title: Intra-arterial chemotherapy as a treatment for intraocular retinoblastoma: alternatives to direct ophthalmic artery catheterization.
abstract: OBJECTIVE
  Intra-arterial chemotherapy is a very effective treatment option for intraocular retinoblastoma. However, direct catheterization of the OA is not always possible. The purpose of this work was to report our initial results with intra-arterial chemotherapy for intraocular retinoblastoma when delivery of the drug was not via direct catheterization of the OA.
  
  
  METHODS
  Retrospective review of 110 eyes (89 patients) undergoing a total of 351 intra-arterial treatments at our institution between 2006 and 2010 identified 18 eyes (14 patients) that received at least 1 infusion via a vascular route other than direct OA catheterization. Alternatives included catheterization of the orbital branch of the MMA and temporary balloon occlusion of the ICA.
  
  
  RESULTS
  Tumor control was observed in 17 of 18 eyes at a mean follow-up of 18.9 months (median, 17.5 months; range, 8-36 months). The mean number of intra-arterial infusions was 3.7 per eye (median, 3; range, 2-9). Treatment routes included the following: MMA only, 3 eyes; MMA + OA, 4 eyes; MMA + balloon, 2 eyes; balloon only, 1 eye; balloon + OA, 7 eyes; balloon + OA + MMA, 1 eye. Intra-arterial chemotherapies included melphalan, topotecan, and carboplatin. Complications were all transient. ERG readings were the following: stable, 10 eyes; improved, 3 eyes; reduced, 5 eyes. One patient died from a second malignancy (pinealoblastoma).
  
  
  CONCLUSIONS
  This initial experience shows that when direct OA catheterization is not possible, using alternative routes of intra-arterial chemotherapy saves eyes and preserves vision with acceptable side effects.
authors.affiliation: Department of Ophthalmology, New York-Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Klufas
authors.forename: Y P
authors.initials: YP
authors.lastname: Gobin
authors.forename: B
authors.initials: B
authors.lastname: Marr
authors.forename: S E
authors.initials: SE
authors.lastname: Brodie
authors.forename: I J
authors.initials: IJ
authors.lastname: Dunkel
authors.forename: D H
authors.initials: DH
authors.lastname: Abramson
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002343:Carotid Artery, Internal; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D004596:Electroretinography; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects; D008576:Meningeal Arteries; D009880:Ophthalmic Artery; D015641:Radiography, Interventional; D019572:Retinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D012175:Retinoblastoma / Q000175:diagnosis / Q000188:drug therapy*