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May 2016

Intra-arterial Chemotherapy for Retinoblastoma: A Systematic Review

Author Affiliations
  • 1Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
  • 2Department of Surgery, King Hussein Cancer Center, Amman, Jordan
  • 3Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
  • 4Angeles University Foundation Medical Center, Philippines
  • 5Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
  • 6Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
  • 7Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  • 8Department of Medical Biophysics and Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
JAMA Ophthalmol. 2016;134(5):584-591. doi:10.1001/jamaophthalmol.2016.0244

Importance  Intra-arterial chemotherapy has emerged as a treatment for intraocular retinoblastoma and has been quickly adopted by centers worldwide.

Objective  To conduct a systematic review and attempt a meta-analysis to summarize the reported outcomes of intra-arterial chemotherapy.

Evidence Review  In January 2015, we performed comprehensive searches in Medline, Embase, Cochrane, and Web of Science from inception through January 2015, including any peer-reviewed English-language publication that described outcomes related to toxicity or efficacy in at least 4 patients.

Findings  From a total of 208 identified publications, 28 met inclusion criteria. Twelve reports with discernable nonduplicative information were included, reporting 655 patients, 757 eyes, and 2350 catheterizations. All were single-arm case series, and 67% (8 of 12) were retrospective. Across all studies, globe salvage was achieved for 502 (66%) of all eyes. Most common reported toxicities were chorioretinal atrophy and vascular occlusions. There were at least 13 reports of children with metastases. After publication, 7 additional children had metastases. The 4 different classification systems used challenged the comparison of disease severity at presentation. Visual outcome was not addressed in most studies. Meta-analyses were not possible because no study had a comparative group. Assessment of risk of bias was not possible because no validated tool for single-arm studies was available.

Conclusions and Relevance  Intra-arterial chemotherapy is a promising new treatment associated with high rates of globe salvage. However, the literature is limited by the predominance of retrospective case series, absence of comparison groups, short median follow-up, heterogeneous definitions and tumor classifications, and frequent duplicate reporting. Metastases have been observed, and long-term follow-up is needed. Until the results of clinical, prospective studies are available, it is recommended that intra-arterial chemotherapy be offered selectively among other options, with fully informed discussion about all possible risks, benefits, and uncertainties.

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