Introduction Intra-arterial delivery of chemotherapy (chemosurgery) via selective ophthalmic artery infusion has had an increasing role in the treatment of retinoblastoma. However reported success rates and enucleation rates have varied. The many differences in institutional protocols including choice of first line therapy, availability of patient follow-up and rationale for enucleation yields different results. We hypothesized that a quantitative assessment of tumor size reduction on wide angle funduscopic imaging would show differences in tumor response with regards to cycle of treatment, adjunct treatments, and prior IV chemotherapy.
Materials and methods Following IRB approval, a retrospective review of pediatric patients with retinoblastoma who had been referred for chemosurgery at our institution in the past 6 years was performed. Data collected included patient demographics, retinoblastoma classification, prior and concurrent treatments, chemotherapy agents, catheterization technique, fluoroscopy time, vascular anatomy, complications, and response on funduscopic examination. RetCam wide angle fundoscopic images were digitally transferred to DICOM image processing software for analysis or digitized from hard copy. Quantitative changes in tumor volume between images were measured.
Results From June 2013 to March 2019, a total of 114 chemosurgery cases were performed on 30
patients to treat 32 eyes. All patients received eye exams under anesthesia. 158 eye exams under anesthesia were reviewed including analysis of wide angle fundoscopic images when available.
After the first cycle of intra-arterial chemotherapy, response to treatment progressively decreased, with greatest change in tumor volume at time of first treatment. Decrease tumor size decrease per treatment was much greater when intra-arterial therapy was utilized as a first line therapy.
Combination therapy appears to be more efficacious than IA alone for cycles 3 and greater.
The catheters were placed in two locations, either the middle meningeal artery or the origin of the ophthalmic artery. A slightly greater average decrease in tumor size per cycle was seen with middle meningeal infusion (17.63%) versus ophthalmic artery infusion (12.38%).
Conclusion Quantitative assessment of wide angle fundoscopic imaging for tumor size helps evaluate Chemosurgery efficacy retrospectively. Utilizing this measurement allows us to more accurately assess treatment effects, which appear to be greater in IV chemotherapy naïve patients.
Disclosures S. Chen: None. P. Chévez-Barrios: None. M. Chintagumpala: None. F. Lin: None. P. Kan: 1; C; Stryker Neurovascular, MacDonald Research Fund. 2; C; Stryker Neurovascular, Medtronic. C. Area: None. C. Herzog: None. D. Gombos: 1; C; Houseman/Wilkin Opthalmologicl Foundation. 2; C; Abbvie, Aura, 3T Ophthalmics. 6; C; Children’s Oncology Group.
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