The Safety and Effectiveness of Melphalan-Based Intra-Arterial Chemotherapy for Retinoblastoma: An Updated Single-Arm Systematic Review and Meta-Analysis

Cao, Yang; Zhou, Mi; Tian, Min; Lv, Hong-bin

doi:https://doi.org/10.1155/2022/3156503

Evidence-Based Complementary and Alternative Medicine

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Abstract Introduction Results Discussion Data Availability Ethical Approval Conflicts of Interest Authors’ Contributions Acknowledgments References Copyright Related Articles

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Volume 2022 | Article ID 3156503 | https://doi.org/10.1155/2022/3156503

The Safety and Effectiveness of Melphalan-Based Intra-Arterial Chemotherapy for Retinoblastoma: An Updated Single-Arm Systematic Review and Meta-Analysis

Yang Cao,¹Mi Zhou,²Min Tian,¹and Hong-bin Lv¹

Academic Editor: Qing Li

Received07 Dec 2021

Revised19 Jan 2022

Accepted26 Jan 2022

Published14 Feb 2022

Abstract

Melphalan-based intra-arterial chemotherapy was considered an innovative treatment for retinoblastoma patients because high rates of globe salvage could be obtained. Now it has been widely applied for primary or secondary treatment of retinoblastoma. This meta-analysis summarizes the most up-to-date evidence regarding the safety and effectiveness of melphalan-based intra-arterial chemotherapy in the treatment of retinoblastoma. The authors searched PubMed, EMBASE, and the Web of Science electronic databases for studies investigating the safety and effectiveness of melphalan-based intra-arterial chemotherapy in the treatment of retinoblastoma. Studies reporting outcomes and complications of melphalan-based intra-arterial chemotherapy for the treatment of retinoblastoma patients would be included. A total of 33 observational studies that involved 1900 patients and 2336 eyes were included. The overall globe salvage rate was 79.6% (773/971 eyes, 0.74 [95% CI: 0.66, 0.80]) for patients treated with IAC as primary therapy in 28 studies. The overall globe salvage rate was 66.4% (923/1391 eyes, 0.68 [95% CI: 0.60, 0.76]) for patients treated with IAC as secondary therapy in 25 studies. The most common ocular complications were retinopathy (32%) and palpebral edema (29.7%). The most common systemic complications were nausea/vomiting (20.9%). The overall metastasis rate was 1.1% (21/1793 patients, 0.038 [95% CI: 0.020, 0.038]). Twenty-nine studies that involved 1783 patients reported the mortality and the overall mortality was 1.5% (26/1783 patients, 0.029 [95% CI: 0.020, 0.048]). Our meta-analysis showed that melphalan-based IAC treatment was an option for retinoblastoma patients with acceptable efficacy according to retrospective studies. Further high-quality randomized control trials are necessary to provide more accurate and reliable results.

1. Introduction

Retinoblastoma is the most common ocular malignancy in children, and the incidence is about 11 new cases per million individuals under 5 years old in Europe and the US [1, 2]. 75% of these patients will present with unilateral disease, with a median age peak of 2 to 3 years [1, 3]. Enucleation, systemic chemotherapy, radiotherapy, and local therapies are considered standard treatment methods. However, in the past decade, intra-arterial chemotherapy (IAC) was used for improving tumor control and increasing globe salvage rates as a primary or secondary treatment [4].

IAC, a local administration method, importantly avoided several adverse reactions caused by systemic chemotherapy such as ototoxicity and neurotoxicity [5]. Before the application of IAC, nearly 80% of advanced patients would eventually be forced to choose enucleation [6]. In recent years, melphalan-based intra-arterial chemotherapy has been extensively applied for the treatment of retinoblastoma patients [7]. Other major combination chemotherapy drugs include topotecan, carboplatin, and methotrexate. Though an increasing number of centers worldwide have adopted IAC, the optimal role for IAC is still undetermined.

Some previous systematic reviews have provided an extensive assessment of the evidence for IAC use in retinoblastoma [8, 9]. Since these studies, there have been several further studies published. In addition, the lack of randomized controlled trials makes the pivotal assessment of effectiveness and adverse reaction rates difficult. The authors conducted this systematic review and meta-analysis and provided an updated review of the IAC technique for the treatment of retinoblastoma patients.

2. Method

2.1. Inclusion Criteria

Studies that investigated the safety and effectiveness of melphalan-based intra-arterial chemotherapy for retinoblastoma and reported any of the following: globe salvage, ocular complications, systemic complications, metastasis, and death would be included.

2.2. Retrieval Strategy

This meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. This study was not a human or animal experiment; thus, ethical approval was not necessary. PubMed, EMBASE, and the Web of Science electronic databases were searched with the terms “intra-arterial chemotherapy,” “intra-arterial therapy,” “melphalan,” and “retinoblastoma.” In addition, reference lists of the included studies were manually checked for potentially eligible studies, and Google Scholar search engines were used to find additional references. The last search was performed on October 8, 2021, without any restriction to the language of publication.

2.3. Literature Screening and Data Extraction

Two authors independently completed the literature screening and data extraction. The extracted general data included author, year, chemotherapy agents, follow-up, country of publication, and sample size. The main outcomes contained globe salvage, ocular complications, systemic complications, metastasis, and death. A third reviewer would be invited if there were any disputes.

2.4. Evaluation of Literature Quality

The methodological qualities of the non-RCTs were assessed independently by two authors using the Methodological Index for Non-Randomized Studies (MINORS) [10].

2.5. Statistical Analysis

Outcomes were estimated by calculating the pooled odds ratio (OR) (95% confidence intervals (CIs)) by RevMan software (version 5.1; Cochrane Collaboration, Copenhagen, Denmark). Heterogeneity was assessed by the I² test. I² < 50% suggests low heterogeneity. The analysis result of the single rate meta-analysis method was adopted (P2 and SE2 data), which requires effect size conversion [11]. Conversion of effect indicators: Pt = OR/(1+OR), 95% CI lower limit conversion: LL = LLOR/(1 + LLOR), and 95% CI upper limit conversion: UL = ULOR/(1 + ULOR).

3. Results

3.1. Search Results and Characteristics of Included Studies

A total of 581 potential articles were initially identified through database searches on 8 October 2021. A total of 537 studies were considered potentially eligible for further assessment after duplicates were removed. Finally, 33 observational studies [5, 11–42] that involved a total of 1900 patients and 2336 eyes published between 2011 and 2021 met the inclusion criteria and were included in this meta-analysis after a full-text review. All these studies reported indications for IAC as primary or secondary. Figure 1 shows the literature selection process. Table 1 summarizes the details of the included studies.

3.2. Literature Quality

All studies were assessed using the MINORS score (Table 2). All included studies scored 13–14. Due to the lack of a control group, the risk of bias was found in all the studies, and this was moderate throughout.

4. Outcomes

4.1. Globe Salvage

Thirty-three studies that involved 1900 patients and 2336 eyes reported globe salvage rates of 30% to 100%. The overall globe salvage rate was 79.6% (773/971 eyes) for patients treated with IAC as primary therapy in 28 studies. After pooling single-arm studies, the overall effect size of the proportion of globe salvage was 0.74 (95% CI: 0.66, 0.80) (Figure 2). The overall globe salvage rate was 66.4% (923/1391 eyes) for patients treated with IAC as secondary therapy in 25 studies. After pooling single-arm studies, the overall effect size of the proportion of globe salvage was 0.68 (95% CI: 0.60, 0.76) (Figure 3).

4.2. Ocular Complications

Ocular complications are described in Table 3. The most common ocular complications were retinopathy, with 8 events of 25 eyes and 25 patients (32%); palpebral edema, with 22 events of 74 eyes and 68 patients (29.7%); choroidal occlusion, with 5 events of 25 eyes and 21 patients (20%); and retinal detachment, with 28 events of 158 eyes and 148 patients (17.7%).

4.3. Systemic Complications

Systemic complications are described in Table 3. The most common systemic complications were nausea/vomiting, with 115 events of 549 patients (20.9%); cardiorespiratory disturbances, with 4 events of 25 patients (16%); and neutropenia, with 7 events of 64 patients (10.9%).

4.4. Metastasis

Thirty studies that involved 1793 patients reported the metastasis rate. Most patients in these studies did not have metastasis. The overall metastasis rate was 1.1% (21/1793 patients). After pooling single-arm studies, the overall effect size of the proportion of metastasis was 0.038 (95% CI: 0.020, 0.038) (Figure 4). Details are shown in Table 4.

4.5. Death

Twenty-nine studies that involved 1783 patients reported the mortality, and the overall mortality was 1.5% (26/1783 patients). After pooling single-arm studies, the overall effect size of the proportion of metastasis was 0.029 (95% CI: 0.020, 0.048) (Figure 5). Details are shown in Table 4.

5. Discussion

Systemic chemotherapy remained the standard care for most advanced cancer patients, such as nonsmall cell lung cancer [43] and gastric cancer [44]. Systemic administration means that the drug will be acted on throughout the body, and it is more likely to have drug-related adverse effects.

A combination of intravenous chemotherapy with vincristine, etoposide, and carboplatin was the classical chemotherapy for retinoblastoma in the past [1]. Yamane et al. [45] first reported the selective ophthalmic arterial infusion of chemotherapy in 2004. Subsequently, despite the apparent technical challenge of effectively catheterizing a small vessel, this technique has become widely utilized. As a local administration method, intra-arterial chemotherapy has been performed in 26 countries worldwide in the last seven years [46]. Intra-arterial chemotherapy for retinoblastoma has been adopted as a first-line treatment option by numerous tertiary centers, and Ravindran et al. [9] performed a meta-analysis with 20 studies with a 35.6% globe salvage rate. However, various drugs were adopted in different studies. Besides, there have been several novel studies published afterward. Thus, it is necessary to update the results.

We conducted this meta-analysis with 33 studies involving a total of 1900 patients and 2336 eyes to evaluate melphalan-based intra-arterial chemotherapy for the management of retinoblastoma patients. IAC was used in all studies, and the chemotherapy drugs should include melphalan. The overall globe salvage rate was 79.6% for patients treated with IAC as primary therapy and 66.4% for patients treated with IAC as secondary therapy. These results were similar to a newly published systemic review performed by Runnels et al. [8], which included 24 studies. The globe salvage rate was lower than that reported by Ravindran et al. [9], which included 20 studies. However, IAC used by primary or secondary was not considered in that study. Periocular edema (10.5%) was the most common ocular complication reported in the systemic review performed by Runnels. However, the most common ocular complication in our study is retinopathy (32%), followed by palpebral edema (29.7%). Besides, we reported a lower rate of metastasis (1.1%) and death (1.5%).

5.1. Limitations of This Study

First, due to the lack of randomized controlled trials, we cannot perform this meta-analysis based on high-level studies. Second, several other chemotherapeutic regimens were included besides melphalan, though we have tried to limit the study to at least melphalan. This may still lead to a certain degree of heterogeneity. Third, little information was known about progression-free survival and disease control rates after IAC treatment, as these are important indicators of treatment effectiveness.

5.2. Conclusions

Our meta-analysis showed that melphalan-based IAC treatment was an option for retinoblastoma patients with acceptable efficacy according to retrospective studies. Further high-quality randomized control trials are necessary to provide more accurate and reliable results.

Data Availability

All data generated or analyzed during this study are included within the article.

Ethical Approval

It was not required as this research was a meta-analysis.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors’ Contributions

Yang Cao contributed to designing the study and writing this article. Mi Zhou and Min Tian were responsible for collecting the data and performing the statistical analysis. Hong-bin LV contributed to reviewing this article.

Acknowledgments

The authors thank all the participants of the studies included in the present study.

References

M. V. Ortiz and I. J. Dunkel, “Retinoblastoma,” Journal of Child Neurology, vol. 31, no. 2, pp. 227–236, 2016.
View at: Publisher Site | Google Scholar
E. Broaddus, A. Topham, and A. D. Singh, “Incidence of retinoblastoma in the USA: 1975–2004,” British Journal of Ophthalmology, vol. 93, no. 1, pp. 21–23, 2009.
View at: Publisher Site | Google Scholar
A. G. Knudson, “Mutation and cancer: statistical study of retinoblastoma,” Proceedings of the National Academy of Sciences, vol. 68, no. 4, pp. 820–823, 1971.
View at: Publisher Site | Google Scholar
D. H. Abramson, A. W. M. Fabius, J. H. Francis et al., “Ophthalmic artery chemosurgery for eyes with advanced retinoblastoma,” Ophthalmic Genetics, vol. 38, no. 1, pp. 16–21, 2017.
View at: Publisher Site | Google Scholar
M. Chen, J. Zhao, J. Xia et al., “Intra-arterial chemotherapy as primary therapy for retinoblastoma in infants less than 3 Months of age: a series of 10 case-studies,” PLoS One, vol. 11, no. 8, p. e0160873, 2016.
View at: Publisher Site | Google Scholar
L. A. Dalvin, M. Kumari, V. A. Essuman et al., “Primary intra-arterial chemotherapy for retinoblastoma in the intravitreal chemotherapy era: five years of experience,” Ocular oncology and pathology, vol. 5, no. 2, pp. 139–146, 2019.
View at: Publisher Site | Google Scholar
N. Grigorovski, E. Lucena, C. Mattosinho et al., “Use of intra-arterial chemotherapy for retinoblastoma: results of a survey,” International Journal of Ophthalmology, vol. 7, no. 4, pp. 726–730, 2014.
View at: Publisher Site | Google Scholar
J. Runnels, G. Acosta, A. Rose et al., “The role for intra-arterial chemotherapy for refractory retinoblastoma: a systematic review,” Clinical and Translational Oncology, vol. 23, no. 10, pp. 2066–2077, 2021.
View at: Publisher Site | Google Scholar
K. Ravindran, L. A. Dalvin, J. S. Pulido, and W. Brinjikji, “Intra-arterial chemotherapy for retinoblastoma: an updated systematic review and meta-analysis,” Journal of Neurointerventional Surgery, vol. 11, no. 12, pp. 1266–1272, 2019.
View at: Publisher Site | Google Scholar
Y.-X. Xu, Y.-Z. Ren, Z.-P. Zhao, Y.-Z. Wang, T. Wang, and T. Li, “Hip survival rate in the patients with avascular necrosis of femoral head after transtrochanteric rotational osteotomy: a systematic review and meta-analysis,” Chinese Medical Journal, vol. 132, no. 24, pp. 2960–2971, 2019.
View at: Publisher Site | Google Scholar
D. H. Abramson, B. P. Marr, J. H. Francis et al., “Simultaneous bilateral ophthalmic artery chemosurgery for bilateral retinoblastoma (tandem therapy),” PLoS One, vol. 11, no. 6, p. e0156806, 2016.
View at: Publisher Site | Google Scholar
C. Akyüz, H. Kıratlı, H. Şen, B. Aydın, B. Tarlan, and A. Varan, “Intra-arterial chemotherapy for retinoblastoma: a single-center experience,” Ophthalmologica. Journal International d’ophtalmologie. International Journal of Ophthalmology. Zeitschrift fur Augenheilkunde, vol. 234, no. 4, pp. 227–232, 2015.
View at: Publisher Site | Google Scholar
M. Chen, H. Jiang, J. Zhang et al., “Outcome of intra-arterial chemotherapy for retinoblastoma and its influencing factors: a retrospective study,” Acta Ophthalmologica, vol. 95, no. 6, pp. 613–618, 2017.
View at: Publisher Site | Google Scholar
J. H. Francis, A. M. Levin, E. C. Zabor, Y. P. Gobin, and D. H. Abramson, “Ten-year experience with ophthalmic artery chemosurgery: ocular and recurrence-free survival,” PLoS One, vol. 13, no. 5, p. e0197081, 2018.
View at: Publisher Site | Google Scholar
S. Funes, C. Sampor, F. Villasante et al., “Feasibility and results of an intraarterial chemotherapy program for the conservative treatment of retinoblastoma in Argentina,” Pediatric Blood and Cancer, vol. 65, no. 8, p. e27086, 2018.
View at: Publisher Site | Google Scholar
F. Ghassemi, H. Ghanaati, R. Karkhaneh, L. Boujabadi, S. Z. Tabatabaie, and M. T. Rajabi, “Outcome of retinoblastoma following limited sessions of intra-arterial chemotherapy in Iran,” Iranian Journal of Radiology: A Quarterly Journal Published by the Iranian Radiological Society, vol. 11, no. 3, p. e16958, 2014.
View at: Publisher Site | Google Scholar
Y. P. Gobin, I. J. Dunkel, B. P. Marr, S. E. Brodie, and D. H. Abramson, “Intra-arterial chemotherapy for the management of retinoblastoma,” Archives of Ophthalmology, vol. 129, no. 6, pp. 732–737, 2011.
View at: Publisher Site | Google Scholar
J. Hua, S. Gang, J. Yizhou, and Z. Jing, “Intra-arterial chemotherapy as second-line treatment for advanced retinoblastoma: a 2-year single-center study in China,” Journal of Cancer Research and Therapeutics, vol. 14, no. 1, pp. 106–110, 2018.
View at: Publisher Site | Google Scholar
H. Kiratli, İ. Koç, O. Inam, A. Varan, and C. Akyüz, “Retrospective analysis of primarily treated group D retinoblastoma,” Graefes Archive for Clinical and Experimental Ophthalmology, vol. 256, no. 11, pp. 2225–2231, 2018.
View at: Publisher Site | Google Scholar
C. A. Leal-Leal, L. Asencio-López, J. Higuera-Calleja et al., “Globe salvage with intra-arterial topotecan-melphalan chemotherapy in children with a single eye,” Revista de Investigación Clínica, vol. 68, no. 3, pp. 137–142, 2016.
View at: Google Scholar
J. Li, C. Jing, X. Hua et al., “Outcome of salvage intra-arterial chemotherapy for recurrent retinoblastoma,” Eye (London, England), 2021.
View at: Publisher Site | Google Scholar
C. C. Liu, A. Mohmood, N. Hamzah, J. H. Lau, N. Khaliddin, and J. Rahmat, “Intra-arterial chemotherapy for retinoblastoma: our first three-and-a-half years’ experience in Malaysia,” PLoS One, vol. 15, no. 5, p. e0232249, 2020.
View at: Publisher Site | Google Scholar
B. P. Marr, S. E. Brodie, I. J. Dunkel, Y. P. Gobin, and D. H. Abramson, “Three-drug intra-arterial chemotherapy using simultaneous carboplatin, topotecan and melphalan for intraocular retinoblastoma: preliminary results,” British Journal of Ophthalmology, vol. 96, no. 10, pp. 1300–1303, 2012.
View at: Publisher Site | Google Scholar
S. T. Michaels, T. A. Abruzzo, J. J. Augsburger, Z. M. Corrêa, A. Lane, and J. I. Geller, “Selective ophthalmic artery infusion chemotherapy for advanced intraocular retinoblastoma,” Journal of Pediatric Hematology, vol. 38, no. 1, pp. 65–69, 2016.
View at: Publisher Site | Google Scholar
W. J. Muen, J. E. Kingston, F. Robertson, S. Brew, M. S. Sagoo, and M. A. Reddy, “Efficacy and complications of super-selective intra-ophthalmic artery melphalan for the treatment of refractory retinoblastoma,” Ophthalmology, vol. 119, no. 3, pp. 611–616, 2012.
View at: Publisher Site | Google Scholar
F. L. Munier, P. Mosimann, F. Puccinelli 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,” British Journal of Ophthalmology, vol. 101, no. 8, pp. 1086–1093, 2017.
View at: Publisher Site | Google Scholar
F. L. Munier, M. Beck-Popovic, A. Balmer, M.-C. Gaillard, E. Bovey, and S. Binaghi, “Occurrence of sectoral choroidal occlusive vasculopathy and retinal arteriolar embolization after superselective ophthalmic artery chemotherapy for advanced intraocular retinoblastoma,” Retina, vol. 31, no. 3, pp. 566–573, 2011.
View at: Publisher Site | Google Scholar
S. J. Ong, A.-N. Chao, H.-F. Wong, K.-L. Liou, and L.-Y. Kao, “Selective ophthalmic arterial injection of melphalan for intraocular retinoblastoma: a 4-year review,” Japanese Journal of Ophthalmology, vol. 59, no. 2, pp. 109–117, 2015.
View at: Publisher Site | Google Scholar
J. I. Oporto, P. Zúñiga, D. Ossandón et al., “Intra-arterial chemotherapy for retinoblastoma treatment in Chile: experience and results 2013–2020,” Archivos de la Sociedad Espanola de Oftalmologia, vol. 96, no. 6, pp. 288–292, 2021.
View at: Publisher Site | Google Scholar
A. Parareda, J. Català, A. M. Carcaboso et al., “Intra-arterial chemotherapy for retinoblastoma. Challenges of a prospective study,” Acta Ophthalmologica, vol. 92, no. 3, pp. 209–215, 2014.
View at: Publisher Site | Google Scholar
E. C. Peterson, M. S. Elhammady, S. Quintero-Wolfe, T. G. Murray, and M. A. Aziz-Sultan, “Selective ophthalmic artery infusion of chemotherapy for advanced intraocular retinoblastoma: initial experience with 17 tumors,” Journal of Neurosurgery, vol. 114, no. 6, pp. 1603–1608, 2011.
View at: Publisher Site | Google Scholar
M. A. Reddy, Z. Naeem, C. Duncan et al., “Reduction of severe visual loss and complications following intra-arterial chemotherapy (IAC) for refractory retinoblastoma,” British Journal of Ophthalmology, vol. 101, no. 12, pp. 1704–1708, 2017.
View at: Publisher Site | Google Scholar
P. Rishi, T. Sharma, M. Sharma et al., “Intra-arterial chemotherapy for retinoblastoma: two-year results from tertiary eye-care center in India,” Indian Journal of Ophthalmology, vol. 65, no. 4, pp. 311–315, 2017.
View at: Publisher Site | Google Scholar
P. Rishi, A. Agarwal, P. Chatterjee et al., “Intra-arterial chemotherapy for retinoblastoma: four-year results from tertiary center in India,” Ocular Oncology and Pathology, vol. 6, no. 1, pp. 66–73, 2020.
View at: Publisher Site | Google Scholar
D. Rojanaporn, E. Chanthanaphak, R. Boonyaopas, T. Sujirakul, S. Hongeng, and S. S. N. Ayudhaya, “Intra-arterial chemotherapy for retinoblastoma: 8-year experience from a tertiary referral institute in Thailand,” Asia-Pacific journal of ophthalmology (Philadelphia, Pa.), vol. 8, no. 3, pp. 211–217, 2019.
View at: Publisher Site | Google Scholar
C. L. Shields, F. P. Manjandavida, S. E. Lally et al., “Intra-arterial chemotherapy for retinoblastoma in 70 eyes,” Ophthalmology, vol. 121, no. 7, pp. 1453–1460, 2014.
View at: Publisher Site | Google Scholar
C. L. Shields, P. W. Dockery, A. Yaghy et al., “Intra-arterial chemotherapy for retinoblastoma in 341 consecutive eyes (1,292 infusions): comparative analysis of outcomes based on patient age, race, and sex,” Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus, vol. 25, no. 3, 2021.
View at: Publisher Site | Google Scholar
S. Suzuki, T. Yamane, M. Mohri, and A. Kaneko, “Selective ophthalmic arterial injection therapy for intraocular retinoblastoma: the long-term prognosis,” Ophthalmology, vol. 118, no. 10, pp. 2081–2087, 2011.
View at: Publisher Site | Google Scholar
P. Taich, A. Ceciliano, E. Buitrago et al., “Clinical pharmacokinetics of intra-arterial melphalan and topotecan combination in patients with retinoblastoma,” Ophthalmology, vol. 121, no. 4, pp. 889–897, 2014.
View at: Publisher Site | Google Scholar
S. Thampi, S. W. Matthay, D. L. Hetts et al., “Superselective intra-arterial melphalan therapy for newly diagnosed and refractory retinoblastoma: results from a single institution,” Clinical Ophthalmology, vol. 7, pp. 981–989, 2013.
View at: Publisher Site | Google Scholar
S. Tuncer, S. Sencer, R. Kebudi, B. Tanyıldız, Z. Cebeci, and K. Aydın, “Superselective intra-arterial chemotherapy in the primary management of advanced intra-ocular retinoblastoma: first 4-year experience from a single institution in Turkey,” Acta Ophthalmologica, vol. 94, no. 7, pp. e644–e651, 2016.
View at: Publisher Site | Google Scholar
C. Venturi, S. Bracco, A. Cerase et al., “Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments,” Acta Ophthalmologica, vol. 91, no. 4, pp. 335–342, 2013.
View at: Publisher Site | Google Scholar
D. S. Ettinger, D. E. Wood, D. L. Aisner et al., “Non-small cell lung cancer, version 5.2017, NCCN clinical practice guidelines in oncology,” Journal of the National Comprehensive Cancer Network: Journal of the National Comprehensive Cancer Network, vol. 15, no. 4, pp. 504–535, 2017.
View at: Publisher Site | Google Scholar
T. H. Lee and D. Le, “A rare case of severe lactic acidosis from 5-fluorouracil after mFOLFOX6 treatment in a patient with advanced gastric cancer,” Case Reports in Oncology, vol. 14, no. 1, pp. 545–549, 2021.
View at: Publisher Site | Google Scholar
T. Yamane, A. Kaneko, and M. Mohri, “The technique of ophthalmic arterial infusion therapy for patients with intraocular retinoblastoma,” International Journal of Clinical Oncology, vol. 9, no. 2, pp. 69–73, 2004.
View at: Publisher Site | Google Scholar
D. H. Abramson, “Chemosurgery for retinoblastoma,” Archives of Ophthalmology, vol. 129, no. 11, pp. 1492–1494, 2011.
View at: Publisher Site | Google Scholar

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