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Original research
Intra-arterial chemotherapy for retinoblastoma: an updated systematic review and meta-analysis
  1. Krishnan Ravindran1,
  2. Lauren A Dalvin2,
  3. Jose S Pulido2,
  4. Waleed Brinjikji3
  1. 1 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Radiology and Neurosurgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  1. Correspondence to Dr Krishnan Ravindran, Department of Radiology, Mayo Clinic, Rochester, MN, USA; krish931{at}


Background and purpose Intra-arterial chemotherapy for retinoblastoma has been adopted as a first-line treatment option by numerous tertiary centers. The effect of intra-arterial chemotherapy on future rates of metastatic disease as well as on globe salvage in advanced eyes remains relatively unknown.

Methods A search of PubMED, MEDLINE, EMBASE, and Web of Science electronic databases was conducted from inception until January 2019 for studies with a minimum of 10 patients reporting outcomes and complications following intra-arterial chemotherapy for retinoblastoma.

Results A total of 20 studies met the inclusion criteria for analysis, comprising 873 patients and 1467 eyes. Only one study was comparative; there was substantial heterogeneity in reported outcomes and several overlapping patient cohorts that were published. Across all studies, 174 of 1467 eyes were enucleated (11.8%). Metastatic disease occurred in 8 of 513 patients (1.6%). Globe salvage was achieved in 318 of 906 (35.6%) cases of advanced retinoblastoma. The most common ocular complication was retinal detachment, occurring in 23% of eyes, and the most common systemic complications were transient fever and nausea/vomiting.

Conclusions There is a paucity of higher-level evidence with adequate follow-up surrounding the long-term safety of intra-arterial chemotherapy and effect on metastasis in retinoblastoma. Studies to date have been limited by short-term follow-up. Longitudinal prospective studies could provide greater insight into the ability of intra-arterial chemotherapy to reduce the risk of retinoblastoma metastasis.

  • intervention
  • guidewire
  • orbit

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  • Contributors KR and WB designed study, performed the literature search, selected studies for inclusion in the meta-analysis, abstracted data, performed statistical analysis, and drafted and revised the manuscript. LAD and JSP revised and drafted the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.