Effectiveness of alternative routes of intra-arterial chemotherapy administration for retinoblastoma: Potential for response and complications

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Intra-arterial chemotherapy (IAC) is now the first line treatment for selected patients with retinoblastoma (Rb). Typically, IAC is infused following the selective catheterization of the ophthalmic artery (OA) on the affected side. However, in some patients, the OA alone may not provide vascular supply to the tumor, whereas in other instances the efficacy of IAC could be compromised due to the presence of prominent collateral vessels from the external carotid artery (ECA). We report our experience with catheterizing vessels other than the OA for IAC treatment for Rb. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> After institutional review board approval, a retrospective analysis was conducted of electronic medical records and imaging of our Rb population. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> We identified 13 patients who received IAC for Rb treatment. Of these, five patients required alternative methods of chemotherapy delivery other than through the OA, totaling 17 treatments. Two patients needed balloon-assisted occlusion of the ECA, two patients required selective catheterization of the middle meningeal artery, and one patient had no internal carotid artery supply to the choroidal blush, thus the superficial temporal artery provided access for IAC. Total globe salvage rate was 76% and 80% with the alternative route subset. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Alternatives to the OA may be necessary to deliver IAC for selected cases of Rb. These routes can be safe and effective. However, thorough understanding of the orbital blood supply is essential. Whether these alternative IAC methods result in similar outcomes to OA infusions has not been established. </jats:p></jats:sec>

Intra-arterial chemotherapy in retinoblastoma – A paradigm change

“…The patient developed forehead necrosis and complete ptosis that required reconstructive surgery. [36]…”

Retrograde Approach for Intra-arterial Chemotherapy Delivery in Retinoblastoma

“…7 Other alternatives for catheterization of the OA have been described previously: through the middle meningeal artery if an adequate anastomosis is developed between the ICA and ECA and on the other hand, the "Japanese technique" using a balloon just distal to the OA origin to deliver the drugs are available methods. 4,9,10 In cases in which the catheterization of the OA is unsuccessful through the ICA due to a challenging carotid siphon or angulation, assessment of a well-developed PComA can help to navigate and catheterize the OA in a geometric and retrograde fashion successfully. The position of the OA and the configuration of the carotid siphon correlate with higher fluoroscopy times.…”

“…7 Other alternatives for catheterization of the OA have been described previously: through the middle meningeal artery if an adequate anastomosis is developed between the ICA and ECA and on the other hand, the "Japanese technique" using a balloon just distal to the OA origin to deliver the drugs are available methods. 4,9,10 Intra-arterial Chemotherapy Delivery in Retinoblastoma Saal-Zapata et al…”

Embryology of the ophthalmic artery

“…Alternative routes of intra-arterial chemotherapy for retinoblastoma are based on the embryological and, thus, anatomical variations of the ophthalmic artery. Although the embryology of the ophthalmic artery is briefly discussed in this excellent clinical paper, 1 I would like to comment on this.…”