IIRC）as group B(n=1, 2.4%), group C (n=3, 7.1%), group D (n=32, 76.2%), or group E (n=6, 14.3%). Tumor recurrence and tumor enlargement after IVC were 4 and 10 eyes respectively, accounting for 9.0% and 24.0% respectively. Sequential treatment after IVC followed by IAC were 28 eyes, accounting for 67.0%. All treatment eyes received IAC combined with laser, cryotherapy and other eye local treatment. The IAC regimen adopted the combination and alternation administration mode, by the combination of melphalan and carboplatin or the combination of melphalan and topotecan. According to the tumor changes after IAC decide whether IAC again. If tumors increased, vitreous or subretinal implants increased will be termination of IAC and enucleation. The mean follow-up time was (21.4±3.7) months after the last IAC treatment and (6.2±2.9) months after enucleation. Ocular preservation rate and complication were evaluated. Results The average IAC procedures performed on 42 eyes were (4.0±0.9). An overall ocular preservation rate of 76.2% was observed during follow-up periods due to calcification or inactivation of tumors (32 eyes), including group B (n=1, 100%), group C (n=1, 33.3%), group D (n=27, 84.4%), group E (n=3, 50%). 10 eyes were enucleated. Among them, 2 eyes of the tumor did not shrink after IAC, tumor recurrence (n=3), vitreous hemorrhage (n=3), enophthalmos (n=1), vitreous disseminated (n=1). 34 cases of children, transient eyelid oedema were 18 cases, vitreous hemorrhage and bone marrow suppression (Ⅰ-Ⅳ) were 1, 22 casese respectively. Conclusions IAC as secondly treatment is safe and effective for RB patients, however, there is still tumor recurrence. No serious ocular local and systemic complications were observed.

Citation： Jiang Hua, Fang Qian, Deng Hailang, Xia Jiejun, Luo Fang, Zhang Jing. Intra-arterial chemotherapy as secondly therapy for retinoblastoma. Chinese Journal of Ocular Fundus Diseases, 2017, 33(6): 612-615. doi: 10.3760/cma.j.issn.1005-1015.2017.06.014 Copy

1.	Shields CL, Mashayekhi A, Au AK, et al. The International Classification of Retinoblastoma predicts chemoreduction success[J]. Ophthalmology, 2006, 113(12): 2276-2280.
2.	Gobin YP, Dunkel IJ, Marr BP, et al.Intra arterial chemotherapy for the management of retinoblastoma: four-year experience[J]. Arch Ophthalmol, 2011, 129(6): 732-737. DOI: 10.1001/archophthalmo1.2011.5．.
3.	Eagle RC Jr. High-risk features and tumor differentiation in retinoblastoma: a retrospective histopathologic study[J]. Arch Pathol Lab Med, 2009, 133(8): 1203-1209. DOI: 10.1043/1543-2165-133.8.1203.
4.	Shields CL, Manjandavida FP, Lally SE, et al. Intra-arterial chemotherapy for retinoblastoma in 70 eyes: outcomes based on the international classification of retinoblastoma[J]. Ophthalmology, 2014, 121(7): 1453-1460. DOI: 10.1016/j.ophtha.2014.01.026.
5.	张靖, 赵军阳, 项道满, 等.经导管眼动脉灌注化疗治疗眼内晚期视网膜母细胞瘤化疗失败患者的价值[J]. 中华放射学杂志, 2014, 48(7): 577-581. DOI: 10.3760/cma.j.issn.1005-1201.2014.07.012.Zhang J, Zhao JY, Xiang DM, et al. Analysis of clinical curative effect of transcatheter ophthalmic arterial chemotherapy for chemotherapy failure of advanced intraocular retinoblastoma[J]. Chin J Radiol, 2014, 48(7): 577-581. DOI: 10.3760/cma.j.issn.1005-1201.2014.07.012.
6.	季迅达, 李家恺, 赵军阳, 等.眼内晚期视网膜母细胞瘤静脉化学治疗失败后行眼动脉介入化学治疗的疗效观察[J]. 中华眼底病杂志, 2015, 31(6): 556-559. DOI: 10.3760/cma.j.issn.1005-1015.2015.06.011.Ji XD, Li JK, Zhao JY, et al. Efficacy of intra-arterial chemotherapy for advanced retinoblastoma after failure of intravenous chemotherapy[J]. Chin J Ocul Fundus Dis, 2015, 31(6): 556-559. DOI: 10.3760/cma.j.issn.1005-1015.2015.06.011.
7.	Gobin YP, Dunkel IJ, Marr BP, et al. Intra-arterial chemotherapy for the management of retinoblastoma: four-year experience[J]. Arch Ophthalmol, 2011, 129(6): 732-737. DOI: 10.1001/archophthalmol.2011.5.
8.	Shields CL, Shields JA. Basic understanding of current classification and management of retinoblastoma[J]. Curr Opin Ophthalmol, 2006, 17(3): 228-234.
9.	Duffaud F, Therasse P.New guidelines to evaluate the response to treatment in solid tumors[J]. Bull Cancer, 2000, 87(12): 881-886.
10.	钱江, 薛康.晚期视网膜母细胞瘤可否保眼治疗[J]. 中华眼科杂志, 2016, 52(10): 728-732. DOI: 10.3760/cma.j.issn.0412-4081.2016.10.003.Qian J, Xue K.Eyeball salvage treatment or enucleation for advanced retinoblastoma[J]. Chin J Ophthalmol, 2016, 52(10): 728-732. DOI: 10.3760/cma.j.issn.0412-4081.2016.10.003.
11.	张靖, 姜华, 申刚, 等.经导管眼动脉灌注化疗治疗晚期视网膜母细胞瘤30例[J]. 介入放射学杂志, 2014, 23(1): 31-34. DOI: 10.3969/j.issn.1008-794X.2014.01.009.Zhang J, Jiang H, Shen G, et al. Selective ophthalmic arterial injection therapy for advanced retinoblastoma: initial experience in 30 cases[J]. J Intervent Radiol, 2014, 23(1): 31-34. DOI: 10.3969/j.issn.1008-794X.2014.01.009.
12.	Suzuki S, Yamane T, Mohri M, et al. Selective ophthalmic arterial injection therapy for intraocular retinoblastoma: the long-term prognosis[J]. Ophthalmology, 2011, 118(10): 2081-2087. DOI: 10.1016/j.ophtha.2011.03.013.
13.	Muen WJ, Kingston JE, Robertson F, et al. Efficacy and complications of super-selective intra-ophthalmic artery melphalan for the treatment of refractory retinoblastoma[J]. Ophthalmology, 2012, 119(3): 611-616. DOI: 10.1016/j.ophtha.2011.08.045.
14.	Abramson DH, Daniels AB, Marr BP, et al. Intra-arterial chemotherapy (ophthalmic artery chemosurgery) for group D retinoblastoma[J/OL].PLoS One, 2016, 11(1): 0146582[2016-01-12]. https://doi.org/10.1371/journal.pone.0146582. DOI: 10.1371/journal.pone.0146582.
15.	张靖, 姜华, 申刚, 等.经眼动脉灌注化疗治疗视网膜母细胞瘤临床疗效多因素分析[J]. 介入放射学杂志, 2015, 24(12): 1062-1066. DOI: 10.3969/j.issn.1008-794X.2015.12.009.Zhang J, Jiang H, Shen G, et al. Percutaneous transcatheter chemotherapy via ophthalmic artery for retinoblastoma: a multivariate analysis of clinical curative effect[J]. J Intervent Radiol, 2015, 24(12): 1062-1066. DOI: 10.3969/j.issn. 1008-794X.2015.12.009.
16.	Shields CL, Say EA, Pointdujour-Lim R, et al. Rescue intra-arterial chemotherapy following retinoblastoma recurrence after initial intra-arterial chemotherapy[J]. J Fr Ophtalmol, 2015, 38(6): 542-549. DOI: 10.1016/j.jfo.2015.03.004.
17.	Francis JH, Abramson DH, Gobin YP, et al. Efficacy and toxicity of second-course ophthalmic artery chemosurgery for retinoblastoma[J]. Ophthalmology, 2015, 122(5): 1016-1022. DOI: 10.1016/j.ophtha.2014.11.029.
18.	高翔, 王海燕, 王雨生, 等.复发或顽固性眼内视网膜母细胞瘤玻璃体腔化学药物治疗的现状与进展[J]. 中华眼底病杂志, 2016, 32(4): 449-453. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.028.Gao X, Wang HY, Wang YS, et al. The status and progress of intravitreal chemotherapy for resistant or recurrent retinoblastoma[J]. Chin J Ocul Fundus Dis, 2016, 32(4): 449-453. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.028.
19.	Chen M, Jiang H, Zhang J, et al. Outcome of intra-arterial chemotherapy for retinoblastoma and its influencing factors: a retrospective study[J]. Acta Ophthalmol, 2017, 95(6): 613-618. DOI: 10.1111/aos.13333.
20.	侯宪如, 程湧, 张琦, 等.玻璃体腔注射卡铂联合贝伐单抗治疗难治型视网膜母细胞瘤的疗效观察[J]. 中华眼科杂志, 2015, 51(2): 126-129. DOI: 10.3760/cma.j.issn.0412-4081.2015.02.013.Hou X, Cheng Y, Zhang Q, et al. Efficacy of intravitreal carboplatin plus bevacizumab in refractory retinoblastoma[J]. Chin J Ophthalmol, 2015, 51(2): 126-129. DOI: 10.3760/cma.j.issn.0412-4081.2015.02.013.

1. Shields CL, Mashayekhi A, Au AK, et al. The International Classification of Retinoblastoma predicts chemoreduction success[J]. Ophthalmology, 2006, 113(12): 2276-2280.
2. Gobin YP, Dunkel IJ, Marr BP, et al.Intra arterial chemotherapy for the management of retinoblastoma: four-year experience[J]. Arch Ophthalmol, 2011, 129(6): 732-737. DOI: 10.1001/archophthalmo1.2011.5．.
3. Eagle RC Jr. High-risk features and tumor differentiation in retinoblastoma: a retrospective histopathologic study[J]. Arch Pathol Lab Med, 2009, 133(8): 1203-1209. DOI: 10.1043/1543-2165-133.8.1203.
4. Shields CL, Manjandavida FP, Lally SE, et al. Intra-arterial chemotherapy for retinoblastoma in 70 eyes: outcomes based on the international classification of retinoblastoma[J]. Ophthalmology, 2014, 121(7): 1453-1460. DOI: 10.1016/j.ophtha.2014.01.026.
5. 张靖, 赵军阳, 项道满, 等.经导管眼动脉灌注化疗治疗眼内晚期视网膜母细胞瘤化疗失败患者的价值[J]. 中华放射学杂志, 2014, 48(7): 577-581. DOI: 10.3760/cma.j.issn.1005-1201.2014.07.012.Zhang J, Zhao JY, Xiang DM, et al. Analysis of clinical curative effect of transcatheter ophthalmic arterial chemotherapy for chemotherapy failure of advanced intraocular retinoblastoma[J]. Chin J Radiol, 2014, 48(7): 577-581. DOI: 10.3760/cma.j.issn.1005-1201.2014.07.012.
6. 季迅达, 李家恺, 赵军阳, 等.眼内晚期视网膜母细胞瘤静脉化学治疗失败后行眼动脉介入化学治疗的疗效观察[J]. 中华眼底病杂志, 2015, 31(6): 556-559. DOI: 10.3760/cma.j.issn.1005-1015.2015.06.011.Ji XD, Li JK, Zhao JY, et al. Efficacy of intra-arterial chemotherapy for advanced retinoblastoma after failure of intravenous chemotherapy[J]. Chin J Ocul Fundus Dis, 2015, 31(6): 556-559. DOI: 10.3760/cma.j.issn.1005-1015.2015.06.011.
7. Gobin YP, Dunkel IJ, Marr BP, et al. Intra-arterial chemotherapy for the management of retinoblastoma: four-year experience[J]. Arch Ophthalmol, 2011, 129(6): 732-737. DOI: 10.1001/archophthalmol.2011.5.
8. Shields CL, Shields JA. Basic understanding of current classification and management of retinoblastoma[J]. Curr Opin Ophthalmol, 2006, 17(3): 228-234.
9. Duffaud F, Therasse P.New guidelines to evaluate the response to treatment in solid tumors[J]. Bull Cancer, 2000, 87(12): 881-886.
10. 钱江, 薛康.晚期视网膜母细胞瘤可否保眼治疗[J]. 中华眼科杂志, 2016, 52(10): 728-732. DOI: 10.3760/cma.j.issn.0412-4081.2016.10.003.Qian J, Xue K.Eyeball salvage treatment or enucleation for advanced retinoblastoma[J]. Chin J Ophthalmol, 2016, 52(10): 728-732. DOI: 10.3760/cma.j.issn.0412-4081.2016.10.003.
11. 张靖, 姜华, 申刚, 等.经导管眼动脉灌注化疗治疗晚期视网膜母细胞瘤30例[J]. 介入放射学杂志, 2014, 23(1): 31-34. DOI: 10.3969/j.issn.1008-794X.2014.01.009.Zhang J, Jiang H, Shen G, et al. Selective ophthalmic arterial injection therapy for advanced retinoblastoma: initial experience in 30 cases[J]. J Intervent Radiol, 2014, 23(1): 31-34. DOI: 10.3969/j.issn.1008-794X.2014.01.009.
12. Suzuki S, Yamane T, Mohri M, et al. Selective ophthalmic arterial injection therapy for intraocular retinoblastoma: the long-term prognosis[J]. Ophthalmology, 2011, 118(10): 2081-2087. DOI: 10.1016/j.ophtha.2011.03.013.
13. Muen WJ, Kingston JE, Robertson F, et al. Efficacy and complications of super-selective intra-ophthalmic artery melphalan for the treatment of refractory retinoblastoma[J]. Ophthalmology, 2012, 119(3): 611-616. DOI: 10.1016/j.ophtha.2011.08.045.
14. Abramson DH, Daniels AB, Marr BP, et al. Intra-arterial chemotherapy (ophthalmic artery chemosurgery) for group D retinoblastoma[J/OL].PLoS One, 2016, 11(1): 0146582[2016-01-12]. https://doi.org/10.1371/journal.pone.0146582. DOI: 10.1371/journal.pone.0146582.
15. 张靖, 姜华, 申刚, 等.经眼动脉灌注化疗治疗视网膜母细胞瘤临床疗效多因素分析[J]. 介入放射学杂志, 2015, 24(12): 1062-1066. DOI: 10.3969/j.issn.1008-794X.2015.12.009.Zhang J, Jiang H, Shen G, et al. Percutaneous transcatheter chemotherapy via ophthalmic artery for retinoblastoma: a multivariate analysis of clinical curative effect[J]. J Intervent Radiol, 2015, 24(12): 1062-1066. DOI: 10.3969/j.issn. 1008-794X.2015.12.009.
16. Shields CL, Say EA, Pointdujour-Lim R, et al. Rescue intra-arterial chemotherapy following retinoblastoma recurrence after initial intra-arterial chemotherapy[J]. J Fr Ophtalmol, 2015, 38(6): 542-549. DOI: 10.1016/j.jfo.2015.03.004.
17. Francis JH, Abramson DH, Gobin YP, et al. Efficacy and toxicity of second-course ophthalmic artery chemosurgery for retinoblastoma[J]. Ophthalmology, 2015, 122(5): 1016-1022. DOI: 10.1016/j.ophtha.2014.11.029.
18. 高翔, 王海燕, 王雨生, 等.复发或顽固性眼内视网膜母细胞瘤玻璃体腔化学药物治疗的现状与进展[J]. 中华眼底病杂志, 2016, 32(4): 449-453. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.028.Gao X, Wang HY, Wang YS, et al. The status and progress of intravitreal chemotherapy for resistant or recurrent retinoblastoma[J]. Chin J Ocul Fundus Dis, 2016, 32(4): 449-453. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.028.
19. Chen M, Jiang H, Zhang J, et al. Outcome of intra-arterial chemotherapy for retinoblastoma and its influencing factors: a retrospective study[J]. Acta Ophthalmol, 2017, 95(6): 613-618. DOI: 10.1111/aos.13333.
20. 侯宪如, 程湧, 张琦, 等.玻璃体腔注射卡铂联合贝伐单抗治疗难治型视网膜母细胞瘤的疗效观察[J]. 中华眼科杂志, 2015, 51(2): 126-129. DOI: 10.3760/cma.j.issn.0412-4081.2015.02.013.Hou X, Cheng Y, Zhang Q, et al. Efficacy of intravitreal carboplatin plus bevacizumab in refractory retinoblastoma[J]. Chin J Ophthalmol, 2015, 51(2): 126-129. DOI: 10.3760/cma.j.issn.0412-4081.2015.02.013.

Chinese Journal of Ocular Fundus Diseases

Intra-arterial chemotherapy as secondly therapy for retinoblastoma

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