Safety and Efficacy of Intra-Arterial Chemotherapy in Retinoblastoma

Abstract

Background: The most common ocular neoplasm in children is retinoblastoma which can spreads to the brain via the optic nerve in untreated patients. The most common treatment is enucleation, but modern eye-preserving therapies may save the globe. In advanced stages, globe-preserving strategies are often insufficient to prevent enucleation and direct infusion of chemotherapeutic agents into the ophthalmic artery may be required to control the tumor. Objectives: In this presentation, we aim to report our experience about the safety and efficacy of intra-ophthalmic artery melphalan (IAM) injection in the treatment of retinoblastoma. : Patients and Methods: Totally 46 patients were enrolled into the study. Mean age was 36.8 + 22.2 months (7100 months). Using digital subtraction angiography, under roadmap guidance a microcatheter was introduced into the ophthalmic artery, subsequently melphalan was injected over 3040 minutes. The response of the retinoblastoma tumor(s) and any associated local side effects of the treatment were observed. Results: Twenty-three patients were male (50%). Mean weight was 11.2 + 3.9 Kg (420) and mean height was 89.3 + 16.2 cm (65110). The disease was in the right eye in 19 patients (41.3%), left eye in 23 patients (50%) and bilateral in 3 patients (6.5%). The ophthalmic arteries were successfully cannulated except in one patient. There were not severe systemic side effects in our patients. Vasospasm happened in one patient. Canulization failed in one patient out of 29 (3.4%). Conclusions: Intra-arterial melphalan injection into the ophthalmic artery is an effective and safe therapeutic modality for retinoblastoma.