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.
Objective To observe and evaluate the short-term therapeutic effect of intravitreal injection with topotecan for refractory vitreous seeding from retinoblastoma (RB)． Methods Eleven patients (11 eyes) of RB with refractory vitreous seeding (received intravenous chemotherapy, intra-arterial chemotherapy, intravitreal melphalan, laser, cryotherapy and subsequently developed refractory viable vitreous seeds) were enrolled in this study. There were 6 males (6 eyes) and 5 females (5 eyes). The aged from 9 to 44 months, with the mean age of 26 months. According to International Intraocular Retinoblastoma Classification, 11 eyes were initially classified as group E (3 eyes), D (6 eyes), B (1 eye) or A (1 eye). All patients were received intravitreal injection with topotecan. A total of 32 intravitreal topotecan injections were performed with a mean of 2.9 injections (median 3 injections; range 2−4 injections). The mean follow-up was 10 months. The safety and effectiveness of intravitreal injection with topotecan for refractory vitreous seeding from RB were observed. Results Complete regression of vitreous seeds was achieved in 11 of 11 eyes (100%), including complete disappearance in 9 eyes and fibrosis in 2 eyes. None of the patients needed enucleation and occured ocular or systemic complications in the follow-up period. Conclusion Intravitreal injection with topotecan for refractory vitreous seeds from RB is effective and safe.