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O-047 Advancement in super-selective catheterization and drug selection for intra-arterial chemotherapy for retinoblastoma: a 15-year evolution
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  1. G Kocharian1,
  2. Y Gobin2,
  3. N Kharas1,
  4. J Knopman1,
  5. J Francis3,
  6. D Abramson3
  1. 1Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
  2. 2Division of Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY
  3. 3Ophthalmologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY

Abstract

Background Retinoblastoma (Rb) is the most common primary ocular malignancy of childhood. Left untreated, it is 100% fatal and carries a substantial risk for impaired vision and removal of one or both eyes. Intraarterial chemotherapy (IAC) for Rb 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 for 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% procedural success rate. The rate of successful super-selective catheterizations over the three periods ranged from 80% in P1, 84.9% in P2, to 89.2% in P3. Catheterization related complication rates ranged from 0.7% in P1, 1.1% in P2, to 0.6% in P3. Chemotherapeutics used included combinations of melphalan, topotecan and carboplatin. The rate of patients receiving triple-therapy among all groups ranged from 128 (21%) in P1, 487 (41.9%) in P2, to 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 is a significant trend towards triple chemotherapy over time.

Abstract O-047 Figure 1

Algorithm for ophthalmic artery catheterization for IAC delivery demonstrating, (1) direct OA catheterization using ”puff & pull back” technique with either a flexible or stiff microcatheter, (2) OA-MMA anastomosis catheterization via the ECA, (3) direct OA catheterization via the VA/PCoA, and (4) IAC delivery via a guide catheter with ICA balloon occlusion distal to the OA. Note, the central retinal artery is depicted here, but not angiographically visible

Disclosures G. Kocharian: None. Y. Gobin: None. N. Kharas: None. J. Knopman: None. J. Francis: None. D. Abramson: None.

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