title: Intra-arterial Chemotherapy for Retinoblastoma: A Systematic Review.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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
  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.
authors.affiliation: Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada2Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Yacoub A
authors.initials: YA
authors.lastname: Yousef
authors.affiliation: Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada3Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Sameh E
authors.initials: SE
authors.lastname: Soliman
authors.affiliation: Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada4Angeles University Foundation Medical Center, Philippines.
authors.forename: Paulita Pamela P
authors.initials: PPP
authors.lastname: Astudillo
authors.affiliation: Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Priya
authors.initials: P
authors.lastname: Durairaj
authors.affiliation: Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Dimaras
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada6Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Helen S L
authors.initials: HSL
authors.lastname: Chan
authors.affiliation: Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada7Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elise
authors.initials: E
authors.lastname: Héon
authors.affiliation: Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada7Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada8Department of Medical Biophysics and Molecular Genetics.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Gallie
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada6Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Furqan
authors.initials: F
authors.lastname: Shaikh