Benefits and Risks Intra-arterial Chemotherapy for Retinoblastoma

Intra-arterial chemotherapy for the treatment of retinoblastoma can result in "dramatic response", but also raises the risk of side effects ranging from mild to severe. This finding revealed by dr. Carol Shields and colleagues, from the Wills Eye Institute Philadelphia, published in the Archives of Ophthalmology. In the study, intra-arterial chemotherapy (intra-arterial chemotherapy, IAC) was done in 17 children with retinoblastoma are aged 4 to 74 months. Complete response was found in 14 children and 10 of whom remained free of tumor when performed follow-up a year later.
Successful catheterization in 16 children with retinoblastoma median basal dimension of 20 mm and the average thickness of 9 mm. IAC is actually scheduled for 3 times with an interval of one month, but the researchers decided not to increase the cycles of chemotherapy if the tumor has shown complete regression. IAC is a primary therapy in 12 children, and the eyeball was saved in eight children among them - including all children who are classified as category C or D according to the International Classification of Retinoblastoma (scale categories: A through E; E most severe). Meanwhile, the eyeball is also saved on 2 of 4 children who underwent the IAC as a secondary therapy. Primary tumor regresses post-chemotherapy; basal dimensions shrink 31% and the thickness decreased 56%.
Tumor recurrence occurred in three children only once, each in the form of solid tumor, the seeds of the tumor in subretina (subretinal seeds), and the seeds of the tumor in the anterior chamber or glass body (anterior chamber or vitreous seeds). Enucleation had to be done in six children, external beam radiotherapy twice, and plaque radiotherapy once. Recognized researchers, IAC has a number of advantages over other therapeutic modalities for retinoblastoma cases, partly because the dose is small enough to do one day so enlarge the biological effects at the target location while minimizing toxic effects on other body parts. However, the IAC procedure is technically quite difficult, and children should be watched closely in order to be aware of the possibility of serious side effects. During follow-up period, reported some mild side effects of short duration, covering palpebra edema (in 13 children a month later), blefaroptosis (10 children), and orbital congestion (12 children), all of which recovered within 6 months. More serious side effects of oftalmika artery stenosis (3 cases of permanent, temporary 1 case) and central retinal artery occlusion (two cases of permanent, one temporary).
Researchers recommend that each health care center is working on fluorescein angiography IAC always do first in order to assess ocular blood flow, especially for detecting atrophy of the choroid. The team of researchers themselves have diagnosed five cases of choroid atrophy among patients who participated in this study. "The impact of atrophy of the choroid to the sharpness of vision can be very bad boy. In fact, enucleation should be performed on the eyeball atrophy choroid; if not, the child continues to be blind," said dr. Shields. Not encountered in cases of arterial embolism, metastasis, neurological defects, occlusion of the internal carotid artery or femoral artery, and stroke in children.
Thus, dr. Shields concludes that although retinoblastoma is very responsive to the IAC, the tendency should be wary of the emergence of toxic effects due to exposure to chemotherapy or radiotherapy. Therefore, the IAC for retinoblastoma should be considered with caution in certain cases.