Intra-arterial chemotherapy for Retinoblastoma.

What is intra-arterial chemotherapy? 

Intra-arterial chemotherapy refers to a novel treatment that consists in delivering the chemo directly into the artery feeding the eye, because of this doctors can use much smaller doses of chemo drugs (less than 10% of the doses used for systemic chemo). Therefore, there are significantly fewer side effects from the chemo.

Did you know? 

  • A thin catheter, no thicker than a strand of angel hair pasta,  is inserted into an artery in the thigh. The procedure is extremely delicate.
  • Intra-arterial chemotherapy can be used as the first treatment or for recurrent retinoblastoma.
  •  It is indicated in unilateral retinoblastoma (one eye involved) when children are 9 months or older and if there are no signs of cancer outside the eye (moderate or advanced disease). For minor retinoblastoma, less invasive treatments can be used.
  • Younger babies receive whole-body chemotherapy instead of intra-arterial chemotherapy because they have very small blood vessels.

 

History.

  • In 1945 The treatment of intraocular retinoblastoma was first performed by Algernon B. Reese.
  • During 1968 Other investigators including Kiribuchi in Japan experimented with local delivery of drug to the eye.
  • In 2004 the idea was revisited by Yamane & Kaneko from Japan. https://www.ncbi.nlm.nih.gov/pubmed/15108036
  • In 2006 the technique was adopted and revolutionized in the United States.

 

The Japanese technique of ‘selective ophthalmic artery infusion’ was further developed into ‘direct intra-arterial (ophthalmic artery) infusion’ under the pioneering work of Abramson and Gobin in New York, NY at Memorial Sloan-Kettering Cancer Center and New York-Presbyterian Hospital/Weill Cornell Medical Center under an institutional review board approved-protocol that began in May 2006. Abramson’s initial report on the technique was groundbreaking as it was the first truly selective delivery by direct catheterization of the ophthalmic artery which allows rapidness, efficiency, and safety in young children with intraocular Retinoblastoma. 

 

Experts:

  • David H. Abramson M,D Ophthalmic Oncologist, Chief, Ophthalmic Oncology Service, Department of Surgery at Memorial Sloan Kettering . Expert and pioneer in the field of intr-arterial Chemotherapy.
  • Y. Pierre Gobin M,D director of interventional neuroradiology at the Weill Cornell Brain and Spine Center. Expert and pioneer in the field of intr-arterial Chemotherapy.

 

Videos:

If you want to know more specific details such as: what is IAC, how it is done, classification and many other aspects, here is a useful video(9.34 minutes) of one of the most renowned groups that treat Retinoblastoma (Wills eye hospital).

 

 

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