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.