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Correspondence on 'Intra-arterial chemotherapy for retinoblastoma: an updated systematic review and meta-analysis' by Ravindran et al
  1. Veronique Promelle1,
  2. Prakash Muthusami2,
  3. Stephanie N Kletke1,3,
  4. Furqan Shaikh4,
  5. Brenda L Gallie1,3,
  6. Ashwin Mallipatna1,3
  1. 1 Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3 Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  4. 4 Department of Hematology Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Dr Ashwin Mallipatna, Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; ashwin.mallipatna{at}

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Dear Editor,

We read with interest the article by Ravindran et al.1 We commend the authors for undertaking and presenting a systematic literature review on the efficacy and safety of intra-arterial chemotherapy (IAC) with a focus on advanced disease. In this letter, we point out some important facts to consider while interpreting the data.

In the past 10 years, IAC has shown encouraging results in the management of retinoblastoma, delivering chemotherapy to the ophthalmic artery and thus avoiding the complications of intravenous chemotherapy. Since the first reports of the use of IAC in 20082 and 20103 by Abramson et al, many retrospective series have reported successful treatment of eyes even with advanced retinoblastoma, defined by the authors of this review as groups D and E eyes according to either the International Classification for Retinoblastoma (ICRB)4 or the International Intraocular Retinoblastoma Classification (IIRC).5 However, the potential for globe salvage and the subsequent rate of metastatic disease remains unclear, with little prospective evidence published.

Disparities exist between studies in regard to the characteristics of the treated eyes, including the use of different classification systems for retinoblastoma, and in treatment protocols (number of chemotherapy agents used, dose, number of IAC sessions, and concurrent treatments). In the absence of such standardization, drawing definitive conclusions from assumed comparative analyses is challenging at best and risks inaccuracy. …

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  • Contributors All the authors contributed to the project, drafting, writing and revision of this letter.

  • 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.

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