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Technical and anatomical factors affecting intra-arterial chemotherapy fluoroscopy time and radiation dose for intraocular retinoblastoma
  1. Corey Area1,
  2. Christopher J Yen1,
  3. Patricia Chevez-Barrios2,
  4. Cynthia Herzog3,
  5. Peter Kan4,
  6. Wei Zheng5,
  7. Frank Lin6,
  8. Murali Chintagumpala7,
  9. Dan Gombos8,
  10. Stephen R Chen1
  1. 1 Diagnostic and Interventional Radiology, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Pathology, Houston Methodist Hospital, Houston, Texas, USA
  3. 3 Pediatric Hematology/Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4 Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  5. 5 Statistics, Texas Children’s Hospital, Houston, Texas, USA
  6. 6 Hematology/Oncology, Texas Children’s Hospital, Houston, Texas, USA
  7. 7 Texas Children’s Cancer Center, Baylor College of Medicine, Houston, Texas, USA
  8. 8 Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr. Stephen R Chen; Stephen.Chen2{at}


Background Intra-arterial chemotherapy has an increasingly prominent role in the management of retinoblastoma. One concern regarding this technique is procedural radiation exposure.

Objectives To examine the effects of our institution’s procedural technique on fluoroscopy parameters for patients undergoing intra-arterial chemotherapy infusions for intraocular retinoblastoma. Secondary goals included describing the effect of anatomical variations of the carotid siphon and ophthalmic artery on radiation dose.

Methods A retrospective review of pediatric patients with retinoblastoma referred to interventional neuroradiology for chemosurgery was performed. Techniques were classified as: A (1.2 Fr or 1.5 Fr microcatheter with continuous verapamil flush, advanced without guide through a 2 Fr sheath) or B (1.5 Fr or 1.7 Fr microcatheter advanced within a 4 Fr base catheter, through a 4 Fr sheath). Statistical analysis was performed to determine if there was a significant difference in fluoroscopy parameters based on technique or due to anatomical variation.

Results 26 patients were treated with 94 intra-arterial chemotherapy infusions. 34 procedures were performed using technique A and 60 using technique B. Mean fluoroscopy time (4.75 min), fluoroscopy dose (23.3 mGy), and dose–area product (DAP; 85.2 μGy.m2) for technique A were significantly lower (p value <0.05) than for technique B, 14.0 min., 191 mGy, and 586 μGy.cm2, respectively.

Conclusions Microcatheter-only technique with continuous verapamil infusion resulted in decreased fluoroscopy times, DAP, and radiation doses at our institution for the treatment of intraocular retinoblastoma. Furthermore, our fluoroscopy times using this technique are the lowest reported in the current literature. Additionally, our anatomical analysis has demonstrated a positive correlation between increasing vessel tortuosity and fluoroscopy times.

  • embolic
  • malignant
  • orbit
  • pediatrics
  • technique

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  • Contributors Each of the listed authors directly contributed to the study design, acquisition or interpretation of data, manuscript revision or final approval of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CH reports personal fees from Merck, outside the submitted work. DG reports non-financial support and other from Children’s Oncology Group, during the conduct of the study; grants from Houseman/Wilkins Ophthalmological Foundation, personal fees, and non-financial support from Abbvie, other from 3T Ophthalmics, other from Aura Biosciences, outside the submitted work.

  • Ethics approval Institutional review board for Baylor College of Medicine and Affiliated Hospitals H-43720.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice Since this paper was first published online, the corresponding author has been updated to Stephen Chen. The author Dan Gambos has been updated to Dan Gombos.

  • Patient consent for publication Not required.