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BMC Cancer
Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Comparison between intravenous chemotherapy and intra-arterial chemotherapy for retinoblastoma: a meta-analysis

Authors: Qiuying Chen, Bin Zhang, Yuhao Dong, Xiaokai Mo, Lu Zhang, Wenhui Huang, Hua Jiang, Jiejun Xia, Shuixing Zhang

Published in: BMC Cancer | Issue 1/2018

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Abstract

Background

Intravenous chemotherapy (IVC) and intra-arterial chemotherapy (IAC) have become the primary treatments for retinoblastoma; however, some controversy remains over which method is more effective. We conducted a meta-analysis to compare the clinical efficacy of IVC and IAC.

Methods

We systematically searched literature published on PubMed, Embase, and Cochrane Library up to May 2017. Studies containing either IAC or IVC that reported on efficacy were included. The effects estimate was expressed as a pooled rate with 95% confidence interval (CI), using a fixed-effects or random-effects model.

Results

Twenty-six studies were identified which included 1541 eyes (IAC: 11 trials, 445 eyes; IVC: 16 trials, 1096 eyes). The mean follow-up times were 49.4 months (range, 13.0–105.3 months) for IVC and 21.7 months (range, 8.8–38.7 months) for IAC. For the International Classification of Intraocular Retinoblastoma (ICRB) grading, the overall success rate was higher with IAC than with IVC (75.7% [95%CI: 65.7%–83.6%] vs. 69.5% [95%CI: 51.9%–82.8%], P < 0.001). The globe salvage with IAC was higher than with IVC in group D eyes (79.5% [95%CI: 71.8%–85.4%] vs. 55.1% [95%CI: 45.6%–64.2%], P < 0.001), but not in groups B (95.8% [95%CI: 57.5%–99.7%] vs. 82.5% [95%CI: 58.9%–94.0%], P = 0.163), C (91.3% [95%CI: 65.9%–98.3%] vs. 89.0% [95%CI: 69.0%–96.7%], P = 0.212), and E eyes (51.2% [95%CI: 37.0%–65.2%] vs. 43.2% [95%CI: 18.3%–72.1%], P = 0.578). IAC and IVC were not significantly different regarding the recurrence and metastasis rates (15.0% vs. 15.4%, P = 0.148 and 2.7% vs. 0.6%, P = 0.194, respectively). For Reese-Ellsworth (RE) grading, IAC had a higher globe salvage in groups IV (90.9% [95%CI: 56.0%–98.7%] vs. 66.3% [95%CI: 32.4%–89.0%], P = 0.047) and V eyes (83.2% [95%CI: 72.0%–90.5%] vs. 59.9% [95%CI: 43.1%–74.6%], P = 0.003), but not in group I-III eyes (88.6% [95%CI: 58.3%–97.7%] vs. 88.1% [95%CI: 76.6%–94.4%], P = 0.244). The overall success rate was higher in IAC than in IVC (87.1% [95%CI: 78.1%–92.7%] vs. 77.3% [95%CI: 68.1%–84.4%], P = 0.033).

Conclusions

IAC may be superior to IVC for the treatment of retinoblastoma, with a higher overall success rate and higher globe salvage in group D or groups IV and V eyes.
Appendix
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Literature
1.
Narang S, Mashayekhi A, Rudich D, Shields CL. Predictors of long-term visual outcome after chemoreduction for management of intraocular retinoblastoma. Clin Exp Ophthalmol. 2012;40:736–42.CrossRefPubMed
2.
Rothschild PR, Levy D, Savignoni A, Lumbroso-Le Rouic L, Aerts I, Gauthier-Villars M, Esteve M, Bours D, Desjardins L, Doz F, Levy-Gabriel C: Familial retinoblastoma: fundus screening schedule impact and guideline proposal. A retrospective study. Eye (Lond) 2011, 25:1555–1561.
3.
Canturk S, Qaddoumi I, Khetan V, Ma Z, Furmanchuk A, Antoneli CB, Sultan I, Kebudi R, Sharma T, Rodriguez-Galindo C, et al. Survival of retinoblastoma in less-developed countries impact of socioeconomic and health-related indicators. Br J Ophthalmol. 2010;94:1432–6.CrossRefPubMed
4.
MacCarthy A, Birch JM, Draper GJ, Hungerford JL, Kingston JE, Kroll ME, Stiller CA, Vincent TJ, Murphy MF. Retinoblastoma: treatment and survival in great Britain 1963 to 2002. Br J Ophthalmol. 2009;93:38–9.CrossRefPubMed
5.
Kupfer C. Retinoblastoma treated with intravenous nitrogen mustard. Am J Ophthalmol. 1953;36:1721–3.CrossRefPubMed
6.
Yanik O, Gunduz K, Yavuz K, Tacyildiz N, Unal E. Chemotherapy in retinoblastoma: current approaches. Turk J Ophthalmol. 2015;45:259–67.PubMedPubMedCentral
7.
Reese AB, Hyman GA, Merriam GR Jr, Forrest AW, Kligerman MM. Treatment of retinoblastoma by radiation and triethylenemelamine. AMA Arch Ophthalmol. 1954;53(4):505–13.CrossRefPubMed
8.
Yamane T, Kaneko A, Mohri M. The technique of ophthalmic arterial infusion therapy for patients with intraocular retinoblastoma. Int J Clin Oncol. 2004;9:69–73.CrossRefPubMed
9.
Abramson DH, Marr BP, Dunkel IJ, Brodie S, Zabor EC, Driscoll SJ, Gobin YP. Intra-arterial chemotherapy for retinoblastoma in eyes with vitreous and/or subretinal seeding: 2-year results. Br J Ophthalmol. 2012;96:499–502.CrossRefPubMed
10.
Abramson DH, Fabius AW, Issa R, Francis JH, Marr BP, Dunkel IJ, Gobin YP. Advanced unilateral retinoblastoma: the impact of ophthalmic artery chemosurgery on enucleation rate and patient survival at MSKCC. PLoS One. 2015;10:e0145436.CrossRefPubMedPubMedCentral
11.
Shields CL, Bianciotto CG, Jabbour P, Ramasubramanian A, Lally SE, Griffin GC, Rosenwasser R, Shields JA. Intra-arterial chemotherapy for retinoblastoma: report no. 1, control of retinal tumors, subretinal seeds, and vitreous seeds. Arch Ophthalmol. 2011;129:1399–406.CrossRefPubMed
12.
Yu CL, Tucker MA, Abramson DH, Furukawa K, Seddon JM, Stovall M, Fraumeni JF Jr, Kleinerman RA. Cause-specific mortality in long-term survivors of retinoblastoma. J Natl Cancer Inst. 2009;101:581–91.CrossRefPubMedPubMedCentral
13.
Marees T, Moll AC, Imhof SM, de Boer MR, Ringens PJ, van Leeuwen FE. Risk of second malignancies in survivors of retinoblastoma: more than 40 years of follow-up. J Natl Cancer Inst. 2008;100:1771–9.CrossRefPubMed
14.
Munier FL, Mosimann P, Puccinelli F, Gaillard MC, Stathopoulos C, Houghton S, Bergin C, Beck-Popovic M. 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. Br J Ophthalmol. 2017;101:1086–93.CrossRefPubMed
15.
Novetsky DE, Abramson DH, Kim JW, Dunkel IJ. Published international classification of retinoblastoma (ICRB) definitions contain inconsistencies--an analysis of impact. Ophthalmic Genet. 2009;30:40–4.CrossRefPubMed
16.
Yousef YA, Nazzal RM, Khalil MB, Deebajah R, Mehyar M, Hajja S, Mohammad M, Al Jabary R, Jaradat I, Sultan I, Al Nawaiseh I. Management outcome(s) in eyes with retinoblastoma previously inadequately treated with systemic chemotherapy alone without focal therapy. Oman J Ophthalmol. 2017;10:70–5.CrossRefPubMedPubMedCentral
17.
Friedman DL, Krailo M, Villaluna D, Gombos D, Langholz B, Jubran R, Shields C, Murphree L, O'Brien J, Kessel S, et al. Systemic neoadjuvant chemotherapy for group B intraocular retinoblastoma (ARET0331): a report from the Children's oncology group. Pediatr Blood Cancer. 2017;64
18.
Fabian ID, Stacey AW, Johnson KP, Onadim Z, Chowdhury T, Duncan C, Reddy MA, Sagoo MS. Primary intravenous chemotherapy for group D retinoblastoma: a 13-year retrospective analysis. Br J Ophthalmol. 2017;101:82–8.CrossRefPubMed
19.
Berry JL, Shah S, Bechtold M, Zolfaghari E, Jubran R, Kim JW. Long-term outcomes of group D retinoblastoma eyes during the intravitreal melphalan era. Pediatr Blood Cancer. 2017;64
20.
Berry JL, Kogachi K, Aziz HA, McGovern K, Zolfaghari E, Murphree AL, Jubran R, Kim JW. Risk of metastasis and orbital recurrence in advanced retinoblastoma eyes treated with systemic chemoreduction versus primary enucleation. Pediatr Blood Cancer. 2017;64
21.
Berry JL, Jubran R, Kim JW, Wong K, Bababeygy SR, Almarzouki H, Lee TC, Murphree AL. Long-term outcomes of group D eyes in bilateral retinoblastoma patients treated with chemoreduction and low-dose IMRT salvage. Pediatr Blood Cancer. 2013;60:688–93.CrossRefPubMed
22.
Kaliki S, Shields CL, Shah SU, Eagle RC Jr, Shields JA, Leahey A. Postenucleation adjuvant chemotherapy with vincristine, etoposide, and carboplatin for the treatment of high-risk retinoblastoma. Arch Ophthalmol. 2011;129:1422–7.CrossRefPubMed
23.
Shin JY, Kim JH, Yu YS, Khwarg SI, Choung HK, Shin HY, Ahn HS. Eye-preserving therapy in retinoblastoma: prolonged primary chemotherapy alone or combined with local therapy. Korean J Ophthalmol. 2010;24:219–24.CrossRefPubMedPubMedCentral
24.
Shields CL, Ramasubramanian A, Thangappan A, Hartzell K, Leahey A, Meadows AT, Shields JA. Chemoreduction for group E retinoblastoma: comparison of chemoreduction alone versus chemoreduction plus low-dose external radiotherapy in 76 eyes. Ophthalmology. 2009;116:544–551.e541.CrossRefPubMed
25.
Cohen VM, Kingston J, Hungerford JL. The success of primary chemotherapy for group D heritable retinoblastoma. Br J Ophthalmol. 2009;93:887–90.CrossRefPubMed
26.
Shields CL, Mashayekhi A, Au AK, Czyz C, Leahey A, Meadows AT, Shields JA. The international classification of retinoblastoma predicts chemoreduction success. Ophthalmology. 2006;113:2276–80.CrossRefPubMed
27.
Chen M, Jiang H, Zhang J, Shen G, Jiang Y, Li H, Liu Z. Outcome of intra-arterial chemotherapy for retinoblastoma and its influencing factors: a retrospective study. Acta Ophthalmol. 2017;95:613–8.CrossRefPubMed
28.
Tuncer S, Sencer S, Kebudi R, Tanyildiz B, Cebeci Z, Aydin K. Superselective intra-arterial chemotherapy in the primary management of advanced intra-ocular retinoblastoma: first 4-year experience from a single institution in Turkey. Acta Ophthalmol. 2016;94:e644–51.CrossRefPubMed
29.
Abramson DH, Daniels AB, Marr BP, Francis JH, Brodie SE, Dunkel IJ, Gobin YP. Intra-arterial chemotherapy (ophthalmic artery chemosurgery) for group D retinoblastoma. PLoS One. 2016;11:e0146582.CrossRefPubMedPubMedCentral
30.
Shields CL, Manjandavida FP, Lally SE, Pieretti G, Arepalli SA, Caywood EH, Jabbour P, Shields JA. Intra-arterial chemotherapy for retinoblastoma in 70 eyes: outcomes based on the international classification of retinoblastoma. Ophthalmology. 2014;121:1453–60.CrossRefPubMed
31.
Thampi S, Hetts SW, Cooke DL, Stewart PJ, Robbins E, Banerjee A, Dubois SG, Char D, Halbach V, Matthay K. Superselective intra-arterial melphalan therapy for newly diagnosed and refractory retinoblastoma: results from a single institution. Clin Ophthalmol. 2013;7:981–9.CrossRefPubMedPubMedCentral
32.
Gobin YP, Dunkel IJ, Marr BP, Brodie SE, Abramson DH. Intra-arterial chemotherapy for the management of retinoblastoma: four-year experience. Arch Ophthalmol. 2011;129:732–7.CrossRefPubMed
33.
Abramson DH, Dunkel IJ, Brodie SE, Kim JW, Gobin YP. A phase I/II study of direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma initial results. Ophthalmology. 2008;115:1398–1404, 1404.e1391.CrossRefPubMed
34.
Kim JH, Yu YS, Khwarg SI, Choi HS, Shin HY, Ahn HS. Clinical result of prolonged primary chemotherapy in retinoblastoma patients. Korean J Ophthalmol. 2003;17:35–43.CrossRefPubMed
35.
Gombos DS, Kelly A, Coen PG, Kingston JE, Hungerford JL. Retinoblastoma treated with primary chemotherapy alone: the significance of tumour size, location, and age. Br J Ophthalmol. 2002;86:80–3.CrossRefPubMedPubMedCentral
36.
Brichard B, De Bruycker JJ, De Potter P, Neven B, Vermylen C, Cornu G. Combined chemotherapy and local treatment in the management of intraocular retinoblastoma. Med Pediatr Oncol. 2002;38:411–5.CrossRefPubMed
37.
Abramson DH, Dunkel IJ, Brodie SE, Marr B, Gobin YP. Superselective ophthalmic artery chemotherapy as primary treatment for retinoblastoma (chemosurgery). Ophthalmology. 2010;117:1623–9.CrossRefPubMed
38.
Fabian ID, Naeem Z, Stacey AW, Chowdhury T, Duncan C, Reddy MA, Sagoo MS. Long-term visual acuity, strabismus, and nystagmus outcomes following multimodality treatment in group D retinoblastoma eyes. Am J Ophthalmol. 2017;179:137–44.CrossRefPubMed
39.
Turaka K, Shields CL, Meadows AT, Leahey A. Second malignant neoplasms following chemoreduction with carboplatin, etoposide, and vincristine in 245 patients with intraocular retinoblastoma. Pediatr Blood Cancer. 2012;59:121–5.CrossRefPubMed
40.
Shields CL, Bianciotto CG, Jabbour P, Griffin GC, Ramasubramanian A, Rosenwasser R, Shields JA. Intra-arterial chemotherapy for retinoblastoma: report no. 2, treatment complications. Arch Ophthalmol. 2011;129:1407–15.CrossRefPubMed
41.
Shields CL, Fulco EM, Arias JD, Alarcon C, Pellegrini M, Rishi P, Kaliki S, Bianciotto CG, Shields JA. Retinoblastoma frontiers with intravenous, intra-arterial, periocular, and intravitreal chemotherapy. Eye (Lond). 2013;27:253–64.CrossRef
42.
Kaliki S, Shields CL, Rojanaporn D, Al-Dahmash S, McLaughlin JP, Shields JA, Eagle RC Jr. High-risk retinoblastoma based on international classification of retinoblastoma: analysis of 519 enucleated eyes. Ophthalmology. 2013;120:997–1003.CrossRefPubMed
43.
Suzuki S, Yamane T, Mohri M, Kaneko A. Selective ophthalmic arterial injection therapy for intraocular retinoblastoma: the long-term prognosis. Ophthalmology. 2011;118:2081–7.CrossRefPubMed
44.
Ramot Y, Amir G, Willenz EP, Nyska A. Foreign-body granulomas within intramyocardial arteries in a transcoronary safety assessment in pigs. Toxicol Pathol. 2008;36:385–7.CrossRefPubMed
45.
Travis LB, Holowaty EJ, Bergfeldt K, Lynch CF, Kohler BA, Wiklund T, Curtis RE, Hall P, Andersson M, Pukkala E, et al. Risk of leukemia after platinum-based chemotherapy for ovarian cancer. N Engl J Med. 1999;340:351–7.CrossRefPubMed
46.
Smith MA, Rubinstein L, Ungerleider RS. Therapy-related acute myeloid leukemia following treatment with epipodophyllotoxins: estimating the risks. Med Pediatr Oncol. 1994;23:86–98.CrossRefPubMed
47.
Pedersen-Bjergaard J, Rowley JD. The balanced and the unbalanced chromosome aberrations of acute myeloid leukemia may develop in different ways and may contribute differently to malignant transformation. Blood. 1994;83:2780–6.PubMed
Metadata
Title
Comparison between intravenous chemotherapy and intra-arterial chemotherapy for retinoblastoma: a meta-analysis
Authors
Qiuying Chen
Bin Zhang
Yuhao Dong
Xiaokai Mo
Lu Zhang
Wenhui Huang
Hua Jiang
Jiejun Xia
Shuixing Zhang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-4406-6

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