Results
Of the enrolled patients, four were male, and one was female. One
patient had hepatic metastases at the time of first RB diagnosis, and
four were diagnosed with hepatic metastases at the time of relapse or
disease progression. The interval between the first symptom and hepatic
metastasis ranged from 1–41 months. Three patients had unilateral
tumors (two left and one right), while two had bilateral tumors. Using
the International Integrated Reporting Council staging, of the seven
enrolled eyes, six were classified as stage E, and one was classified as
stage C. Detailed clinical characteristics are shown in Table 1.
The hepatic lesions were mainly observed on abdominal CT. Three patients
had multiple lesions, while two had single lesions. All lesions were
low-density foci. One had significant calcification, and four had no
calcification. Mild enhancement was seen in two patients, and no
enhancement seen in the other three. After chemotherapy, tumor
regression was observed in four patients, while no response was seen in
one patient. Representative CT results are shown in Fig. 1 and Fig. 2.
All the administered treatments are shown in Table 2. Though scheduled,
no patient underwent radiotherapy and APBSCT. Two patients died, and in
one case, the tumor progressed before radiotherapy and stem cell
collection. The other two patients are still receiving chemotherapy;
radiotherapy and APBSCT will be performed after they have achieved
complete remission. Three patients who underwent enucleation had
high-risk pathological factors for extensive choroidal invasion.
Detailed pathological examination results are shown in Table 3.
Complications of chemo-radiotherapy were evaluated; headache, vomiting,
fever, and myelosuppression were common and disappeared after treatment.
Neither hemorrhagic cystitis nor peripheral nervous system damage was
found.
Results of the laboratory investigations are shown in Table 4. Serum NSE
and LDH levels increased significantly in all the patients. After
treatment, NSE levels decreased in four patients and were unchanged in
one. Liver metabolism indexes and AFP levels were within the normal
range. All patients were followed until October 31, 2020 or until death.
Two patients died, while three survived. The overall survival durations
of the two deceased patients after the diagnosis of hepatic metastasis
were 1 month and 3 months; one of them experienced remission after
chemotherapy, but died from severe infection in the myelosuppression
stage, while the other died of multiple organ failure due to tumor
progression. The three surviving patients underwent follow-up at 6, 18,
and 3 months, respectively. After the diagnosis of hepatic metastasis;
two had partial remission, and one experienced tumor progression. All
the surviving patients are still under therapy.