A Retro Spective Analysis Of Intravenous Chemotherapy And Intra-Aterial Chemotherapy In Treating Introcular Retinoblastoma

BackgroundRetinoblastoma is the most common intraocular malignancy in children.It can cause poor vision,vision loss and even death.Chemotherapy combined with focal treatment plays an important role in the retention of eyes,and the current major chemotherapies are intravenous chemotherapy(IVC)and intra-arterial chemotherapy(IAC).PurposeTo evaluate the effectiveness and the safety of first-line intra-arterial chemotherapy(IAC)and first-line intravenous chemotherapy(IVC),and to explore the prognostic factors of the global survival in intraocular retinoblastoma.MethodsThis study had a comparative,retrospective design,including 167 eyes from 152 patients with intraocular retinoblastoma(stage of C to E)who were consecutively enrolled from January 2014 to June 2017 and were treated with either first-line I VC or first-line IAC at our hospital.To compare globe retention rate,metastasis rate,tumour-related death rate and adverse events in patients with intraocular retinoblastoma who were treated with first-line IVC and first-line I AC.A multivariate Cox proportional hazard regression model was performedResultsEighty-two eyes from 82 patients were treated with first-line IAC and 85 eyes from 70 patients were treated with first-line IVC.The mean follow-up periods were 15.9 months(range 6.0-42.5 months)and 25.8 months(range 6.1-90.1 months),respectively.In the IAC group,3(5.7%)eyes from group D and 2(9.1%)eyes from group E underwent enucleation In the IVC group,6(13.6%)eyes from group D and 14(51.9%)eyes from group E underwent enucleation.No metastasis or tumour-related death was observed in the IAC group,whereas in the IVC group,3(4.3%)patients died of retinoblastoma,with a median survival time 24.0 months(range 13.7-25.2 months).Ocular adverse events occurred in the IAC group,including palpebral oedema(n=12,14.6%),bulbar conjunctival congestion(n=24,29.3%),ptosis(n=2,2.4%),vitreous haemorrhage(n=5,6.1%),subretinal haemorrhage(n=6,7.3%),ophthalmic artery spasm with reperfusion(n=3,3.7%)and cataract(n=7,8.5%).Systematic complications were observed more severe in IVC groups,including myelosuppression,fever,vomiting and hair loss.Patients who underwent primary IAC(HR:3.58,P=0.015)and younger patients(HR:1.02,P=0.049)exhibited lower rates of enucleationConclusionsPatients with intraocular retinoblastoma(stage D and E without high clinical risk factors)treated with first-line IAC displayed better globe salvage outcomes,fewer instances of metastasis and lower mortality than patients treated with first-line IVC.In addition to first-line IAC,a younger age at the first treatment cycle was also correlated with a better prognosis for globe retention.