Predictors of enucleation after intra-arterial chemotherapy for retinoblastoma.

Abstract

Intra-arterial chemotherapy (IAC) has emerged as a minimally invasive treatment modality for globe salvage in patients with retinoblastoma (Rb). There is limited knowledge of the factors that influence rates of enucleation after IAC. Our study identifies predictors of enucleation among Rb patients receiving IAC. This was a retrospective study of Rb patients who received IAC between January 2010 and December 2024 at a single center in the United States. The primary outcome was enucleation at last follow-up. Of 305 patients, 26.89% (n=82) underwent enucleation and 73.11% (n=223) did not. On multivariate analysis, factors associated with increased risk for enucleation were greatest basal diameter (OR 1.07, 95% CI 1.00 to 1.15, p=0.035), bilateral Rb (OR 2.82, 95% CI 1.36 to 5.81, p=0.005), and advanced-stage disease at presentation (OR 7.45, 95% CI 1.92 to 28.9, p=0.004). The use of combination chemotherapy was associated with lower odds for enucleation compared with single-agent chemotherapy (OR 0.29, 95% CI 0.11 to 0.80, p=0.016), whereas double-agent chemotherapy was not significantly associated with enucleation (OR 0.90, 95% CI 0.46 to 1.75, p=0.75). Larger tumors, bilateral disease, and advanced-stage disease were linked to higher odds of enucleation, whereas combination chemotherapy was associated with lower odds compared with single-agent chemotherapy. Future studies could help validate these results.