Article Text

PDF

First-line intra-arterial versus intravenous chemotherapy in unilateral sporadic group D retinoblastoma: evidence of better visual outcomes, ocular survival and shorter time to success with intra-arterial delivery from retrospective review of 20 years of treatment
  1. Francis L Munier1,
  2. Pascal Mosimann2,
  3. Francesco Puccinelli2,
  4. Marie-Claire Gaillard1,
  5. Christina Stathopoulos1,
  6. Susan Houghton1,
  7. Ciara Bergin1,
  8. Maja Beck-Popovic3
  1. 1Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles
  2. 2Department of Radiology, Interventional Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  3. 3Unit of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  1. Correspondence to Professor Francis L Munier, Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Avenue de France 15, 1000 Lausanne 7, Vaud, Switzerland; francis.munier{at}fa2.ch

Abstract

Purpose The introduction of intra-arterial chemotherapy (IAC) as salvage treatment has improved the prognosis for eye conservation in group D retinoblastoma. The aim of this study was to compare the outcomes of consecutive patients with advanced unilateral disease treated with either first-line intravenous chemotherapy (IVC) or first-line IAC.

Design This is a retrospective mono-centric comparative review of consecutive patients.

Patients Sporadic unilateral retinoblastoma group D cases treated conservatively at Jules-Gonin Eye Hospital and CHUV between 1997 and 2014. From January 1997 to August 2008, IVC, combined with focal treatments, was the primary treatment approach. From September 2008 to October 2014, IAC replaced IVC as first-line therapy.

Methods 48 patients met the inclusion criteria, receiving only either IAC or IVC as primary treatment modality.

Results Outcomes of 23 patients treated by IVC were compared with those of 25 treated by IAC; mean follow-up was 105.3 months (range 29.2–218.6) and 41.7 months (range 19.6–89.5), respectively. Treatment duration was significantly shorter in the IAC group (p<0.001). Ten eyes in the IVC group underwent enucleation. Recordable visual acuity of the salvaged eyes was significantly better in the IAC group (0.9 vs 1.4 logarithm of the minimum angle of resolution, p<0.01). No extraocular disease, metastases or long-term systemic complications were observed in either group.

Conclusions The difference in the time frame between treatment groups had an impact on the availability of intravitreal chemotherapy treatment. Despite this, the results reported here imply that eyes treated with first-line IAC will have shorter treatment period, better ocular survival and visual acuity than first-line IVC.

  • Retina
  • Treatment Medical
  • Child health (paediatrics)
  • Neoplasia

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Statistics from Altmetric.com

Footnotes

  • Contributors FLM made substantial contributions to the conception and design of the work, the acquisition and interpretation of data. He contributed to revising the article critically for important intellectual content and gave final approval of the version published. He agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CB made substantial contributions to the analysis and interpretation of data. She drafted and revised the article critically for important intellectual content and gave final approval of the version published. She agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SH and MB-P made substantial contributions to the acquisition of data. Both drafted and revised the article critically for important intellectual content and gave final approval of the version published. Both agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. M-CG, CS, FP and PM made substantial contributions to the acquisition of data. They revised the article critically for important intellectual content and gave final approval of the version published. They agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Ethics approval Ethical committee of Vaud.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost B Jonas