Advancements in super-selective catheterization and drug selection for intra-arterial chemotherapy for retinoblastoma: a 15-year evolution

Abstract

BackgroundRetinoblastoma (Rb) is the most common primary ocular malignancy of childhood. Left untreated, it is 100% fatal and carries a substantial risk of impaired vision and removal of one or both eyes. Intra-arterial chemotherapy (IAC) has become a pillar in the treatment paradigm for Rb that allows for better eye salvage and vision preservation without compromising survival. We describe the evolution of our technique over 15 years.MethodsA retrospective chart review was conducted of 571 patients (697 eyes) and 2391 successful IAC sessions over 15 years. This cohort was separated into three 5-year periods (P1, P2, P3) to assess trends in IAC catheterization technique, complications, and drug delivery.ResultsFrom a total of 2402 attempted IAC sessions, there were 2391 successful IAC deliveries, consistent with a 99.5% success rate. The rate of successful super-selective catheterizations over the three periods ranged from 80% in P1 to 84.9% in P2 and 89.2% in P3. Catheterization-related complication rates were 0.7% in P1, 1.1% in P2, and 0.6% in P3. Chemotherapeutics used included combinations of melphalan, topotecan and carboplatin. The rate of patients receiving triple therapy among all groups was 128 (21%) in P1, 487 (41.9%) in P2, and 413 (66.7%) in P3.ConclusionsThe overall rate of successful catheterization and IAC started high and has improved over 15 years, and catheterization-related complications are rare. There has been a significant trend towards triple chemotherapy over time.

No child left behind

“…While several therapies exist to treat intraocular retinoblastomachemotherapy, cryosurgery, laser ablation, external beam radiation, and surgical enucleation chief among them 10 -there has been particular interest in intra-arterial chemotherapy (IAC) as a means to achieve globe salvage. 11 In some patients, IAC is the only viable alternative to the far more drastic option of enucleation. IAC works by delivering a high local concentration of chemotherapy at the tumor site while minimizing systemic effects that could otherwise limit the dose of drug that can be administered.…”

The Evolving Role of Intra-arterial Chemotherapy in Adult and Pediatric Cancers: A Comprehensive Review

“…Consequently, the emergence of methodologies such as IAC ensued. Over the course of time, there has been a notable advancement in the sophistication of techniques employed in the administration of IAC [3]. The advancement of angiography and radiologic imaging techniques has played a crucial role in facilitating the precise positioning of catheters within the desired arteries, thereby ensuring the accurate administration of drugs [4].…”

Intra‐arterial chemotherapy for retinoblastoma: Centralization of care is essential

“…The occurrence of complications during the catheterization procedure, impeding the access to the ophthalmic artery in a number of patients, was the major cause of feasibility failure according to their criteria 9 . Technical issues like an insertion of the catheter beyond the ostium of the ophthalmic artery causing a greater incidence of spasm episodes may explain this event 10 . This is seldom seen as experience is gained in this procedure and experienced groups report a greater than 98% success rate in the ophthalmic artery catheterization 10 .…”

“…Technical issues like an insertion of the catheter beyond the ostium of the ophthalmic artery causing a greater incidence of spasm episodes may explain this event 10 . This is seldom seen as experience is gained in this procedure and experienced groups report a greater than 98% success rate in the ophthalmic artery catheterization 10 . The management of anatomical differences in the origin of the ophthalmic artery also requires vast experience to use axial or bi‐axial approaches to enhance the stability of the distal catheter with the help of road mapping.…”