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E-043 complications of intra-arterial chemotherapy (chemosurgery) for retinoblastoma
  1. Y Gobin1,
  2. J Francis2,
  3. B Marr3,
  4. S Brodie4,
  5. I Dunkel5,
  6. D Abramson3
  1. 1Y. Pierre Gobin, MD, New York, NY, USA
  2. 2Ophthalmic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
  3. 3Memorial Sloan Kettering Cancer Center, New York, NY, USA
  4. 4Mount Sinai Hospital, New York, NY, USA
  5. 5Pediatric, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Abstract

Purpose To document, explain, and attempt to prevent complications of chemosurgery for retinoblastoma

Methods Retrospective review of a prospectively maintained database of all children with retinoblastoma treated with chemosurgery at our institution.

Results At the date of submission, 1210 intra-arterial infusions were performed during 1040 procedures (170 bilateral infusions) in 354 eyes of 284 patients. Complications were divided into transient neurological (1); ocular severe: occlusive arteriopathy leading to blindness (4),central retinal artery occlusions (1), hemi central retinal vein occlusion (1);ocular benign: frequent edema, periocular erythema and ciliary madarosis; arterial: asymptomatic occlusion (1) and stenosis (2) of the ophthalmic artery, asymptomatic occlusion (1) and stenosis (2) of the middle meningeal artery, asymptomatic transient dissection of the carotid artery (1);femoral access: asymptomatic permanent (1) and transient (1) occlusion of the femoral artery, significant groin hematoma (1), foot petechia (3); hematological: 30% Grade 3–4 toxicity requiring intervention in 20 cases; allergic (2); epistaxis (3). Respiratory reactions consist in acute decrease in lung compliance appearing at catheterization of the cavernous carotid or the ophthalmic artery. They are frequent and potentially severe if epinephrine is not used.

Conclusion Complications of chemosurgery for retinoblastoma are rarely severe. With experience we have learned the following key points

  1. We can minimize access (groin) complications by decreasing the size of the introducer sheath to 3F. This requires to forgo using an intermediary 4F or 5F catheter and to perform the entire catheterization using the microcatheter only.

  2. We can minimize irradiation by doing the entire procedure with digital subtracted fluoroscopy instead of digital subtracted angiography.

  3. The drugs and doses of chemotherapy are determined according to age (as an approximation for eye size) then adapted to each patient and each procedure, according to the angioanatomy, position of the microcatheter, and results of the former chemosurgery.

  4. The respiratory reaction to catheterization consists of a decrease in lung compliance; it should be differentiated from an allergic reaction (contrast media or carboplatin); it is very effectively treatable with epinephrine.

  5. The microcatheter should be positioned at the ostium of the ophthalmic artery and not advanced further.

  6. Failure of catheterization is rare when one uses the three techniques of catheterization (ophthalmic artery, middle meningeal artery and balloon assisted infusion).

Disclosures Y. Gobin, MD: 4; C; Lazarus Effect, Inc. J. Francis: 1; C; Foundation for ophthalmic knowledge. B. Marr: 1; C; Foundation for ophthalmic knowledge. S. Brodie: None. I. Dunkel: None. D. Abramson: 1; C; Foundation for ophthalmic knowledge.

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