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  • Advancements in super-selective catheterization and drug selection for intra-arterial chemotherapy for retinoblastoma: a 15-year evolution

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New devices and techniques
Original research
Advancements in super-selective catheterization and drug selection for intra-arterial chemotherapy for retinoblastoma: a 15-year evolution
  1. Gary Kocharian1,2,
  2. Y Pierre Gobin1,2,
  3. Natasha Kharas1,
  4. Jared Knopman1,2,
  5. Jasmine H Francis3,
  6. David H Abramson3
  1. 1 Department of Neurological Surgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
  2. 2 Division of Interventional Neuroradiology, Weill Cornell Medical College, New York, New York, USA
  3. 3 Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr Gary Kocharian, Neurological Surgery, Weill Cornell Brain and Spine Center, New York, NY 10022, USA; gary.kocharian{at}live.com

Abstract

Background Retinoblastoma (Rb) is the most common primary ocular malignancy of childhood. Left untreated, it is 100% fatal and carries a substantial risk of impaired vision and removal of one or both eyes. Intra-arterial chemotherapy (IAC) has become a pillar in the treatment paradigm for Rb that allows for better eye salvage and vision preservation without compromising survival. We describe the evolution of our technique over 15 years.

Methods A retrospective chart review was conducted of 571 patients (697 eyes) and 2391 successful IAC sessions over 15 years. This cohort was separated into three 5-year periods (P1, P2, P3) to assess trends in IAC catheterization technique, complications, and drug delivery.

Results From a total of 2402 attempted IAC sessions, there were 2391 successful IAC deliveries, consistent with a 99.5% success rate. The rate of successful super-selective catheterizations over the three periods ranged from 80% in P1 to 84.9% in P2 and 89.2% in P3. Catheterization-related complication rates were 0.7% in P1, 1.1% in P2, and 0.6% in P3. Chemotherapeutics used included combinations of melphalan, topotecan and carboplatin. The rate of patients receiving triple therapy among all groups was 128 (21%) in P1, 487 (41.9%) in P2, and 413 (66.7%) in P3.

Conclusions The overall rate of successful catheterization and IAC started high and has improved over 15 years, and catheterization-related complications are rare. There has been a significant trend towards triple chemotherapy over time.

  • Drug
  • Tumor
  • Technique
  • Pediatrics
  • Orbit

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jnis-2023-020109

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @garykochar

    • Contributors All authors contributed extensively to this work. GK contributed to the data gathering, data tabulation/analysis, writing and editing of the manuscript. YPG was involved in >99% of the procedures evaluated in this study, data gathering for all cases, writing, and editing/reviewing the manuscript, and is the guarantor for this work. NK contributed extensively to the data analysis and formal statistical review, and the writing up of these statistics and results. JK was involved in some of the procedures evaluated in this study and the writing/editing/reviewing of the manuscript. JHF and DHA contributed to the ophthalmologic oncologic care of all of the patients in this study and were involved in data gathering and the writing/editing/reviewing of the manuscript.

    • Funding All funding for this research was provided independently through the Division of Interventional Neuroradiology at Weill Cornell Medicine.

    • Competing interests None declared.

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