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USE OF FEMORAL ARTERY ULTRASOUND DURING INTRAARTERIAL CHEMOTHERAPY FOR CHILDREN UNDER 10 KG WITH RETINOBLASTOMA

Kim, Ryan, S., BA*,†; Dannenbaum, Mark, J., MD; Lin, Michael, W., MD§; Bretana, Maria, E., CDOS*; Brown, Deborah, L., MD; Schefler, Amy, C., MD*,**

doi: 10.1097/IAE.0000000000001713
Original Study: PDF Only

Purpose: To demonstrate the safety and efficacy of intraarterial chemotherapy (IAC) in small infants (<10 kg) with retinoblastoma.

Methods: Retrospective, consecutive, observational case series of patients treated with IAC. Femoral arterial access was obtained using a micropuncture kit and ultrasound guidance, which enabled direct visualization. Melphalan (1.5–5.0 mg), topotecan (0.3–2.0 mg), and/or carboplatin (30–40 mg) were used. Patients underwent adjuvant therapies including laser, cryotherapy, and intravitreal melphalan if persistent disease or recurrence was observed.

Results: Fifty-nine injections were administered to 11 eyes of 6 patients. All eyes but one were classified as International Classification Groups C or D. Median patient weight at first IAC cycle was 9.2 kg (mean, 8.9 kg). Median diameter of the femoral artery at the catheterization site was 3.74 mm, measured by two independent observers. Median follow-up was 21.4 months (range 13.1–34.5 months). All eyes were salvaged.

Conclusion: This study confirmed the safety and efficacy of IAC in infants under 10 kg. Ultrasound guidance enabled successful catheterization of femoral arteries as small as 2.7 mm in diameter. Patients in this study appeared to require fewer injections and lower total doses of chemotherapy compared with previously reported series of comparably advanced disease in larger infants.

This is a retrospective consecutive study of 11 retinoblastoma eyes in 6 patients treated with intraarterial chemotherapy. All patients were under 10 kg at the time of their first procedure. Tumor response and any adjuvant therapy were recorded. No eyes were lost to either enucleation or external beam radiation.

*Retina Consultants of Houston, Houston, Texas;

McGovern Medical School, The University of Texas Health Science Center, Houston, Texas;

Department of Neurological Surgery, McGovern Medical School, The University of Texas Health Science Center, Mischer Neuroscience Institute, Memorial Hermann Hospital, Houston, Texas;

§Department of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center, Memorial Hermann Hospital, Houston, Texas;

Department of Pediatrics, Division of Hematology-Oncology, McGovern Medical School, The University of Texas Health Science Center, Children's Memorial Hermann Hospital, Houston, Texas; and

**Robert Cizik Eye Clinic, Ruiz Department of Ophthalmology and Visual Sciences, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas.

Reprint requests: Amy C. Schefler, MD, 6560 Fannin Street, Suite 750, Houston, TX 77030; e-mail: acsmd@houstonretina.com

None of the authors has any financial/conflicting interests to disclose.

All authors have met the authorship criteria described in Retina.

© 2018 by Ophthalmic Communications Society, Inc.