Abstract
Purpose: To evaluate the efficacy of an external carotid artery (ECA) alternative route in intra-arterial chemotherapy (IAC) for treatment of retinoblastoma.Methods: In this retrospective, single-centre, case-control study, 98 retinoblastoma patients who received successful IAC were included. The drug delivery routes were the primary ophthalmic artery (OA) route and the ECA route when OA catheterization was not feasible.Results: A total of 337 successful IAC procedures were performed in our study, of which 32 (9.5%) procedures were performed through the ECA route. Eighteen eyes (18.4%) accepted at least one IAC through branches of the ECA. Statistical analysis showed that there was no significant difference in ocular clinical results (enucleation, death, recurrence and event-free) between the ECA and OA routes. No significant association was found between the route of drug delivery and the ocular survival time (p = 0.69). The use of ECA catheterization in at least one IAC cycle was not a predictor of enucleation (HR: 1.58; 95% CI: 0.56–4.46, p = 0.39). The increasing number of procedures through the ECA route did not increase the risk of enucleation (HR: 1.64; 95% CI: 0.42–6.39, p = 0.48).Conclusion: The ECA alternative route did not affect the efficacy of IAC in retinoblastoma. When the standard OA approach is not feasible, ECA system catheterization should be considered.
Highlights
Retinoblastoma is the most common primary intraocular cancer in children, and it has been estimated that the annual incidence of retinoblastoma is 264 cases in North America, 464 cases in Europe and 4,258 cases in Asia [1, 2]
We reviewed the Intra-arterial chemotherapy (IAC) treatment experiences of 98 retinoblastoma patients at our center and compared the clinical outcomes of the standard ophthalmic artery (OA) route and alternative external carotid artery (ECA) route to verify whether there is a difference in therapeutic effect between these two routes
The median age at diagnosis was 21.62 months, and 46.9% of the retinoblastomas occurred in male patients; 75.5% of the study cases were unilateral disease
Summary
Retinoblastoma is the most common primary intraocular cancer in children, and it has been estimated that the annual incidence of retinoblastoma is 264 cases in North America, 464 cases in Europe and 4,258 cases in Asia [1, 2]. In the past three decades, treatment for retinoblastoma has undergone a shift from radiotherapy to systemic. Intra-arterial chemotherapy (IAC) is one of the best advances in in situ chemotherapy, which efficiently increases the local intraocular drug concentration and reduces the systemic side effects of intravenous chemotherapy (IVC). The conventional mode of anticancer drug delivery in IAC is through infusion into the ophthalmic artery (OA) [5]. It is necessary to find an alternative route for drug delivery when OA catheterization is difficult. We reviewed the IAC treatment experiences of 98 retinoblastoma patients at our center and compared the clinical outcomes of the standard OA route and alternative ECA route to verify whether there is a difference in therapeutic effect between these two routes
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