Purpose

To examine the outcome of salvage intra-arterial chemotherapy (IAC) for patients with recurrent retinoblastoma after the initial course of IAC and determine the factors influencing clinical outcome.

Methods

A total of 73 eyes of 71 patients with recurrent retinoblastoma undergoing salvage IAC after initial successfully IAC between May 2014 and May 2019 were retrospectively reviewed for clinical outcomes. Ocular survival and progression-free survival were used to examine the efficacy of salvage IAC. The factors influencing clinical outcomes were determined using univariate and multivariate analyses.

Results

The salvage IAC was delivered at mean 9.4 months (median 7, range 2.1–38.3 months) following the last cycle of initial IAC. 86.5% (64/73) eyes relapsed 16 months after the initial IAC. After the salvage IAC, 57 eyes (78.1%) were salvaged, and no further-line therapies were required for 36 eyes (49.3%). The 2-year Kaplan–Meier ocular survival and progression-free survival estimates after salvage IAC were 66.4% (95% CI, 31.5–42.1%) and 38.2% (95% CI, 17.8–28.8%), respectively. Univariate and multivariate analyses showed that the ocular survival and progression-free survival after salvage IAC were significantly associated with the history of vitreous seeds (p = 0.02 and p = 0.03, respectively).

Conclusion

Salvage IAC is effective for the management of recurrent retinoblastoma after the initial successful IAC. Eyes with a history of vitreous seeds in the course of the disease are more likely to relapse and with worse ocular survival. A close follow-up strategy is imperative to treat the recurrent tumour after salvage IAC.

中文翻译：

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复发性视网膜母细胞瘤的挽救性动脉内化疗的结果

目的

研究 IAC 初始疗程后复发性视网膜母细胞瘤患者的挽救性动脉内化疗 (IAC) 的结果，并确定影响临床结果的因素。

方法

回顾性回顾了 2014 年 5 月至 2019 年 5 月期间初次成功 IAC 后接受挽救性 IAC 的 71 名复发性视网膜母细胞瘤患者的 73 只眼的临床结果。眼部生存期和无进展生存期用于检查挽救 IAC 的疗效。使用单变量和多变量分析确定影响临床结果的因素。

结果

在初始 IAC 的最后一个周期后，抢救 IAC 在平均 9.4 个月（中位数 7，范围 2.1-38.3 个月）交付。86.5% (64/73) 的眼睛在初次 IAC 后 16 个月复发。抢救 IAC 后，57 只眼 (78.1%) 获救，36 只眼 (49.3%) 无需进一步线治疗。挽救 IAC 后的 2 年 Kaplan-Meier 眼部生存率和无进展生存率估计分别为 66.4%（95% CI，31.5-42.1%）和 38.2%（95% CI，17.8-28.8%）。单变量和多变量分析表明，挽救 IAC 后的眼部生存期和无进展生存期与玻璃体种子的病史显着相关（分别为p  = 0.02 和p  = 0.03）。

结论

挽救性 IAC 对初次成功 IAC 后复发性视网膜母细胞瘤的管理是有效的。在疾病过程中具有玻璃体种子病史的眼睛更容易复发并且眼睛存活率更差。在挽救 IAC 后，必须采取密切的随访策略来治疗复发的肿瘤。