title: First-line intra-arterial versus intravenous chemotherapy in unilateral sporadic group D retinoblastoma: evidence of better visual outcomes, ocular survival and shorter time to success with intra-arterial delivery from retrospective review of 20 years of treatment.
abstract: The introduction of intra-arterial chemotherapy (IAC) as salvage treatment has improved the prognosis for eye conservation in group D retinoblastoma. The aim of this study was to compare the outcomes of consecutive patients with advanced unilateral disease treated with either first-line intravenous chemotherapy (IVC) or first-line IAC.
  
  
  
  This is a retrospective mono-centric comparative review of consecutive patients.
  
  
  
  Sporadic unilateral retinoblastoma group D cases treated conservatively at Jules-Gonin Eye Hospital and CHUV between 1997 and 2014. From January 1997 to August 2008, IVC, combined with focal treatments, was the primary treatment approach. From September 2008 to October 2014, IAC replaced IVC as first-line therapy.
  
  
  
  48 patients met the inclusion criteria, receiving only either IAC or IVC as primary treatment modality.
  
  
  
  Outcomes of 23 patients treated by IVC were compared with those of 25 treated by IAC; mean follow-up was 105.3 months (range 29.2-218.6) and 41.7 months (range 19.6-89.5), respectively. Treatment duration was significantly shorter in the IAC group (p<0.001). Ten eyes in the IVC group underwent enucleation. Recordable visual acuity of the salvaged eyes was significantly better in the IAC group (0.9 vs 1.4 logarithm of the minimum angle of resolution, p<0.01). No extraocular disease, metastases or long-term systemic complications were observed in either group.
  
  
  
  The difference in the time frame between treatment groups had an impact on the availability of intravitreal chemotherapy treatment. Despite this, the results reported here imply that eyes treated with first-line IAC will have shorter treatment period, better ocular survival and visual acuity than first-line IVC.
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles.
authors.forename: Francis L
authors.initials: FL
authors.lastname: Munier
authors.affiliation: Department of Radiology, Interventional Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Mosimann
authors.affiliation: Department of Radiology, Interventional Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Puccinelli
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles.
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Gaillard
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles.
authors.forename: Christina
authors.initials: C
authors.lastname: Stathopoulos
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles.
authors.forename: Susan
authors.initials: S
authors.lastname: Houghton
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles.
authors.forename: Ciara
authors.initials: C
authors.lastname: Bergin
authors.affiliation: Unit of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Maja
authors.initials: M
authors.lastname: Beck-Popovic
mesh_terms: D000359:Aftercare; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008558:Melphalan / Q000008:administration & dosage; D019572:Retinal Neoplasms / Q000188:drug therapy*; D012175:Retinoblastoma / Q000188:drug therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome; D014786:Vision Disorders / Q000517:prevention & control
chemical_list: D005047:Etoposide; D016190:Carboplatin; D008558:Melphalan
keywords: Child health (paediatrics); Neoplasia; Retina; Treatment Medical