Retinoblastomais the most commonintraoculartumorin childhood. For a long time enucleation, radiation and systemic chemotherapy was the only way to accomplish full recovery. Nowadays we have developed and mastered a modern method of treatingretinoblastoma–intraarterialchemotherapy through ophthalmic artery, right to malignancy in retina.
Intraarterialchemotherapy (IAC) is an invasive procedure and, in our institute, it is performed by an interventional radiologist in cooperation with an ophthalmologist. The ophthalmologist is the one who qualifies the patient for the procedure andperformscomplementarytreatment including : cryotherapy and laser therapy. In some cases...
Methods and materials
The IAC has been performed under anticoagulation with intravenous heparin (70units/kilo till 2018, 50 units per kilo from 2019) with a 3,5F leading catheter in ICA and 1,2-1,5 catheterplacedat the entrance to the ophthalmic artery. Apreinfusionarteriogramis taken to confirm patency of the ophthalmic artery.
Chemotherapeutic agents diluted in saline are delivered to retina using apulsationtechnique. The selected chemotherapy drugs areMelphalan(2-5 mg) combined withTopotecan(0,3-1 mg).Carboplatin(20-40 mg) is used as well in most cases. Drugs combinations were modified for children with bilateralretinoblastoma(under 20%)
The patient’s age ranged...
Between 2015 and 2019 we have performed over 200 IAC procedures with over 95% technicalsuccessin thewholeperiod and 100% technicalsuccessin the last year.
Recurrence rate is under 30 %, mostly in one eye in children with bilateralretinoblastoma(children withmodyfiedchemotherapy). Less that 15% need next IAC session apartfromcrioteraphyand laser therapy. We observed constant number of recurrence in bilateralretinoblastomagroupand lower number of recurrenttumorsin unilateralretinoblastomagroupwith development ofmeningealmedia approach and desist of theballoontechnique.
Predictable side effects of IAC include swelling of the eyelid, bleeding into the eye, eye muscle dysfunctions, drooping...
This treatment allows not only to save life, but also eyes, and vision. IAC allows delivering chemotherapy locally to the eye while minimizing systemic exposure with very low procedure risk and very high effectiveness.
In some cases the anatomy might be demanding or even impossible to overcome, specially in the smallest children under 2 months and 4 kg. We believe though that it still is not a contraindication for the treatment, just arisk factorof technical failure easy to overcome with experience, training and development of...
Personal information and conflict of interest
J. Debska; Warsaw/PL - nothing to disclose U. H. Pasik; Warsaw/PL - nothing to disclose E. Jurkiewicz; Warsaw/PL - nothing to disclose J. Bartuszek; Warsaw/PL - nothing to disclose P. A. Rago; Warsaw/PL - nothing to disclose
1. Intra-arterial Chemotherapy for the Management of Retinoblastoma Four-Year Experience .
Y. Pierre Gobin, MD;Ira J. Dunkel, MD;Brian P. Marr, MD;et al
2.Retinoblastoma frontiers with intravenous, intra-arterial, periocular, and intravitreal chemotherapy C L Shields,E M Fulco,J D Arias,C Alarcon,M Pellegrini,P Rishi,S Kaliki,C G Bianciotto&J A ShieldsCambridge Ophthalmological Symposium Published:21 September 2012
3. Retinoblastomamanagement: advances inenucleation,intravenous chemoreduction, andintra-arterial chemotherapy
Shields, Carol L; Shields, Jerry A
Current Opinion in Ophthalmology:May 2010 - Volume 21 - Issue 3 - p 203–212
4.Intravitreal chemotherapy for vitreous disease...