Abstract
Retinoblastoma is the most common eye malignancy in children that if left untreated can invade intraocular structures, metastasize, and rarely lead to death. Traditionally treated with systemic chemotherapy, Intra-arterial chemotherapy is gaining popularity as it allows for the direct administration of chemotherapy through the ophthalmic artery, thus reducing systemic side effects. Intra-arterial chemotherapy procedures have evolved, with refinements to reduce risks and radiation exposure. Intra-arterial chemotherapy boasts an impressive technical success rate and one year ocular survival even amongst advanced cases. This review offers a thorough examination of the technique, indications, contraindications, outcomes, and alternative options for Intra-arterial chemotherapy.
Similar content being viewed by others
References
Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17–48. https://doi.org/10.3322/caac.21763.
Kivelä T. The epidemiological challenge of the most frequent eye cancer: retinoblastoma, an issue of birth and death. Br J Ophthalmol. 2009;93(9):1129–31. https://doi.org/10.1136/bjo.2008.150292.
Fabian ID, Sagoo MS. Understanding retinoblastoma: epidemiology and genetics. Community Eye Health. 2018;31(101):7.
Cruz-Gálvez CC, Ordaz-Favila JC, Villar-Calvo VM, Cancino-Marentes ME, Bosch-Canto V. Retinoblastoma: review and new insights. Front Oncol. 2022;12:963780. https://doi.org/10.3389/fonc.2022.963780.
Dimaras H, Corson TW, Cobrinik D, et al. Retinoblastoma. Nat Rev Dis Primers. 2015;1:15021. https://doi.org/10.1038/nrdp.2015.21.
Aerts I, Lumbroso-Le Rouic L, Gauthier-Villars M, Brisse H, Doz F, Desjardins L. Retinoblastoma. Orphanet J Rare Dis. 2006;1:31. https://doi.org/10.1186/1750-1172-1-31.
Monroe EJ, Otjen JP, Wright JN, et al. Prospective determination of orbital perfusion dominance before intra-arterial chemotherapy for retinoblastoma using time-of-flight magnetic resonance angiography. J Clinic Intervent Radiol isvir. 2022;07(01):064–8. https://doi.org/10.1055/s-0042-1743498.
Chen Q, Zhang B, Dong Y, et al. Evaluating primary intra-arterial chemotherapy versus intravenous plus intra-arterial chemotherapy for advanced intraocular retinoblastoma. Cancer Chemother Pharmacol. 2020;85(4):723–30. https://doi.org/10.1007/s00280-020-04036-w.
Runnels J, Acosta G, Rose A, et al. The role for intra-arterial chemotherapy for refractory retinoblastoma: a systematic review. Clin Transl Oncol. 2021;23(10):2066–77. https://doi.org/10.1007/s12094-021-02610-z.
Rishi P, Agarwal A, Chatterjee P, Sharma T, Sharma M, Saravanan M, Ravikumar R. Intra-arterial chemotherapy for retinoblastoma: four-year results from tertiary center in India. Ocular Oncol Pathol. 2020;6(1):66–73. https://doi.org/10.1159/000500010.
Monroe EJ, Chick JFB, Stacey AW, et al. Radiation dose reduction during intra-arterial chemotherapy for retinoblastoma: a retrospective analysis of 96 consecutive pediatric interventions using five distinct protocols. Pediatr Radiol. 2021;51(4):649–57. https://doi.org/10.1007/s00247-020-04892-x.
Sweid A, Hammoud B, Weinberg JH, Texakalidis P, Xu V, Shivashankar K, Baldassari MP, Das S, Ramesh S, Tjoumakaris S, Shields CL, Ancona-Lezama D, Lim LS, Dalvin LA, Jabbour P. Intra-arterial chemotherapy for retinoblastoma in infants ≤10 kg: 74 treated eyes with 222 IAC sessions. AJNR Am J Neuroradiol. 2020;41(7):1286–92. https://doi.org/10.3174/ajnr.A6590.
Liang T, Zhang X, Li J, Hua X, Zhao P, Ji X. Intra-arterial chemotherapy as primary treatment for advanced unilateral retinoblastoma in China. Front Med. 2022;9: 855661. https://doi.org/10.3389/fmed.2022.855661.
Saglam M, Sarici A, Anagnostakou V, et al. An alternative technique of the superselective catheterization of the ophthalmic artery for intra-arterial chemotherapy of the retinoblastoma: retrograde approach through the posterior communicating artery to the ophthalmic artery. Neuroradiology. 2014;56(9):751–4. https://doi.org/10.1007/s00234-014-1388-1.
Abruzzo TA, Geller JI, Kimbrough DA, et al. Adjunctive techniques for optimization of ocular hemodynamics in children undergoing ophthalmic artery infusion chemotherapy. J Neurointerv Surg. 2015;7(10):770–6. https://doi.org/10.1136/neurintsurg-2014-011295.
Chen Q, Zhang B, Dong Y, et al. Intra-arterial chemotherapy as primary or secondary treatment for infants diagnosed with advanced retinoblastoma before 3 months of age. BMC Cancer. 2019;19(1):693. https://doi.org/10.1186/s12885-019-5844-5.
Abramson DH, Daniels AB, Marr BP, et al. Intra-arterial chemotherapy (ophthalmic artery chemosurgery) for group D retinoblastoma. PLoS ONE. 2016;11(1):e0146582. https://doi.org/10.1371/journal.pone.0146582.
Suzuki S, Yamane T, Mohri M, Kaneko A. Selective ophthalmic arterial injection therapy for intraocular retinoblastoma: the long-term prognosis. Ophthalmology. 2011;118(10):2081–7. https://doi.org/10.1016/j.ophtha.2011.03.013.
Fabian ID, Reddy A, Sagoo MS. Classification and staging of retinoblastoma. Comm Eye Health. 2018;31(101):11–3.
Shields CL, Dockery PW, Yaghy A, et al. Intra-arterial chemotherapy for retinoblastoma in 341 consecutive eyes (1,292 infusions): comparative analysis of outcomes based on patient age, race, and sex. J Amer Assoc Pediatric Ophthalmol Strabismus. 2021;25(3):150.e1-150.e9. https://doi.org/10.1016/j.jaapos.2020.12.006.
Manjandavida FP, Stathopoulos C, Zhang J, Honavar SG, Shields CL. Intra-arterial chemotherapy in retinoblastoma—A paradigm change. Indian J Ophthalmol. 2019;67(6):740–54. https://doi.org/10.4103/ijo.IJO_866_19.
Cao Y, Zhou M, Tian M, Lv HB. The safety and effectiveness of melphalan-based intra-arterial chemotherapy for retinoblastoma: an updated single-arm systematic review and meta-analysis. Evid Based Complement Alternat Med. 2022;2022:3156503. https://doi.org/10.1155/2022/3156503.
Friedman EL, Froehler MT, Daniels AB. Orbital swelling in a child with retinoblastoma following intra-arterial chemotherapy. JAMA Ophthalmol. 2021;139(3):357. https://doi.org/10.1001/jamaophthalmol.2020.4675.
Stathopoulos C, Bartolini B, Marie G, Beck-Popovic M, Saliou G, Munier FL. Risk factors for acute choroidal ischemia after intra-arterial melphalan for retinoblastoma. Ophthalmology. 2021;128(5):754–64. https://doi.org/10.1016/j.ophtha.2020.09.021.
Bogan CM, Kaczmarek JV, Pierce JM, et al. Evaluation of intravitreal topotecan dose levels, toxicity and efficacy for retinoblastoma vitreous seeds: a preclinical and clinical study. Br J Ophthalmol. 2021;106(2):288–96. https://doi.org/10.1136/bjophthalmol-2020-318529.
Zhou M, Wen X, Jia S, et al. Risk factors for ophthalmic artery stenosis and occlusion in patients with retinoblastoma treated with intra-arterial chemotherapy. Br J Ophthalmol. 2021;106(11):1581–6. https://doi.org/10.1136/bjophthalmol-2021-319118.
Daniels AB, Froehler MT, Kaczmarek JV, et al. Efficacy, toxicity, and pharmacokinetics of intra-arterial chemotherapy versus intravenous chemotherapy for retinoblastoma in animal models and patients. Transl Vision Sci Technol. 2021;10(11):10. https://doi.org/10.1167/tvst.10.11.10.
Francis JH, Levin AM, Zabor EC, Pierre GY, Abramson DH. Ten-year experience with ophthalmic artery chemosurgery: ocular and recurrence-free survival. PLoS ONE. 2018;13(5):e0197081. https://doi.org/10.1371/journal.pone.0197081.e0197081.
Yousef YA, Soliman SE, Astudillo PPP, et al. Intra-arterial chemotherapy for retinoblastoma: a systematic review. JAMA Ophthalmol. 2016;134(5):584–91. https://doi.org/10.1001/jamaophthalmol.2016.0244.
Shields CL, Mashayekhi A, Au AK, et al. The international classification of retinoblastoma predicts chemoreduction success. Ophthalmology. 2006;113(12):2276–80. https://doi.org/10.1016/j.ophtha.2006.06.018.
Wen X, Fan J, Jin M, et al. Intravenous versus super-selected intra-arterial chemotherapy in children with advanced unilateral retinoblastoma: an open-label, multicentre, randomised trial. Lancet Child Adolesc Health. 2023;7(9):613–20. https://doi.org/10.1016/S2352-4642(23)00141-4.
Ancona-Lezama D, Dalvin LA, Shields CL. Modern treatment of retinoblastoma: a 2020 review. Indian J Ophthalmol. 2020;68(11):2356–65. https://doi.org/10.4103/ijo.IJO_721_20.
Shields CL, Lally SE, Leahey AM, et al. Targeted retinoblastoma management: when to use intravenous, intra-arterial, periocular, and intravitreal chemotherapy. Curr Opin Ophthalmol. 2014;25(5):374–85. https://doi.org/10.1097/ICU.0000000000000091.
Shields CL, Fulco EM, Arias JD, et al. Retinoblastoma frontiers with intravenous, intra-arterial, periocular, and intravitreal chemotherapy. Eye (Lond). 2013;27(2):253–64. https://doi.org/10.1038/eye.2012.175.
Chawla B, Jain A, Azad R. Conservative treatment modalities in retinoblastoma. Indian J Ophthalmol. 2013;61(9):479–85. https://doi.org/10.4103/0301-4738.119424.
Shields CL, Shields JA, Kiratli H, De Potter PV. Treatment of retinoblastoma with indirect ophthalmoscope laser photocoagulation. J Pediatr Ophthalmol Strabismus. 1995;32(5):317–22. https://doi.org/10.3928/0191-3913-19950901-12.
Hasanreisoglu M, Saktanasate J, Schwendeman R, Shields JA, Shields CL. Indocyanine green-enhanced transpupillary thermotherapy for retinoblastoma: analysis of 42 tumors. J Pediatr Ophthalmol Strabismus. 2015;52(6):348–54. https://doi.org/10.3928/01913913-20150929-17.
Munier FL, Gaillard MC, Balmer A, et al. Intravitreal chemotherapy for vitreous disease in retinoblastoma revisited: from prohibition to conditional indications. Br J Ophthalmol. 2012;96(8):1078–83. https://doi.org/10.1136/bjophthalmol-2011-301450.
Yousef YA, Al Jboor M, Mohammad M, et al. Safety and efficacy of intravitreal chemotherapy (Melphalan) to treat vitreous seeds in retinoblastoma. Front Pharmacol. 2021;12:696787. https://doi.org/10.3389/fphar.2021.696787.
Liang TY, Zhu XY, Hua XM, Ji XD, Zhao PQ. Combined intra-arterial chemotherapy and intravitreal melphalan for the treatment of advanced unilateral retinoblastoma. Int J Ophthalmol. 2020;13(2):257–62. https://doi.org/10.18240/ijo.2020.02.09.
Shields JA, Parsons H, Shields CL, Giblin ME. The role of cryotherapy in the management of retinoblastoma. Am J Ophthalmol. 1989;108(3):260–4. https://doi.org/10.1016/0002-9394(89)90116-5.
Abramson DH, Ellsworth RM, Rozakis GW. Cryotherapy for retinoblastoma. Arch Ophthalmol. 1982;100(8):1253–6. https://doi.org/10.1001/archopht.1982.01030040231003.
Shields CL, Shields JA, De Potter P, et al. Plaque radiotherapy in the management of retinoblastoma. Use as a primary and secondary treatment. Ophthalmology. 1993;100(2):216–24. https://doi.org/10.1016/s0161-6420(93)31667-2.
Kim JY, Park Y. Treatment of retinoblastoma: the role of external beam radiotherapy. Yonsei Med J. 2015;56(6):1478–91. https://doi.org/10.3349/ymj.2015.56.6.1478.
Blach LE, McCormick B, Abramson DH. External beam radiation therapy and retinoblastoma: long-term results in the comparison of two techniques. Int J Radiat Oncol Biol Phys. 1996;35(1):45–51. https://doi.org/10.1016/s0360-3016(96)85010-3.
Shinohara ET, DeWees T, Perkins SM. Subsequent malignancies and their effect on survival in patients with retinoblastoma. Pediatr Blood Cancer. 2014;61(1):116–9. https://doi.org/10.1002/pbc.24714.
Aerts I, Sastre-Garau X, Savignoni A, et al. Results of a multicenter prospective study on the postoperative treatment of unilateral retinoblastoma after primary enucleation. J Clin Oncol. 2013;31(11):1458–63. https://doi.org/10.1200/JCO.2012.42.3962.
Funding
This study was not supported by any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Ethical Approval
This article does not contain any studies with human participants performed by any of the authors.
Informed Consent
For this type of study informed consent is not required.
Consent for Publication
For this type of study consent for publication is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Kolyvas, P., Mir, A., Stirrat, T. et al. Advanced Interventional Treatments in Retinoblastoma Management: A Comprehensive Review. Cardiovasc Intervent Radiol 47, 407–415 (2024). https://doi.org/10.1007/s00270-024-03692-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-024-03692-2