title: Unilateral Retinoblastoma Managed With Intravenous Chemotherapy Versus Intra-Arterial Chemotherapy. Outcomes Based on the International Classification of Retinoblastoma.
abstract: OBJECTIVE
  The objective of this study was to compare outcomes after intravenous chemotherapy (IVC) versus intra-arterial chemotherapy (IAC) for unilateral retinoblastoma.
  
  
  METHODS
  A retrospective comparative interventional case series.
  
  
  METHODS
  Patients with unilateral retinoblastoma managed with either IVC using vincristine, etoposide, and carboplatin or IAC using melphalan with or without topotecan with a minimum of 1-year follow-up were compared. The primary outcome measure was globe salvage.
  
  
  RESULTS
  Of 91 patients with unilateral retinoblastoma, IVC was employed in 42 (46%) cases and IAC in 49 (54%). By comparison (IVC vs IAC), patients in the IAC group had greater mean tumor diameter (14 vs 18 mm, P < 0.001) and thickness (7 vs 10 mm, P = 0.001), greater percentage with active vitreous seeds (29% vs 55%, P = 0.01), and greater total retinal detachment (10% vs 43%, P < 0.001). There were no cases of group A in either treatment arm. Globe salvage was not significantly different in groups B, C, or E, but there was significantly improved globe salvage with IAC for group D (48% vs 91%, P = 0.004). Control was significantly better with IAC for solid tumor (62% vs 92%, P = 0.002), subretinal seeds (31% vs 86%, P = 0.006), and vitreous seeds (25% vs 74%, P = 0.006). There were no patients with pinealoblastoma, second cancer, metastasis, or death in either group.
  
  
  CONCLUSIONS
  For unilateral retinoblastoma, IAC provided significantly superior globe salvage compared with IVC for group D eyes. In addition, IAC provided significantly superior control for solid tumor, subretinal seeds, and vitreous seeds.
authors.affiliation: From the *Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA; †Ribeirão Preto Medical School, University of São Paulo, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, São Paulo, Brazil; ‡Nemours Center for Cancer and Blood Disorders, Nemours/Alfred I. DuPont Hospital for Children at Thomas Jefferson University; §Pediatric Oncology Department, The Children's Hospital of Philadelphia, University of Pennsylvania; and ¶Department of Neurovascular and Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jorge
authors.forename: Emil Anthony T
authors.initials: EA
authors.lastname: Say
authors.forename: George
authors.initials: G
authors.lastname: Magrath
authors.forename: Adel
authors.initials: A
authors.lastname: Alset
authors.forename: Emi
authors.initials: E
authors.lastname: Caywood
authors.forename: Ann M
authors.initials: AM
authors.lastname: Leahey
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D019572:Retinal Neoplasms / Q000188:drug therapy*; D012175:Retinoblastoma / Q000188:drug therapy*; D012189:Retrospective Studies; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D005047:Etoposide; D016190:Carboplatin