Oculoplasty and Ocular Oncology Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
Department of Interventional Neuroradiology, Artemis Agrim Institute of Neurosciences, Gurugram, Haryana, India.
Indian J Ophthalmol. 2023 Feb;71(2):436-443. doi: 10.4103/ijo.IJO_1388_22.
To evaluate the efficacy of secondary and salvage intra-arterial chemotherapy (IAC) as a globe salvage treatment modality in advanced and refractory intraocular retinoblastoma.
A retrospective chart review of advanced intraocular retinoblastoma (groups D and E International Classification of Retinoblastoma [ICRB] classification) patients refractory to intravenous chemotherapy (IVC) and undergoing IAC as the secondary and salvage treatment modality between December 2018 and June 2021 was carried out. All patients underwent the IAC procedure by super-selective ophthalmic artery catheterization and with triple-drug chemotherapeutic agents of melphalan, topotecan, and carboplatin. Data were collected about tumor regression, eye salvage, metastasis, and survival outcome at follow-up.
Out of 13 patients, 12 patients received secondary IAC after being primarily treated with IVC and focal therapies and one patient received rescue IAC after recurrence following primary IAC. Mean number of IAC cycles administered was 2. Overall, globe salvage rate was 53.84%, with a mean follow-up of 17.53 months (range 6-37 months), three patients had enucleation for residual tumor or tumor recurrence. One patient developed metastasis post enucleation and two patients who were lost to follow-up after enucleation advice for residual tumor developed orbital tumor extension and eventually died of metastasis.
Secondary triple-drug IAC following failure of IVC, along with other adjunct treatment modalities might a be a cost-effective option for eye salvage in advanced intraocular retinoblastoma patients who refuse enucleation, with a globe salvage rate of 53.84%. It can also be an effective approach to improve treatment compliance and can help in addressing the barrier of treatment refusal when enucleation is advised.
评估二次和挽救性动脉内化疗（IAC）作为晚期和难治性眼内视网膜母细胞瘤眼球保存治疗方式的疗效。
回顾性分析了 2018 年 12 月至 2021 年 6 月期间，对静脉化疗（IVC）耐药且接受 IAC 作为二线和挽救性治疗方式的晚期眼内视网膜母细胞瘤（国际视网膜母细胞瘤分类[ICRB] D 组和 E 组）患者的病例。所有患者均通过超选择性眼动脉导管插入术和三药化疗药物（马法兰、拓扑替康和卡铂）进行 IAC 治疗。收集肿瘤消退、眼球保存、转移和随访后的生存结果等数据。
13 例患者中，12 例在接受 IVC 和局部治疗后接受了二次 IAC，1 例在初次 IAC 后复发后接受了挽救性 IAC。平均接受 IAC 周期数为 2 个。总体而言，眼球保存率为 53.84%，平均随访时间为 17.53 个月（6-37 个月），3 例因残留肿瘤或肿瘤复发而行眼球摘除术。1 例患者在眼球摘除术后发生转移，2 例患者在眼球摘除后失访，建议行残留肿瘤治疗，随后发生眼眶肿瘤扩展，最终死于转移。
IVC 治疗失败后，联合其他辅助治疗方式的二次三药 IAC，可能是拒绝眼球摘除的晚期眼内视网膜母细胞瘤患者眼球保存的一种具有成本效益的选择，眼球保存率为 53.84%。它也可以是一种有效的方法，提高治疗的依从性，并有助于解决在建议眼球摘除时患者拒绝治疗的问题。
