Introduction: Retinoblastoma is a deadly pediatric eye cancer, leading to death in 50% to 70% of children in undeveloped nations. This malignancy is the most common intraocular tumor in childhood worldwide. The good prognosis in developed nations is related to early detection and advanced treatments. With the advent of intra-arterial chemotherapy, neurosurgeons have taken a central role in the treatment of this pediatric condition.
Methods: Intra-arterial chemotherapy is a novel treatment for retinoblastoma whereby chemotherapeutic agents are precisely delivered into the ophthalmic artery, minimizing systemic toxicity. This procedure has shown impressive results and has allowed a dramatic decrease in the rate of enucleation (eye removal) in advanced and refractory retinoblastoma.
Results: At Jefferson Hospital for Neuroscience, we have performed 106 intra-arterial chemotherapy procedures in 46 patients with retinoblastoma over a 3-year period. Since then we have accumulated tremendous experience and refinements in our techniques and protocols to address evolving challenges. In our hands, tumor control is excellent with globe salvage at 67% and vascular events <5%, mostly related to improvement in technique.
Conclusions: Intra-arterial chemotherapy holds promise for thousands of children around the globe suffering from this devastating condition. A proper technique is crucial to achieve optimal results and minimize toxic effects.
Patient Care: Our experience will allow Neurosurgeons to understand the importance of intra-arterial chemotherapy for retinoblastoma, and optimize their techniques and protocols to maximize the efficacy of chemotherapy and minimize its toxicity especially the risk of ocular vasculopathy.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the importance and success of intra-arterial chemotherapy in the treatment of retinoblastoma. 2) Identify potential limitations of intra-arterial chemotherapy. 3) Optimize their technique and protocols to maximize treatment efficacy and minimize associated toxicity.