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
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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