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Feasibility of intra-arterial chemotherapy for retinoblastoma: experiences in a large single center cohort study

  • Interventional Neuroradiology
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Abstract

Purpose

In the last 10 years, intra-arterial chemotherapy (IAC) has been increasingly used in the clinical management of retinoblastoma. It is reported to provide tumor control even in advanced stage disease that might have previously required enucleation. In our clinical experience, there are three conditions that may impair the use of IAC: (1) significant collaterals to meningeal arteries, (2) technical failure of ophthalmic artery catheterization, or (3) retina blood supply from collaterals different to the ophthalmic artery. In the current study, we assessed the rate of IACs that could not be carried out in our institution due to these three reasons.

Methods

All patients admitted for IAC in our hospital were retrospectively assessed by chart review. Non-application rate of IAC was assessed and classified according to the three abovementioned criteria. Complication rate of both finalized and interrupted interventions was recorded.

Results

Ninety-eight patients (median age 21.4 months, range 5.3 months–10.5 years) were identified. IAC was performed in 69 (70.4%) patients and interrupted in 12 (12.2%) cases because of meningeal collaterals, in 8 (8.2%) because of technical failure to cannulate the ophthalmic artery, and in 9 (9.2%) because of alternative blood supply of the retina.

Conclusion

The rather defensive approach that is pursued in our center resulted in an overall non-application rate of IAC around 30%. The relatively high probability of conditions that impair the use of IAC needs to be addressed adequately in the patient conversation prior to the procedure. Our rate of 8% of abstention from IAC due to technical limitations might be reduced by the application of more rigorous therapeutic approaches such as balloon occlusion of the distal internal carotid artery. More research is finally needed to determine if IAC can be safely performed in the presence of meningeal collaterals and via branches of the external carotid artery.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Elena Stenzel, Sophia Göricke, Stefan Zülow, Juliane Göbel, Isabel Wanke, Lale Umutlu, Michael Forsting, Alexander Radbruch & Christoph Mönninghoff

  2. Department of Pediatric Hematology and Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Petra Temming

  3. Department of Ophthalmology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Eva Biewald & Norbert Bornfeld

  4. Department of Neurology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Christoph Kleinschnitz

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  1. Elena Stenzel
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  2. Sophia Göricke
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  3. Petra Temming
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  4. Eva Biewald
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  7. Isabel Wanke
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  11. Michael Forsting
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  12. Alexander Radbruch
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Corresponding author

Correspondence to Alexander Radbruch.

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No funding was received for this study.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of retrospective study formal consent is not required and all patient data was anonymized.

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Stenzel, E., Göricke, S., Temming, P. et al. Feasibility of intra-arterial chemotherapy for retinoblastoma: experiences in a large single center cohort study. Neuroradiology 61, 351–357 (2019). https://doi.org/10.1007/s00234-019-02153-9

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  • DOI: https://doi.org/10.1007/s00234-019-02153-9

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