Chemotherapy Approaches in the Treatment of Childhood Retinoblastoma: Comparison of Intravenous, Intra-arterial and Intravitreal Therapies

Retinoblastoma is the most common malignant intraocular tumor of childhood, with important implications for the child’s survival and quality of life. Historically treated by enucleation and external radiotherapy, the management of the disease has evolved significantly with the advent of chemotherapy, which has become a more conservative and effective alternative. This systematic review with meta-analysis aimed to compare the efficacy and safety of the three main chemotherapy approaches currently used in the treatment of childhood retinoblastoma: systemic intravenous chemotherapy (ISCT), intra-arterial chemotherapy (IAQ) and intravitreal chemotherapy (IVCT). 28 studies were included with a total of 3,765 patients and 4,892 eyes treated. The results showed superiority of IAQ and IVQ over ISQ in terms of tumor regression (82.1% and 88.5% versus 62.4%, respectively) and ocular preservation (73.6% and 79.1% versus 54.2%). In addition, the incidence of systemic complications was significantly lower in localized therapies, especially in IVF (2.8%). The discussion based on the scientific literature showed that these locoregional approaches, as well as being more effective, have greater potential for preserving vision and reducing side effects. The conclusion is that the choice of therapeutic approach should take into account tumor staging, the anatomical characteristics of the affected eye and advances in personalized medicine, with a focus on quality of life and long-term visual function. Keywords : retinoblastoma, intra-arterial chemotherapy, intravitreal chemotherapy, pediatric oncology, ocular preservation, individualized treatment.