Comparação entre as vias intra-arterial e intravenosa na aplicação de quimioterápicos para retinoblastoma: revisão sistemática de ensaios clínicos e metanálise

Abstract

INTRODUCTION: Until the 1990s, retinoblastoma was treated mainly with enucleation and external radiotherapy, but these methods were associated with several complications, such as vision loss and toxic side effects. Nowadays, the first-line management of retinoblastoma has changed from external radiotherapy and enucleation to intravenous chemotherapy (IVC) or intra-arterial chemotherapy (IAC) and focal consolidation treatment, in order to promote eye globe salvage. QIA has become a first-line therapy for retinoblastoma in several tertiary eye centers, and although it has demonstrated excellent therapeutic effects, it remains controversial whether QIA can replace QIV. OBJECTIVE: To compare the intra-arterial and intravenous routes of chemotherapy in the treatment of retinoblastoma, to identify which one has superiority. METHODS: Systematic literature review of prospective clinical trials, with meta-analysis, designed according to the PICO strategy and based on the PRISMA protocol, using the LILACS, MEDLINE, SciELO, PubMed and Cochrane Library databases and MeSH and DeCS terms related to chemotherapy, the respective intra-arterial and intravenous routes and retinoblastoma, with bias analysis performed by the Rstudio® 4. 02 and RevMan software and statistical analysis developed with proportions based on group heterogeneity, by the generalized linear mixed method (GLMM) with log transformation (PLOGIT) from the Higgins and Thompson test. RESULTS: There was no significant difference between QIA and QIV in the proportion of total ocular salvage (0.78[95%IC: 0.63-0.88] vs. 0.63 [95%IC: 0.50-0.74] p=0.10). The proportion of ocular salvage was significantly higher in QIA compared to QIV in eye groups D (0.58[95%IC: 0.46-0.70; I2=0%] vs. 0.12[95%IC: 0.03-0.36; I2=83%] p<0.01) and E (0.11[95%IC: 0.05-0.21; I2=0%] vs. 0.02[95%IC: 0.01-0.03; I2=0%] p<0.01). There was no significant difference between groups A-C. The proportion of ocular salvage was significantly higher at QIA compared with QIV in the V-eye groups (0.92 [95%IC: 0.78-0.97; I²=0%] vs. 0.40 [95%IC: 0.29-0.52; I²=88%] p<0.01). There was no significant difference between groups I-IV. CONCLUSION: A superiority of QIA is suggested in cases of advanced retinoblastomas. However, there is a need for more prospective clinical trials and with longer follow-up time for the recrudescence of our findings.