Boddu Srikanth R, Abramson David H, Marr Brian P, Francis Jasmine H, Gobin Y Pierre
Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
J Neurointerv Surg. 2017 Nov;9(11):1107-1112. doi: 10.1136/neurintsurg-2016-012758. Epub 2016 Nov 9.
To evaluate fluoroscopic time and radiation dose parameters, and factors affecting these parameters, during selective ophthalmic artery chemosurgery (SOAC) for retinoblastoma.
Retrospective review from the prospective database of all patients with retinoblastoma treated with SOAC over a 5-year period (September 2009-January 2015) at a single institution after receiving institutional review board approval. Patient demographics, arterial approach, access device, side of treatment, number of SOAC cycles/patient, number of drugs/SOAC, and radiation parameters (outcome variables), including the fluoroscopic time, dose-area product (DAP), and total radiation dose, were obtained from the database. Generalized linear regression was used for univariate and multivariate analysis of the outcome variables.
In 218 patients (M:F=94:124), 272 eyes were treated by 833 SOAC infusions during 792 procedures. Mean age, weight, SOAC cycle/patient, and drugs/cycle were 19±19.5 months, 11.4±6.4 kg, 2.72±1.6, and 2.48±0.8, respectively. Mean fluoroscopic time, DAP, and doses were 10.2±8.4 min, 218.7±240.8 cGy.cm, and 42.3±41.4 mGy, respectively. Radiation parameters (fluoroscopic time, DAP, and dose) were significantly lower (p<0.001) for the ophthalmic artery (OA) approach (7.5±5.4; 147.7±138.4; 28.5±29.4) than with middle meningeal artery (13.4±5.6; 242±138; 51.4±27) and balloon-assisted infusion in the internal carotid artery (ICA; 17.8±11.5; 449.8±361; 81.8±63.3). Radiation parameters for microcatheter access (8.6±7.1; 193.4±181.3; 42.3±37) were significantly lower (p<0.001) than with the ICA (17.8±11.5; 449.8±361; 81.8±63.3). Radiation parameters for bilateral IA chemotherapy (IAC; 16.8±11.6; 320.7±268.7; 60.8±45.6) were significantly higher (p<0.001) than for unilateral IAC (8.9±6.6; 212.7±247; 42±41).
In SOAC for retinoblastoma, the OA approach, microcatheter access, and unilateral treatment were associated with significantly lower radiation parameters. We established benchmark radiation parameters for retinoblastoma SOAC in our patient cohort.
评估视网膜母细胞瘤选择性眼动脉化学手术（SOAC）期间的透视时间和辐射剂量参数，以及影响这些参数的因素。
在获得机构审查委员会批准后，对一家机构在5年期间（2009年9月至2015年1月）接受SOAC治疗的所有视网膜母细胞瘤患者的前瞻性数据库进行回顾性分析。从数据库中获取患者人口统计学资料、动脉入路、接入装置、治疗侧、每位患者的SOAC周期数、每次SOAC的药物数量以及辐射参数（结果变量），包括透视时间、剂量面积乘积（DAP）和总辐射剂量。采用广义线性回归对结果变量进行单因素和多因素分析。
218例患者（男∶女 = 94∶124），在792例手术中通过833次SOAC输注治疗了272只眼。平均年龄、体重、每位患者的SOAC周期数和每个周期的药物数分别为19±19.5个月、11.4±6.4 kg、2.72±1.6和2.48±0.8。平均透视时间、DAP和剂量分别为10.2±8.4分钟、218.7±240.8 cGy·cm和42.3±41.4 mGy。眼动脉（OA）入路的辐射参数（透视时间、DAP和剂量）（7.5±5.4；147.7±138.4；28.5±29.4）显著低于脑膜中动脉（13.4±5.6；242±138；51.4±27）和颈内动脉（ICA）球囊辅助输注（17.8±11.5；449.8±361；81.8±63.3）（p<0.001）。微导管接入的辐射参数（8.6±7.1；193.4±181.3；42.3±37）显著低于ICA（17.8±11.5；449.8±361；81.8±63.3）（p<0.001）。双侧眼动脉化疗（IAC）的辐射参数（16.8±11.6；320.7±268.7；60.8±45.6）显著高于单侧IAC（8.9±6.6；212.7±247；42±41）（p<0.001）。
在视网膜母细胞瘤的SOAC中，OA入路、微导管接入和单侧治疗与显著更低的辐射参数相关。我们在患者队列中建立了视网膜母细胞瘤SOAC的辐射参数基准。
