Endovascular Super-Selective Intra-Arterial Chemotherapy for Retinoblastoma: Systematic Review and Institutional Experience. (1st September 2019)

• Record Type: Journal Article
• Authors: Menaker, Simon; Sur, Samir; Mahavadi, Anil; Chen, Stephanie H; Peterson, Eric C; Starke, Robert M
• Is Part Of: Neurosurgery. Volume 66(2010)Supplement 1
• Publication Date: 2019-09-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz310_454
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Selective intra-arterial delivery of chemotherapy (IAC) via microcatheter infusion into the ophthalmic artery has become an increasingly popular treatment modality to accomplish globe salvage in children with retinoblastoma. While previously limited to highly specialized centers, interest in and popularity of this treatment are growing. Here, we provide a comprehensive review of available data in addition to our own experience. METHODS: Systematic literature review was conducted using PRISMA guidelines and 22 studies were identified that met inclusion criteria. In our own series, consecutive patients undergoing IAC for retinoblastoma were identified between January 2009 and December 2016. Pertinent data, including tumor grade, enucleation vs globe salvage, and both ocular and systemic adverse events were recorded. RESULTS: In all1593 total eyes were treated as reported in 22 studies published between 2011 and 2019. Among those in which tumor staging data was available, 396 (27.6%) were less advanced (Reese–Ellsworth A-C, or International Classification I-III) and 997 (69.4%) were more advanced (D-E, IV-V). A total of 21 studies included data on systemic and/or ocular complications, which with few exceptions were transient and resulted in no permanent morbidity. A single permanent neurological complication occurred. Analysis of our institutional experience demonstrated a globe salvage rate of 73% (identical to pooled data from the literature). In 442 procedures, our ocular and systemic complication rates were 10.6% and 13.8%, respectively; virtually all were transient phenomena including orbital edema, myelosuppression, and and brief intraprocedural bronchospasm/bradycardia during drug delivery. CONCLUSION: Although reported predominantly in retrospective series, a systematic review of outcomes in selective IAC for retinoblastoma demonstrates efficacy (73% globe salvage rate) with minimal morbidity, even in advanced disease. Our own results reflect a similar experience and taken together, provide strong evidence that this treatment modality is safe and effective. The data support adoption of this technique as first-line therapy for globe salvage in selected cases of retinoblastoma.