Comparison Of Efficacy Of Intra-arterial Chemotherapy And Intravenous Chemotherapy Plus Intra-arterial Chemotherapy For Intraocular Advanced Retinoblastoma

Purpose: Intraocular advanced retinoblastoma(RB)is the most difficult tumor with the worst prognosis due to the risk of metastasis.Intra-arterial chemotherapy(IAC)is a commonly used treatment method at present,and has achieved good treatment effect initially,but its standardized treatment scheme and long-term efficacy still need to be further explored.A retrospective study was conducted to investigate whether the addition of intravenous chemotherapy(IVC)before IAC had any effect on patient outcomes.Materials and methods: Retrospective analysis was performed on patients diagnosed with intraocular advanced RB between April 2009 and January 2017.According to the treatment regimen,patients were divided into IVC plus IAC group and IAC group.Efficacy evaluation and follow-up were performed using funduscope,computerized tomography,or magnetic resonance.Kaplan-Meier analysis was used to compare the survival outcomes of the two groups,including ocular survival,overall survival and event-free survival.The Cox proportional risk model was performed to assess the effects of gender,age,tumor stage,treatment regimen,and local treatment on the prognosis of RB.Results: A total of 213 patients with intraocular advanced RB who received IVC plus IAC(n=103)or IAC alone(n=110)were included,and the mean follow-up time was 34.8 months and 25.0 months,respectively.The 3-year ocular survival rates were 62% and 68% in the two groups(hazard ratio [HR],0.88;95% confidence interval [CI],0.55–1.43;P=0.61);the 3-year overall survival rates were 97% and 93%,respectively(HR,1.56;95% CI,0.41–5.90;P=0.51);while the 3-year event-free survival rates were 76% and 72%,respectively(HR,0.96;95% CI,0.56–1.65;P=0.89);there were no significant difference between the two groups.The results of multivariate analysis showed that tumor stage and local treatment were important factors of ocular survival.Conclusions: IVC plus IAC produced no additional benefit over primary IAC for treating advanced intraocular RB in terms of local tumor control and extending survival.IIRC and local treatment were important factors of globe salvage.However,longer follow-up periods are required to assess long-term efficacy.