Super Selective Intra - Arterial Chemotherapy for Retinoblastoma - A Prospective Comparative Study

Retinoblastoma is the most common primary intraocular tumor with an incidence of 1: 16,000 to 18,000 live birth and represents 11% of cancers that develop in the first year of life. Retinoblastoma may be unilateral (60%) or bilateral (40%). Bilateral cases are heritable and median age of diagnosis is about 1 year. Unilateral cases are mostly non heritable but 15% can be heritable and median age of presentation is about 2 years.

Intra-arterial chemotherapy (IAC) is a relatively new technique for the management of advanced retinoblastoma.The Indications of IAC as Primary therapy/first-line management includes Unilateral retinoblastoma of groups B, C, and D and Bilateral retinoblastoma groups D and E. The Indications of IAC as Secondary therapy/second-line management include after prior treatment failure - Recurrent tumor, subretinal seeds or both - Persistent tumor, subretinal seeds or both.

This technique of intra-arterial chemotherapy (IAC) through ophthalmic artery has the advantage of higher concentration of chemotherapy drugs reaching the tumor, with negligible systemic side effects when compared with systemic intravenous.There are few systemic complications of IAC, including hematoma at groin entry site and transient pancytopenia from bone marrow suppression. Brain complications have been rarely encountered with carotid vascular spasm, stroke, and magnetic resonance imaging displaying focal perfusion defects. Local ocular toxicities of IAC relate mostly to vascular compromise of the ophthalmic artery, retinal artery, or choroidal vessels, cranial nerve palsy, orbit/eyelid oedema, retinal detachment, vitreous hemorrhage and retinal pigment epithelial changes. The retinal pigment epithelial changes could be related to previous retinal detachment or choroidal vascular compromise from chemotherapy toxicity.

Intra-arterial chemotherapy (IAC) for retinoblastoma involves the direct delivery of chemotherapeutic agents into the ophthalmic artery (OA). This approach is aimed at increasing drug delivery along with reduction of systemic side effects IAC has emerged as a promising option for globe salvage, particularly in advanced intraocular retinoblastoma This study will compare the outcomes of primary verses secondary Super Selective Intra-Arterial Chemotherapy in Retinoblastoma