Retinoblastoma cT3b/c: intra-arterial chemotherapy saved more eyes than intravenous, without a survival cost

Design

Retrospective multicentre cohort, 11 centres

Population

1566 treatment-naive unilateral retinoblastoma eyes (870 cT2, 696 cT3)

Primary outcome

Globe salvage, overall and metastasis-free survival

Effect

IAC vs IVC globe salvage: cT3b HR 3.65 (1.91 to 6.98); cT3c HR 4.02 (2.79 to 5.80); no difference in cT3d

Eleven Chinese tertiary centres reviewed 1566 treatment-naive unilateral retinoblastoma eyes, 870 cT2 and 696 cT3, treated with intra-arterial chemotherapy, intravenous chemotherapy or primary enucleation.

Intra-arterial chemotherapy salvaged more eyes than intravenous in cT3b (HR 3.65, 1.91 to 6.98) and cT3c (HR 4.02, 2.79 to 5.80), but not in cT3d. Overall and metastasis-free survival did not differ between intra-arterial chemotherapy and primary enucleation. Of salvaged cT3b/c eyes, 79% kept at least light perception after intra-arterial and 65% after intravenous treatment.

This supports globe salvage with intra-arterial chemotherapy for cT3b/c eyes where the service exists, and prompt enucleation for cT3d. Treatment was not randomised, and choice of approach varied by centre.

• Stage retinoblastoma using the AJCC 8th edition cT subcategories.
• Discuss intra-arterial chemotherapy for cT3b and cT3c eyes where available.
• Recommend prompt enucleation for cT3d.
• Refer early to a centre offering intra-arterial chemotherapy — in India, access is concentrated in a few centres.

Why it matters

It defines the subgroup of advanced eyes where salvage is realistic and where it is not.

Don't overread it

A retrospective cohort; survival equivalence with enucleation is observed, not proven.

The statistics, in plain English

Hazard ratios of 3.7 and 4.0 for globe salvage are large, but children were not randomised; centres offering intra-arterial therapy may differ in other ways.

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