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

Bertelli, Eugenio; Leonini, Sara; Galimberti, Daniela; Moretti, S; Tinturini, Rebecca; Hadjistilianou, Theodora; Francesco, Sonia De; Romano, Daniele Giuseppe; Vallone, Ignazio Maria; Cioni, Samuele; Galluzzi, Paolo; Grazzini, Irene; Rossi, Stefania; Bracco, Sandra

doi:10.3174/ajnr.a4741

Cited by 37 publications

(60 citation statements)

References 23 publications

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“…Apparently, some of them may appear (i.e. become detectable) under particular hemodynamic circumstances [5, 16]. Thus, it is important to ascertain how powerful angiography is to unveil orbital anastomoses.…”

Section: Introductionmentioning

confidence: 99%

“…This parameter, referred to as the visibility index (VI) (see materials and methods), has been recently introduced to ascertain the ability of angiography to visualize and identify intraorbital arteries [9]. Unfortunately, as it will become apparent in the next paragraphs, in spite of the fact that orbital anastomoses are acknowledged of pivotal importance in several clinical scenarios [5, 17, 34], only limited information on their frequency are available, so that the VI can be calculated just in a small number of cases.…”

Section: Introductionmentioning

confidence: 99%

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An update on the variations of the orbital blood supply and hemodynamic

2016

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PurposeSeveral variations of the arterial blood supply of the orbit have been reported over the years. This review is aimed to provide an update focusing on three important issues: (a) variations of the ophthalmic artery origin; (b) contribution of the external carotid artery to the orbital blood supply; (c) orbital hemodynamic.MethodsA PubMed and Google search was carried out with the following keywords: ophthalmic artery origin, ophthalmic artery anastomoses and ophthalmic artery anatomy.ResultsThe site of origin of the ophthalmic artery displays a limited number of variations. However they are important as they are also associated with course variations. Anastomoses between the ophthalmic artery and the external carotid artery are numerous and many of them can acquire clinical relevance. Records on their anatomic frequency are limited. Orbital hemodynamic variations are a poorly studied subject. Recent investigations in children have unveiled unexpected variability and instability in the way the blood flows through the orbit.ConclusionsThe orbit shows several possible arterial variations. Some of them have a profound influence on its hemodynamic at least in children. More studies are required to ascertain if the hemodynamic variability observed in children can be pinpointed also in adults.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An update on the variations of the orbital blood supply and hemodynamic

2016

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“…[12] Since then, several investigators have reported their experience with IAC. [131415161718192021222324252627282930] In a study done by Tuncer et al ., 26 Group D eyes of 24 treatment-naïve Rb patients managed primarily with IAC were included. [19] Each eye received a mean of three IAC sessions/eye (range, 2–5 sessions).…”

Section: Globe-saving Treatmentsmentioning

confidence: 99%

“…illustrates strategies used when the ophthalmic artery is difficult to catheterize or not visible, and it ascertains the effectiveness and safety of these strategies. [28] They recognized three 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. Alternative routes of IAC for intraocular Rb appeared in the short term as effective and safe as the traditional drug infusion through the ophthalmic artery.…”

Section: Globe-saving Treatmentsmentioning

confidence: 99%

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Recent advances and challenges in the management of retinoblastoma

Chawla

Singh

2017

Indian J Ophthalmol

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The treatment of retinoblastoma (Rb) has improved significantly in recent times. Worldwide, there is an increasing trend to use conservative treatment modalities that aim to preserve the globe as well as vision with minimum morbidity. Recently, the use of targeted delivery of chemotherapy to the eye in the form of selective intra-arterial and intravitreal chemotherapy has shown promising results. Radiotherapy is beneficial in selected cases, either in the form of plaque brachytherapy or as external beam radiotherapy. Orbital disease carries a poor prognosis for survival. However, a multimodal treatment protocol has improved survival in children with extraocular disease. Nevertheless, challenges remain, especially for the developing world. This review aims to highlight recent advances in the management of Rb that have contributed towards improving treatment outcomes and also discuss the challenges ahead, with special reference to the Indian scenario.

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Ocular survival after intra‐arterial chemotherapy for retinoblastoma improves with accrual of experience and programmatic evolution

Marasligiller

Williams

Vadivelu

et al. 2022

Pediatric Blood & Cancer

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Background: Intra-arterial chemotherapy (IAC) for the treatment of intraocular retinoblastoma has gained recognition as a method to improve ocular salvage; however, there is a paucity of evidence supporting treatment factors prognosticating ocular survival. Methods: All patients with retinoblastoma treated with IAC at a single institution between December 2008 and December 2019 were evaluated. Patient demographics, tumor classification, prior treatments, procedural data, other non-IAC therapies, adverse reactions, procedural complications, ocular outcomes, and overall survival were assessed via retrospective chart review. Factors suggestive of increased ocular survival were identified via univariate and multivariate analyses. The impact of accrued treatment experience was evaluated by grouping eyes by the respective year, IAC treatment was initiated.Results: Forty-nine eyes of 43 patients were treated for retinoblastoma with IAC (256 total procedures). At least grade 3 neutropenia was observed following 19% of IAC procedures. The risk of neutropenia was not statistically different between single or multidrug IAC. Comparing those who received balloon-assisted intra-arterial chemotherapy (bIAC) in more than two-thirds of cycles to those who did not, the risk of arterial access site complications was not statistically different. Multivariate analysis revealed a significantly lower risk of enucleation associated with treatment era in years (hazard ratio [HR] = 0.52-1.00, p < .05) and laser therapies (HR = 0.02-0.60, p < .05).Conclusions: Ocular survival rates in patients treated with IAC for retinoblastoma at our institution have increased over time. Accrued treatment experience and programmatic changes have likely contributed. Larger, prospective series may lead to a better understanding of factors that consistently contribute to better ocular salvage.

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

Cited by 37 publications

References 23 publications

An update on the variations of the orbital blood supply and hemodynamic

An update on the variations of the orbital blood supply and hemodynamic

Recent advances and challenges in the management of retinoblastoma

Ocular survival after intra‐arterial chemotherapy for retinoblastoma improves with accrual of experience and programmatic evolution

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