Feasibility of intra-arterial chemotherapy for retinoblastoma: experiences in a large single center cohort study
Autor: | Isabel Wanke, Eva Biewald, Alexander Radbruch, Lale Umutlu, Stefan Zülow, Michael Forsting, Elena Stenzel, Juliane Göbel, Norbert Bornfeld, Christoph Kleinschnitz, Sophia Göricke, Petra Temming, Christoph Mönninghoff |
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Rok vydání: | 2019 |
Předmět: |
Male
medicine.medical_specialty External carotid artery Enucleation Medizin Collateral Circulation Contrast Media Single Center 030218 nuclear medicine & medical imaging Ophthalmic Artery 03 medical and health sciences 0302 clinical medicine medicine.artery medicine Humans Infusions Intra-Arterial Radiology Nuclear Medicine and imaging Child Antineoplastic Agents Alkylating Melphalan Ultrasonography Interventional Interventional neuroradiology Neoplasm Staging Retrospective Studies Neuroradiology business.industry Retinoblastoma Infant Meningeal Arteries Cerebral Angiography Surgery Treatment Outcome Child Preschool Ophthalmic artery Feasibility Studies Female Neurology (clinical) Neurosurgery Internal carotid artery Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
Zdroj: | Neuroradiology. 61:351-357 |
ISSN: | 1432-1920 0028-3940 |
Popis: | 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. 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. 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. 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. |
Databáze: | OpenAIRE |
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