Alternating intra-arterial and intravitreal chemotherapy for advanced intraocular retinoblastoma: First successful results without systemic chemotherapy

Purpose Background: To describe the efficacy of intra-arterial chemotherapy combined with intravitreal chemotherapy for the treatment of advanced stage retinoblastoma Methods The Authors report the medical records of four patients who presented with unilateral retinoblastoma, (Reese-Ellsworth stage Vb/ group D of ABC Classification in the affected eye). They underwent clinical and ophthalmoscopic evaluation and MRI to exclude local and CNS dissemination. All 4 patients received 2 cycles (six infusions) of intrarterial chemotherapy (4-5 mg of melphalan/0.3-0.4 mg of topotecan), and from 7 up to 9 melphalan injections into the vitreous (10-30μg in 0.05 mL). Results Successful control of tumor masses and vitreous seeds was achieved in all cases at long-term (> 6 months) follow-up. Tumor control was 100% in all cases. Complications included: posterior lens opacities, acute ischemic papillitis, transient hypotonia, vitreous hemorrhage. There were no cases of orbital tumor recurrence or metastasis (follow-up range, 6 – 12 months). Conclusion Sequential intra-arterial chemotherapy and intravitreal melphalan for advanced retinoblastoma allowed to provide retinal and vitreous seed control