title: Success of intra-arterial chemotherapy (chemosurgery) for retinoblastoma: effect of orbitovascular anatomy.
abstract: OBJECTIVE
  To review results of orbital angiography performed during intra-arterial chemotherapy (chemosurgery) for treatment of retinoblastoma to assess the association of angiographic variability in orbitovascular anatomy with tumor response and outcomes.
  
  
  METHODS
  Medical records and 64 orbital angiograms were reviewed for 56 pediatric patients with retinoblastoma undergoing chemosurgery using a combination of melphalan hydrochloride, topotecan hydrochloride, or carboplatin. The major orbital arteries and capillary blush patterns were graded, and tumor response and recurrence were compared using the log-rank and Fisher exact tests.
  
  
  RESULTS
  Statistically significant variables for tumor response were lacrimal artery prominence (P = .001), previous treatment (P = .003), and lacrimal blush (P = .004). The only statistically significant variable for vitreous seed response was ciliary body blush (P = .03). Statistically significant variables influencing time to recurrence and time to enucleation were choroidal blush absence (P = .01) and lacrimal artery presence (P = .03), respectively.
  
  
  CONCLUSIONS
  The success of intra-arterial chemotherapy is dependent on delivery of drug to the target tumor within the eye via the ophthalmic artery. Because of the small volume of drug used (0.50-1.25 mL per treatment) and the selectivity of catheterization, variables affecting orbital blood flow greatly influence drug delivery and the success of chemosurgery.
authors.affiliation: Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marr
authors.forename: Crystal
authors.initials: C
authors.lastname: Hung
authors.forename: Yves P
authors.initials: YP
authors.lastname: Gobin
authors.forename: Ira J
authors.initials: IJ
authors.lastname: Dunkel
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brodie
authors.forename: David H
authors.initials: DH
authors.lastname: Abramson
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001783:Blood Flow Velocity; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007223:Infant; D007261:Infusions, Intra-Arterial; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D009880:Ophthalmic Artery / Q000502:physiology; D009915:Orbit / Q000098:blood supply*; D012039:Regional Blood Flow; D019572:Retinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012175:Retinoblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D019772:Topotecan / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D019772:Topotecan; D016190:Carboplatin; D008558:Melphalan