Quinn Coridon, Tummala Ramachandra, Anderson Jill, Dahlheimer Tambra, Nascene David, Jagadeesan Bharathi
Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
Department of Ophthalmology, University of Minnesota, Minneapolis, MN, USA.
Interv Neuroradiol. 2019 Oct;25(5):556-561. doi: 10.1177/1591019919831953. Epub 2019 Mar 31.
Intra-arterial chemotherapy (IAC) is now the first line treatment for selected patients with retinoblastoma (Rb). Typically, IAC is infused following the selective catheterization of the ophthalmic artery (OA) on the affected side. However, in some patients, the OA alone may not provide vascular supply to the tumor, whereas in other instances the efficacy of IAC could be compromised due to the presence of prominent collateral vessels from the external carotid artery (ECA). We report our experience with catheterizing vessels other than the OA for IAC treatment for Rb.
After institutional review board approval, a retrospective analysis was conducted of electronic medical records and imaging of our Rb population.
We identified 13 patients who received IAC for Rb treatment. Of these, five patients required alternative methods of chemotherapy delivery other than through the OA, totaling 17 treatments. Two patients needed balloon-assisted occlusion of the ECA, two patients required selective catheterization of the middle meningeal artery, and one patient had no internal carotid artery supply to the choroidal blush, thus the superficial temporal artery provided access for IAC. Total globe salvage rate was 76% and 80% with the alternative route subset.
Alternatives to the OA may be necessary to deliver IAC for selected cases of Rb. These routes can be safe and effective. However, thorough understanding of the orbital blood supply is essential. Whether these alternative IAC methods result in similar outcomes to OA infusions has not been established.
动脉内化疗（IAC）目前是部分视网膜母细胞瘤（Rb）患者的一线治疗方法。通常，IAC是在对患侧眼动脉（OA）进行选择性插管后注入的。然而，在一些患者中，仅OA可能无法为肿瘤提供血管供应，而在其他情况下，由于存在来自颈外动脉（ECA）的明显侧支血管，IAC的疗效可能会受到影响。我们报告了我们在为Rb患者进行IAC治疗时对除OA以外的血管进行插管的经验。
在获得机构审查委员会批准后，对我们的Rb患者群体的电子病历和影像学资料进行了回顾性分析。
我们确定了13例接受IAC治疗的Rb患者。其中，5例患者需要通过除OA以外的其他方法进行化疗给药，共进行了17次治疗。2例患者需要球囊辅助闭塞ECA，2例患者需要对脑膜中动脉进行选择性插管，1例患者脉络膜充盈无颈内动脉供血，因此颞浅动脉为IAC提供了通路。采用替代途径的亚组患者眼球总挽救率分别为76%和80%。
对于部分Rb病例，可能需要采用OA以外的途径进行IAC给药。这些途径可以是安全有效的。然而，全面了解眼眶血液供应至关重要。这些替代IAC方法是否能产生与OA注入相似的结果尚未确定。
