Intra-arterial Chemotherapy for Retinoblastoma: Real-world Experience

Intra-arterial chemotherapy (IAC) has emerged as a standard of care for retinoblastoma (RB). Our study evaluates the outcomes, adverse effects and challenges of IAC in the management of RB in an Indian cohort. This retrospective study analyzed 20 patients (n=21 eyes) with RB treated with IAC at a single tertiary center. Drugs used were melphalan (5/7.5 mg) and topotecan (1/2 mg) (n=14) or melphalan (5 mg) alone (n=3) or triple therapy, which included carboplatin (30 mg) along with these drugs (n=4). Patient demographics, clinical staging, globe salvage rates, tumor regression, adverse effects, and challenges were assessed. Eyes were classified according to ICRB as group B (n=5), C (n=1), D (n=7), and E (n=8). Of the 21 eyes treated, successful globe salvage was achieved in 81% of the cases, with a median follow-up of 20 months. Complete regression of the main tumor was seen in 12 eyes (57%) and partial regression in 9 eyes (43%). Among adverse effects, vitreous hemorrhage (n=3), rhegmatogenous retinal detachment (n=3), choroidal ischemia (n=1), isolated subretinal hemorrhage (n=2), retinal pigment epithelium degeneration (n=3), ophthalmic artery stenosis (n=2), occlusive vasculitis (n=1), forehead pigmentation in 1 patient, 1 had third nerve palsy with complete ptosis and 1 had 30-degree exotropia. IAC is an effective treatment modality for RB, achieving high globe salvage rates, but parallelly, the adverse effects associated with IAC should be kept in mind. This study provides critical insights into the real-world application of IAC in resource-limited settings, highlighting both its promise and limitations.