The advancement of retinoblastoma treatment over the past 15 years may have resulted in a higher likelihood of vision preservation without compromising survival, according to a recent study presented by Kocharian et al at the Society of NeuroInterventional Surgery (SNIS) Annual Meeting 2024 and simultaneously published in the Journal of NeuroInterventional Surgery.
Background
The rare eye cancer retinoblastoma, which affects young children, carries a risk of impaired vision, removal of one or both eyes, and mortality if left untreated.
Intra-arterial chemotherapy is currently the standard treatment option for retinoblastoma. The therapy may help to minimize the need to remove the affected eye and maximize the ability to see after treatment as well as the potential to survive the cancer.
Study Methods and Results
In the study, a team of researchers comprising neurointerventionalists and ophthalmologic oncologists examined how pediatric patients responded to intra-arterial chemotherapy delivered directly to the affected eye. They evaluated the medical records of 571 pediatric patients who were separated into three cohorts 5 years apart to determine how routes of vascular access to the ophthalmic artery have evolved over time, how many patients have had complications from the procedure, and which combinations of chemotherapy drugs patients have received.
The researchers found that among a total of 2,402 attempted intra-arterial chemotherapy sessions, 99.5% (n = 2,391) of them were successful. Additionally, the success rates of super-selective catheterizations—where the ophthalmic artery was catheterized directly—also improved over time. Compared with an 80% success rate for the earliest procedures, 89.2% of the most recent procedures were found to be successful.
Procedure complication rates remained low over time: 0.7% for the earliest cohort, 1.1% in the middle cohort, and 0.6% in the most recent cohort. Further, the researchers revealed that a larger proportion of pediatric patients successfully received a three-drug chemotherapy combination, increasing from 21% of the earliest cohort to 66.7% of the most recent cohort.
Conclusions
“We are proud to share our history of ongoing success in using this minimally invasive method to care for some of our youngest patients [with cancer],” underscored lead study author Gary Kocharian, MD, Neurosurgery Chief Resident and Endovascular Neurosurgery Fellow at NewYork–Presbyterian Hospital.
The researchers suggested that a stepwise algorithm may help physicians to maximize direct vascular access to the ophthalmic artery. “Giving [pediatric patients] the opportunity to both keep their eyesight and beat this disease is life-changing for families across the world. We look forward to seeing what innovations are made in the next 15 years,” concluded co–study author Y. Pierre Gobin, MD, of NewYork–Presbyterian Hospital.
Disclosure: For full disclosures of the study authors, visit jnis.bmj.com.
