Intra-arterial and Intravitreal Chemotherapy for Retinoblastoma

• Published in: Current ophthalmology reports 2017-03, Vol.5 (1), p.73-84
• Main Authors: Stathopoulos, Christina, Say, Emil Anthony T., Shields, Carol L.
• Format: Article
• Language: English
• Subjects: Carotid arteries; Chemotherapy; Drug dosages; Intubation; Medicine; Medicine & Public Health; Metastasis; Ocular Infections (B Jeng and L Schocket; Ophthalmology; Patients; Radiation; Retinoblastoma; Section Editors; Topical Collection on Ocular Infections; Toxicity; Veins & arteries
• ISSN: 2167-4868; 2167-4868
• DOI: 10.1007/s40135-017-0123-6

Purpose of Review The aim of this review is to summarize history, treatment outcomes, indications, complications, and current controversies of both intra-arterial (IAC) and intravitreal (IViTC) chemotherapy in the management of retinoblastoma (RB). Recent Findings Over the years, the ability of IAC to provide excellent tumor control while limiting systemic toxicity has extended its indications from globe-sparing salvage therapy to the first-line therapy for unilateral disease. The establishment of safe IVitC techniques, on the other hand, has changed treatment philosophies from avoiding intraocular drug delivery at all costs to improve the control of vitreous seeds, which has been an important cause of failure of IAC. The use of both techniques has actually not only managed to reduce the enucleation rate but also to eliminate the need for external beam radiotherapy, at least as the first-line or second-line treatment. Summary During the past decade, IAC and IVitC have completely transformed the management of RB with a considerable improvement in ocular survival without affecting patient survival despite the lack of randomized controlled trials. Long-term prognosis, recurrence rates, and incidence of metastases after IAC and IVitC remain to be determined. Future challenges include studies of drug-induced retinal toxicity and optimization of treatment protocols in order to preserve vision.