Outcomes and adverse events following intra-arterial chemotherapy for retinoblastoma: A single center study in South India

Table 1 Intra-arterial chemotherapy in retinoblastoma as primary or secondary treatment in 17 eyes

	Primary IAC (n = 9)	Secondary IAC with intravitreal chemotherapy (n = 8)	P value (effect size)	95%CI
Median age at presentation months	14 (6, 48)	18 (2, 36)	0.73 (0.09)	0.13-1.30
Sex
Male	2 (22)	3 (38)	0.49 (0.17)	-2.80 to 3.80
Female	7 (78)	5 (62)
Study eye
Oculus dexter	3 (33)	5 (62)	0.23 (0.29)	-3.90 to 6.80
Oculus sinister	6 (67)	3 (38)
Laterality
Unilateral	8 (89)	3 (38)	0.03 (0.54)	-2.80 to 12.60
Bilateral	1 (11)	5 (62)
Inheritance
Hereditary	1 (11)	5 (63)	0.03 (0.54)	-1.80 to 11.60
Sporadic	8 (89)	3 (37)

Data was presented as n (%). For categorical variables, χ² test or Fisher’s exact test was used to test the association between the variables. For continuous variables, the Mann-Whitney U test (non-parametric equivalent of independent sample t test) was used to test the significance between the median of the two groups. IAC: Intra-arterial chemotherapy; CI: Confidence interval.

Table 2 Clinical features of 17 eyes at diagnosis

International classification of retinoblastoma	IAC		Total	P value (Effect size)	95%CI
	Primary IAC (n = 9)	Secondary (n = 8)
Group A	0	0	0	0.51 (0.38)	-0.90 to 1.10
Group B	2	3	5
Group C	0	1	1
Group D	2	2	4
Group E	5	2	7
Total	9	8	17
Mean tumors per eye	1.1	1.5
Optic nerve distance (average)	2.25	1.80
Foveal distance (average)	3.50	1.83
Vitreous seeds quadrant
None	3	2	5	1.00 (0.30)	0.37-1.63
1 quadrant	2	1	3
2 quadrants	1	2	3
3 quadrants	2	1	3
4 quadrants	1	2	3
Subretinal seeds quadrant
None	6	5	11	1.00 (0.45)	0.41-1.59
1 quadrant	1	0	1
2 quadrants	0	1	1
3 quadrants	1	0	1
4 quadrants	1	2	3
Retinal detachment
None	5	8	13	0.47 (0.34)	-0.14 to 1.08
2 quadrants	4	0	4
Vitreous hemorrhage
Yes	1	0	1	1.00 (0.23)	0.36-1.63
No	8	8	16
Anterior chamber seeds
Yes	0	1	1	0.47 (0.26)	-0.20 to 1.14
No	9	7	16
Neovascularization/neovascular glaucoma
Yes	-	-	-	-	-
No	9	8	17

IAC: Intra-arterial chemotherapy; CI: Confidence interval.

Table 3 Treatment features and outcomes of primary vs secondary intra-arterial chemotherapy in 17 eyes

IAC features	Primary IAC (n = 9)	Secondary IAC with intravitreal chemotherapy (n = 8)	P value	Total
Median number of cycles	1 (1-3)	2 (1-3)	0.403	1.7	Mann Whitney U test
Melphalan only	2	1	1.000	3
Melphalan + topotecan	6	6		12	Fisher’s exact test
Melphalan + topotecan + carboplatin	1	1		2
Melphalan [median (range)]	5 (3-12.5)	5 (5-12.5)	0.33	5 (3-12.5)
Topotecan [median (range)]	1 (1-3)	1 (1-3)	1	1 (1-3)
Carboplatin [median (range)]	30 (-)	30 (-)	-	30 (-)
Intravitreal chemotherapy features
Mean number of injections [median (range)]	-	3 (1-5)	-	3 (1-5)
Melphalan only [median (range)]	-	1 (16)		1 (16)
Topotecan only [median (range)]	-	2 (34)		2 (34)
Melphalan + topotecan [median (range)]	-	3 (50)		3 (50)
Systemic chemotherapy
Mean number of cycles [median (range)]	-	8 (6-11)	-	8 (6-11)
Brachytherapy [median (range)]	-	1		1
Outcomes
Follow-up months [median (range)]	20 (1-72)	28 (10-72)	0.385	30.17 (1-72)	Mann Whitney U test
Tumor control	8 (88)	7 (88)	1.00	15 (88)	Fisher’s exact test
Tumor control per ICRB
Group B	2	3	0.72	5	Fisher’s exact
Group C	0	1		1
Group D	2	1		3
Group E	4	2		6
Enucleation per ICRB group
Group B	0	0	-	0
Group C	0	0		0
Group D	0	1		1
Group E	1	0		1
Visual acuity of salvaged eyes	n = 8	n = 7		15
> 6/60 [median (range)]	2 (25)	2 (28.6)	1	4	Fisher’s exact
< 6/60 [median (range)]	6 (75)	5 (71.4)		11

Data were presented as n (%). IAC: Intra-arterial chemotherapy; ICRB: International classification of retinoblastoma.

Table 4 Intra-arterial chemotherapy for retinoblastoma using 29 catheterizations in 17 eyes: Treatment complications

Number	Intra-arterial chemotherapy cycles	Drug used with dose (mg)	Side effects	Fellow eye status	Best corrected visual acuity at last follow-up visit
1	1	M + T (5 + 1)	Nil	Normal	Fixing n following
2	2	M + T (5 + 1)	Nil	Normal	6/6p
3	1	M + T (5 + 1)	Rhegamatogenous retinal detachment, vitreous hemorrhage	Normal	N/A
4	2	M + T (5 + 1)	Subretinal hemorrhage	Normal	Hand movements
5	1	M + T (5 + 1)	Forehead pigmentation	Normal	6/15
6	3	M + T + C (5/7.5 + 1/2 + 30)	Exotropia, vitreous hemorrhage	Normal	Fixing n following
7	3	M + T + C (5/7.5 + 1/2 + 30)	Retinal pigment epithelium degeneration	Enucleated	Fixing n following
8	3	M (5)	Lid edema, vitreous hemorrhage, rhegmatogenous retinal detachment, choroidal ischemia	Normal	N/A
9	2	M (4)	Nil	Normal	6/60
10	1	M + T (5 + 1)	Nil	Normal	Fixing n following
11	1	M + T (5 + 1)	Third nerve palsy with ptosis	Group E, regressed	Not seeing first card (Cardiff)
12	1	M + T (5 + 1)	Nil	Normal	Not seeing first card (Cardiff)
13	1	M + T (5 + 1)	Subretinal bleed	Normal	Fixing n following
14	1	M + T (5 + 1)	Nil	Group D, regressed	Not fixing n following
15	2	M + T (5 + 1)	Nil	Group B, regressed	Fixing n following
16	2	M + T (5 + 1)	Nil	Group C, regressed	Fixing n following
17	2	M (3)	Retinal pigment epithelium degeneration, melphalan toxicity	Group A, regressed	No perception of light

C: Carboplatin; M: Melphalan; N/A: Not applicable; T: Topotecan.