Hemodynamic and Anatomic Variations Require an Adaptable Approach during Intra-Arterial Chemotherapy for Intraocular Retinoblastoma: Alternative Routes, Strategies, and Follow-Up

Intra-arterial chemotherapy for retinoblastoma is not always a straightforward procedure, and it may require an adaptable approach. This study illustrates strategies used when the ophthalmic artery is difficult to catheterize or not visible, and it ascertains the effectiveness and safety of these st...

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Published in:	American journal of neuroradiology : AJNR Vol. 37; no. 7; pp. 1289 - 1295
Main Authors:	Bertelli, E, Leonini, S, Galimberti, D, Moretti, S, Tinturini, R, Hadjistilianou, T, De Francesco, S, Romano, D G, Vallone, I M, Cioni, S, Gennari, P, Galluzzi, P, Grazzini, I, Rossi, S, Bracco, S
Format:	Journal Article
Language:	English
Published:	United States American Society of Neuroradiology 01-07-2016
Subjects:	Anatomic Variation Antineoplastic Agents - administration & dosage Carotid Artery, External - anatomy & histology Carotid Artery, External - physiology Extracranial Vascular Female Follow-Up Studies Hemodynamics Humans Infusions, Intra-Arterial - methods Interventional Ophthalmic Artery - anatomy & histology Ophthalmic Artery - physiology Pediatrics Retinal Neoplasms - drug therapy Retinoblastoma - drug therapy Retrospective Studies
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Summary:	Intra-arterial chemotherapy for retinoblastoma is not always a straightforward procedure, and it may require an adaptable approach. This study illustrates strategies used when the ophthalmic artery is difficult to catheterize or not visible, and it ascertains the effectiveness and safety of these strategies. A retrospective study was performed on a series of 108 eyes affected by intraocular retinoblastoma and selected for intra-arterial chemotherapy (follow-up range, 6-82 months). We recognized 3 different patterns of drug delivery: a fixed pattern through the ophthalmic artery, a fixed pattern through branches of the external carotid artery, and a variable pattern through either the ophthalmic or the external carotid artery. We performed 448 sessions of intra-arterial chemotherapy, 83.70% of them through the ophthalmic artery and 16.29% via the external carotid artery. In 24.52% of eyes, the procedure was performed at least once through branches of the external carotid artery. In 73 eyes, the pattern of drug delivery was fixed through the ophthalmic artery; for 9 eyes, it was fixed through branches of the external carotid artery; and for 17 eyes, the pattern was variable. Statistical analysis did not show any significant difference in the clinical outcome of the eyes (remission versus enucleation) treated with different patterns of drug delivery. Adverse events could not be correlated with any particular pattern. Alternative routes of intra-arterial chemotherapy for intraocular retinoblastoma appear in the short term as effective and safe as the traditional drug infusion through the ophthalmic artery.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 E. Bertelli and S. Leonini contributed equally to this study.
ISSN:	0195-6108 1936-959X
DOI:	10.3174/ajnr.A4741