Selective intra-arterial chemotherapy in infants with intraocular retinoblastoma aged up to 6 months

Introduction. Retinoblastoma (RB) is the most common primary intraocular tumor in childhood. One of the most effective ways of targeted drug delivery directly to the tumor is selective intra-arterial chemotherapy (SIAC). No studies have been found in the world literature that would conduct a detailed assessment of this method of treating intraocular RB in infants under 6 months.

Objective – to evaluate the safety and efficacy of SIAC for the treatment of infants under 6 months of age diagnosed with intraocular RB.

Materials and methods. A single-center, retrospective cohort study was conducted, which included 19 infants (63 sessions of SIAC) who were diagnosed with unilateral or bilateral intraocular RB at the age of up to 6 months and underwent primary or secondary SIAC from December 2017 to November 2020.

Results. The main results included the technical success rate of SIAC, survival rates and adverse events. The age group up to 6 months is represented by 19 patients, in 4 cases with a familial form of RB. The number of boys was 5 (26.3 %), girls – 14 (73.7 %), aged from 0.5 to 5 months (median 3 (2; 5) months), the average weight was 7.13 (median 7.25 (5; 9) kg). 26 affected eyes in 19 patients underwent SIAC.

SIAC was performed primarily in 10 (52.6%) of 19 patients (13 affected eyes). Out of 9 (47.4 %) pretreated patients (13 affected eyes), before SIAC, in 5 cases (8 affected eyes) only systemic chemotherapy (CT) was performed. In 2 of 9 patients, in addition to CT, additional local treatment of 3 affected eyes was performed. 2 of 9 patients underwent only local treatment of 2 affected eyes. Catheterization was successful in 100 % of procedures (n = 63). Indications for additional treatment after SIAC with organ-preserving goal were required in 20 of 26 cases.

There were no cases of using external beam radiotherapy before and after SIAC. Secondary bilateral enucleation was performed in one patient due to complications after brachytherapy. Among the early systemic complications, cardiorespiratory disorders should be noted, which were observed during 23 (36.5 %) SIAC sessions; and among the remote ocular complications, 2 cases (7.7 %) – chorioretinal dystrophy (spread to 3 or more retinal quadrants). There were no cases of stroke, neurological disorders, extraocular tumor growth and metastasis.

In 3 of 19 patients, pineoblastoma was diagnosed as a metronomic manifestation of trilateral RB. The time from the initial diagnosis of bilateral RB to the occurrence of pineoblastoma in these patients was 2 years 11 months, 4 years 11 months and 2 years 8 months In 1 patient with familial bilateral RB, a second tumor was detected – an incidentoloma of the basal ganglia of the brain on the right after 5 years 6 months. from the initial diagnosis of RB. The overall five-year survival rate of patients was 87.4 ± 8.4 %. The cause of death of 2 patients was progression of metachronous trilateral RB. The overall five-year organ (eye) survival was 91.6 ± 5.7 %.

Conclusions. The results of our study indicate that SIAC, both primary and secondary, is effective and safe enough for the treatment of disseminated RB in infants under 6 months of age. However, possible complications associated with both selective intra-arterial catheterization and CT administration cannot be ignored and require further study.

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