Faculty Opinions recommendation of Simultaneous bilateral ophthalmic artery chemosurgery for bilateral retinoblastoma (tandem therapy).

Abstract INTRODUCTION Intra-arterial chemotherapy has been used in early-childhood retinoblastoma. We present some pearls and pitfalls of this technique in a sizable cohort of retinoblastoma patients. METHODS A retrospective, non-comparative cohort of 500 patients with retinoblastoma was grouped between January 2009 and September 2016. Melphalan was infused under fluoroscopic guidance through the ophthalmic artery with supplementary topotecan or carboplatin or both, for a mean of 3 cycles. The mean follow-up was 20.3 months(SD = 11.3). The International Classification of Retinoblastoma (ICRB) was implemented in the assessment of ocular globe preservation and of the tumor's response to treatment. Grade E patients were almost always treated concomitantly with IV chemotherapy. RESULTS >Of 500 patients (mean of age 35 months), we treated 520 eyes. (n1 = 236; [(67) A, (83) B, (48) C, (18) D and (20) E]) received a primary treatment, (n2 = 95) were treated for their advanced disease, (n3 = 67) had bilateral retinoblastoma and (n4 = 55) were treated for a recurrence after conventional intravenous chemotherapy. Globe preservation was achieved in 87% of primary-treated cases(A [100%]; B [100%]; C [100%]; D [92%]; E [46%]) and in 69% of secondary-treated patients. Postprocedural complications were vitreous hemorrhage (3.2%), retinal artery branch occlusion (0.75%), ophthalmic artery (OA) occlusion (1.7%) and spasm (2.2%), limited choroidal ischemia (1.8%) and optic neuropathy (0.7%). 478(92%) patients had complete regression: small tumors 99%[201/203]; well-defined tumors 97%[173/178] and poorly defined tumors 92%[88/97]. There was no motor, sensitive or ictal complications after the intervention. Patients manifested none of the systemic side effects of the dispensed chemotherapy. CONCLUSION Selective intra-ophtalmic chemotherapy has become a gold standard in the treatment of retinoblastoma, with very low mortality, morbidity related to the procedure and a very high cure rate.

Download Full-text

Successful salvage intravenous chemotherapy after tandem selective ophthalmic artery infusion chemotherapy in bilateral retinoblastoma

Indian Journal of Ophthalmology ◽

10.4103/ijo.ijo_576_20 ◽

2020 ◽

Vol 68 (11) ◽

pp. 2618

Author(s):

BasilK Williams ◽

HyunJ Kim ◽

Maura Di Nicola ◽

JamesJ Augsburger

Keyword(s):

Ophthalmic Artery ◽

Intravenous Chemotherapy ◽

Infusion Chemotherapy ◽

Bilateral Retinoblastoma

Download Full-text

The technique of superselective ophthalmic artery chemotherapy for retinoblastoma: The Garrahan Hospital experience

Interventional Neuroradiology ◽

10.1177/1591019917738962 ◽

2017 ◽

Vol 24 (1) ◽

pp. 93-99 ◽

Cited By ~ 4

Author(s):

Flavio Requejo ◽

Juan Marelli ◽

Agustin Ruiz Johnson ◽

Claudia Sampor ◽

Guillermo Chantada

Keyword(s):

Femoral Artery ◽

Ophthalmic Artery ◽

Middle Meningeal Artery ◽

Retinal Hemorrhage ◽

External Carotid Artery ◽

Morbidity Rate ◽

External Carotid ◽

Safe Technique ◽

Tandem Therapy ◽

Effects Of Radiation

Background Superselective ophthalmic artery chemotherapy (SOAC) is a proven therapy for the treatment of retinoblastomas. We describe the technique, results and complications of SOAC performed in our hospital. Objective The aim of this article is to demonstrate that a seemingly complex technique can be carried out with a low morbidity rate. Methods A retrospective analysis of patients receiving SOAC in our department from November 2014 to April 2017 was performed. Data collected were age, gender, number of procedures, arteries approached, bilaterality of treatment, and complications. The procedure was performed using a 3F sheath and a flow-dependent 1.5F microcatheter that was navigated from the femoral artery to the ostium of the ophthalmic artery (OA). When the OA was too small or a stable position could not be achieved, the microcatheter was navigated in the external carotid artery to reach an anastomotic ramus (AR) of the middle meningeal artery (MMA) to the OA. The drugs were then injected through the microcatheter in a pulsatile way. Results Forty-one patients underwent SOAC. A total of 248 procedures were performed in 45 eyes, and 248 arteries were approached (205 OAs and 43 MMAs). Four patients underwent tandem therapy (both eyes treated in the same procedure). Complications were: hypotension and bradycardia during the procedure (five cases), transient thrombosis of the femoral artery (two cases), retinal hemorrhage (one case), alopecia (one case), and anaphylactic shock to carboplatin (one case). No patient showed adverse effects of radiation or ischemic stroke. Conclusion SOAC is a safe technique with a very low complication rate.

Download Full-text