What to Do When Intra-Arterial Chemotherapy Fails in Non-Germline Unilateral Retinoblastoma (ICRB Group B Macular, C, D, or E)
Clinical Scenario
Non-germline unilateral retinoblastoma classified as ICRB Group B with macular involvement, or Group C, D, or E — without high-risk features such as extraocular extension or choroidal/optic nerve invasion. Intra-arterial chemotherapy (IAC) is preferred as primary therapy for this population; when it does not produce adequate tumor control, a structured escalation pathway applies.
Previous treatment — inadequate response
Failure Condition That Triggers This Protocol
First-line intra-arterial chemotherapy (IAC) — delivered supraselectively into the ophthalmic artery over multiple cycles, with focal consolidation as needed — did not achieve its goals of tumor regression with retinal reattachment and calcified scar formation. This failure of the prior line is the trigger for escalation to the current protocol.
Approach After IAC Failure (Partial Overview)
Management escalates to globe salvage strategies selected according to the type and distribution of residual or recurrent disease. The approach differs depending on whether the remaining activity involves solid tumor, vitreous seeds, subretinal seeds, or intracameral involvement — with targeted interventions available for each presentation. The full decision pathway, including which modality applies to each seed type, is available via the link below.
Goal: control and resolution of vitreous and subretinal seeds with tumor regression
References
DOI: 10.4103/ijo.IJO_721_20
- IAC is employed as primary therapy for non‑germline, unilateral, group B, C, D, or E retinoblastoma or as a secondary therapy for unilateral or bilateral advanced recalcitrant disease facing enucleation.
- Hence, the authors prefer IAC over IVC for unilateral retinoblastoma.
- Current indications for IvitC include the presence of refractory or recurrent vitreous seeds following other treatments.
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