Elena Stenzel1, Sophia Göricke1, Petra Temming2, Eva Biewald3, Stefan Zülow1, Juliane Göbel1, Isabel Wanke1, Lale Umutlu1, Christoph Kleinschnitz4, Norbert Bornfeld3, Michael Forsting1, Alexander Radbruch5, Christoph Mönninghoff1. 1. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. 2. Department of Pediatric Hematology and Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. 3. Department of Ophthalmology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. 4. Department of Neurology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. 5. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. alexander.radbruch@uk-essen.de.
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.
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.
Authors: Fairooz P Manjandavida; Christina Stathopoulos; Jing Zhang; Santhosh G Honavar; Carol L Shields Journal: Indian J Ophthalmol Date: 2019-06 Impact factor: 1.848
Authors: Paula Schaiquevich; Jasmine H Francis; María Belén Cancela; Angel Montero Carcaboso; Guillermo L Chantada; David H Abramson Journal: Front Oncol Date: 2022-04-01 Impact factor: 5.738
Authors: Marcel Opitz; Denise Bos; Cornelius Deuschl; Alexander Radbruch; Sebastian Zensen; Selma Sirin; Michael Forsting; Nikolaos Bechrakis; Eva Biewald; Norbert Bornfeld; Petra Ketteler; Beate Timmermann; Martin Stuschke; Maja Guberina; Axel Wetter; Sophia Göricke; Nika Guberina Journal: Neuroradiology Date: 2020-08-29 Impact factor: 2.804