Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Outcome of salvage intra-arterial chemotherapy for recurrent retinoblastoma



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.


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.


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).


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.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: Recurrent tumor control was achieved by salvage IAC.
Fig. 2: Survival analysis of patients in our cohort.


  1. 1.

    Kivelä T. The epidemiological challenge of the most frequent eye cancer: retinoblastoma, an issue of birth and death. Br J Ophthalmol. 2009;93:1129–31.

    Article  Google Scholar 

  2. 2.

    Abramson DH. Retinoblastoma: saving life with vision. Annu Rev Med. 2014;65:171–84.

    CAS  Article  Google Scholar 

  3. 3.

    Gobin YP, Dunkel IJ, Marr BP, Brodie SE, Abramson DH. Intra-arterial chemotherapy for the management of retinoblastoma: four-year experience. Arch Ophthalmol. 2011;129:732–7.

    Article  Google Scholar 

  4. 4.

    Manjandavida FP, Stathopoulos C, Zhang J, Honavar SG, Shields CL. Intra-arterial chemotherapy in retinoblastoma - A paradigm change. Indian J Ophthalmol. 2019;67:740–54.

    Article  Google Scholar 

  5. 5.

    Shields CL, Manjandavida FP, Lally SE, Pieretti G, Arepalli SA, Caywood EH, et al. Intra-arterial chemotherapy for retinoblastoma in 70 eyes: outcomes based on the international classification of retinoblastoma. Ophthalmology. 2014;121:1453–60.

    Article  Google Scholar 

  6. 6.

    Munier FL, Mosimann P, Puccinelli F, Gaillard M-C, Stathopoulos C, Houghton S, et al. First-line intra-arterial versus intravenous chemotherapy in unilateral sporadic group D retinoblastoma: evidence of better visual outcomes, ocular survival and shorter time to success with intra-arterial delivery from retrospective review of 20 years of treatment. Br J Ophthalmol. 2017;101:1086–93.

    Article  Google Scholar 

  7. 7.

    Lorch A, Beyer J. High-dose chemotherapy as salvage treatment in germ-cell cancer: when, in whom and how. World J Urol. 2017;35:1177–84.

    CAS  Article  Google Scholar 

  8. 8.

    Megías-Vericat JE, Martínez-Cuadrón D, Sanz MÁ, Montesinos P. Salvage regimens using conventional chemotherapy agents for relapsed/refractory adult AML patients: a systematic literature review. Ann Hematol. 2018;97:1115–53.

    Article  Google Scholar 

  9. 9.

    Abramson DH, Fabius AWM, Francis JH, Marr BP, Dunkel IJ, Brodie SE, et al. Ophthalmic artery chemosurgery for eyes with advanced retinoblastoma. Ophthalmic Genet. 2017;38:16–21.

    Article  Google Scholar 

  10. 10.

    Francis JH, Levin AM, Zabor EC, Gobin YP, Abramson DH. Ten-year experience with ophthalmic artery chemosurgery: ocular and recurrence-free survival Vavvas DG (ed). Plos One. 2018;13:e0197081.

    Article  Google Scholar 

  11. 11.

    Ravindran K, Dalvin LA, Pulido JS, Brinjikji W. Intra-arterial chemotherapy for retinoblastoma: an updated systematic review and meta-analysis. J. Neurointerventional Surg. 2019;11:1266–72.

  12. 12.

    Chen Q, Zhang B, Dong Y, Mo X, Zhang L, Huang W, et al. Comparison between intravenous chemotherapy and intra-arterial chemotherapy for retinoblastoma: a meta-analysis. BMC Cancer. 2018;18:486.

    CAS  Article  Google Scholar 

  13. 13.

    Francis JH, Abramson DH, Gobin YP, Marr BP, Tendler I, Brodie SE, et al. Efficacy and toxicity of second-course ophthalmic artery chemosurgery for retinoblastoma. Ophthalmology. 2015;122:1016–22.

    Article  Google Scholar 

  14. 14.

    Shields CL, Say EAT, Pointdujour-Lim R, Cao C, Jabbour PM, Shields JA. Rescue intra-arterial chemotherapy following retinoblastoma recurrence after initial intra-arterial chemotherapy. J Fr Ophtalmol. 2015;38:542–9.

    CAS  Article  Google Scholar 

  15. 15.

    Lee JH, Han JW, Hahn SM, Lyu CJ, Kim DJ, Lee SC. Combined intravitreal melphalan and intravenous/intra-arterial chemotherapy for retinoblastoma with vitreous seeds. Graefes Arch Clin Exp Ophthalmol. 2016;254:391–4.

    CAS  Article  Google Scholar 

  16. 16.

    Dalvin LA, Kumari M, Essuman VA, Shohelly Shipa S, Ancona-Lezama D, Lucio-Alvarez JA, et al. Primary intra-arterial chemotherapy for retinoblastoma in the intravitreal chemotherapy era: five years of experience. Ocul Oncol Pathol. 2019;5:139–46.

    Article  Google Scholar 

  17. 17.

    Shields CL, Alset AE, Say EAT, Caywood E, Jabbour P, Shields JA. Retinoblastoma control with primary intra-arterial chemotherapy: outcomes before and during the intravitreal chemotherapy era. J Pediatr Ophthalmol Strabismus. 2016;53:275–84.

    Article  Google Scholar 

Download references


This study was funded by grants from the National Natural Science Foundation of China (81770964 to PZ and 81873679 to JL).

Author information




JL was responsible for designing the review protocol, writing the protocol and article, conducting the search, extracting and analysing data, interpreting results, updating reference lists; CJ was responsible for the operation of intra-arterial chemotherapy, extracting and analysing data; XH was responsible for the operation of intra-arterial chemotherapy and provide clinical data; TL was responsible for the collection and sorting of information; JL was responsible for designing the review protocol and screening potentially eligible studies; PZ contributed to the design of the review protocol and provided feedback on the report; XJ was responsible for the provision of clinical data and designing the review protocol.

Corresponding authors

Correspondence to Peiquan Zhao or Xunda Ji.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, J., Jing, C., Hua, X. et al. Outcome of salvage intra-arterial chemotherapy for recurrent retinoblastoma. Eye (2021).

Download citation


Quick links