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Histopathology of retinoblastoma eyes enucleated after intra-arterial chemotherapy
  1. Eva Maria Biewald1,
  2. Norbert Bornfeld1,
  3. Klaus A Metz2,
  4. Sabrina Schlüter1,
  5. Tobias Kiefer1,
  6. Alexander Radbruch3,
  7. Sophia Göricke3,
  8. Selma Sirin3,
  9. Petra Ketteler4,
  10. Nikolaos E Bechrakis1
  1. 1 Department of Ophthalmology, University Hospital Essen, Essen, Germany
  2. 2 Institute of Pathology and Neuropathology, University Hospital Essen, Essen, Germany
  3. 3 Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
  4. 4 University Hospital Essen Department of Paediatrics III, Essen, Germany
  1. Correspondence to Dr Eva Maria Biewald, Department of Ophthalmology, University Hospital Essen, Essen 45147, Germany; eva.biewald{at}


Background To demonstrate histopathological findings in retinoblastoma eyes enucleated after intra-arterial chemotherapy (IAC) with special emphasis on vascular toxicity and local tumour control.

Methods Retrospective study with a consecutive series of 23 retinoblastoma eyes enucleated after IAC where histopathological work-up was available.

Results From November 2010 to June 2019 23 eyes were enucleated after the attempt of eye salvaging therapy with IAC using melphalan. IAC was the first line treatment in nine and salvage treatment in 14 eyes. Doses of melphalan ranged from 3 to 7.5 mg, whereby a strict protocol with age-appropriate dosage was not used until 2015. The mean number of treatment cycles was 1.8. The main indications for enucleation were poor treatment response or tumour progression in 14 eyes, severe vascular complications in five eyes and a total exudative retinal detachment with amaurosis in the remaining four eyes. We found active disease in 15 eyes with an indication for adjuvant chemotherapy due to high risk factors for metastases in four eyes. To date none of these patients developed metastatic disease. Concerning vascular toxicity, we detected a central retinal artery occlusion in three eyes, severe vasculitis in another three, ischaemic outer retina atrophy and choroidal ischaemia in seven eyes with one eye developing a severe proliferative retinopathy.

Conclusion IAC is a highly effective treatment option for advanced retinoblastoma, but the described potential risks should be kept in mind. These include severe vascular complications, as well as the possibility of persisting vital tumour cells fulfilling high-risk criteria for adjuvant chemotherapy.

  • vascular toxicity
  • melphalan
  • intraocular tumours
  • risk factors
  • metastatic disease

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  • Contributors Conceptualisation: EMB, NB, NEB; investigation: SS, TK, AR, SG, SS, PK; methodology: KAM, EMB, NB; writing original draft: EMB, NB, NEB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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