Secondary and tertiary intra-arterial chemotherapy for massive persistent or recurrent subretinal retinoblastoma seeds following previous chemotherapy exposure: long-term tumor control and globe salvage in 30 eyes

PurposeTo describe the results of intra-arterial chemotherapy (IAC) for control of persistent or recurrent subretinal seeds (SRS) following previous chemotherapy for retinoblastoma.MethodsWe reviewed the medical records of patients with massive persistent or recurrent SRS after intravenous and/or intra-arterial chemotherapy and subsequently treated with superselective ophthalmic artery infusion of melphalan (3, 5, or 7.5 mg) and/or additional topotecan (1 mg) and/or carboplatin (20 or 30 mg) as necessary from January 2009 to March 2014. The main outcome measures were SRS control and globe salvage.ResultsA total of 30 eyes of 29 patients were included. Mean patient age was 19 months (median, 14 months; range, 2-58 months). Previous treatments included intravenous chemotherapy (n = 28) and intra-arterial chemotherapy (n = 5). The SRS occupied a median of 6 clock hours. Retinal detachment was present in 5 eyes (17%). Each eye received a mean of 3 IAC sessions (median, 2; range, 1-7) on a monthly basis. After a mean follow-up of 24 months (median, 18; range, 1-71 months), 27 of eyes (90%) demonstrated complete SRS regression. Overall, globe salvage was achieved in 15 eyes (50%). Fifteen eyes were enucleated because of recurrent SRS (4 eyes), recurrent SRS and vitreous seeds (3 eyes), recurrent solid tumor (1 eye), and neovascular glaucoma from total retinal detachment and/or vitreous hemorrhage (7 eyes), none of which had active tumor.ConclusionsIAC can be an effective second- or third-line therapy in the management of massive persistent or recurrent SRS from retinoblastoma following previous chemotherapy. All eyes in this study were all facing enucleation; lasting seed control was achieved in 70%.