title: Hemodynamic and Anatomic Variations Require an Adaptable Approach during Intra-Arterial Chemotherapy for Intraocular Retinoblastoma: Alternative Routes, Strategies, and Follow-Up.
abstract: Intra-arterial chemotherapy for retinoblastoma is not always a straightforward procedure, and it may require an adaptable approach. This study illustrates strategies used when the ophthalmic artery is difficult to catheterize or not visible, and it ascertains the effectiveness and safety of these strategies.
  
  
  
  A retrospective study was performed on a series of 108 eyes affected by intraocular retinoblastoma and selected for intra-arterial chemotherapy (follow-up range, 6-82 months). We recognized 3 different patterns of drug delivery: a fixed pattern through the ophthalmic artery, a fixed pattern through branches of the external carotid artery, and a variable pattern through either the ophthalmic or the external carotid artery.
  
  
  
  We performed 448 sessions of intra-arterial chemotherapy, 83.70% of them through the ophthalmic artery and 16.29% via the external carotid artery. In 24.52% of eyes, the procedure was performed at least once through branches of the external carotid artery. In 73 eyes, the pattern of drug delivery was fixed through the ophthalmic artery; for 9 eyes, it was fixed through branches of the external carotid artery; and for 17 eyes, the pattern was variable. Statistical analysis did not show any significant difference in the clinical outcome of the eyes (remission versus enucleation) treated with different patterns of drug delivery. Adverse events could not be correlated with any particular pattern.
  
  
  
  Alternative routes of intra-arterial chemotherapy for intraocular retinoblastoma appear in the short term as effective and safe as the traditional drug infusion through the ophthalmic artery.
authors.affiliation: From the Department of Molecular and Developmental Medicine (E.B., S.R.), University of Siena, Siena, Italy.
authors.forename: E
authors.identifier: 0000-0002-9681-4556
authors.initials: E
authors.lastname: Bertelli
authors.affiliation: Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.).
authors.forename: S
authors.identifier: 0000-0001-7158-4427
authors.initials: S
authors.lastname: Leonini
authors.affiliation: Pediatrics (D.G., S.M.).
authors.forename: D
authors.identifier: 0000-0002-5010-6167
authors.initials: D
authors.lastname: Galimberti
authors.affiliation: Pediatrics (D.G., S.M.).
authors.forename: S
authors.identifier: 0000-0002-2046-5126
authors.initials: S
authors.lastname: Moretti
authors.affiliation: Neurosurgical Intensive Care (R.T.), Azienda Ospedaliera Universitaria Senese, University of Siena, Policlinico "Santa Maria alle Scotte," Siena, Italy.
authors.forename: R
authors.identifier: 0000-0001-8675-0328
authors.initials: R
authors.lastname: Tinturini
authors.affiliation: Department of Medicine, Surgery and Neuroscience (T.H., S.D.F.), Unit of Ophthalmology, University of Siena, Policlinico "Santa Maria alle Scotte," Siena, Italy.
authors.forename: T
authors.identifier: 0000-0002-9267-2255
authors.initials: T
authors.lastname: Hadjistilianou
authors.affiliation: Department of Medicine, Surgery and Neuroscience (T.H., S.D.F.), Unit of Ophthalmology, University of Siena, Policlinico "Santa Maria alle Scotte," Siena, Italy.
authors.forename: S
authors.identifier: 0000-0001-7367-5891
authors.initials: S
authors.lastname: De Francesco
authors.affiliation: Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.).
authors.forename: D G
authors.identifier: 0000-0002-7357-7770
authors.initials: DG
authors.lastname: Romano
authors.affiliation: Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.).
authors.forename: I M
authors.identifier: 0000-0002-9729-3158
authors.initials: IM
authors.lastname: Vallone
authors.affiliation: Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.).
authors.forename: S
authors.identifier: 0000-0003-2625-1839
authors.initials: S
authors.lastname: Cioni
authors.affiliation: Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.).
authors.forename: P
authors.identifier: 0000-0002-4745-980X
authors.initials: P
authors.lastname: Gennari
authors.affiliation: Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.).
authors.forename: P
authors.identifier: 0000-0002-7553-5064
authors.initials: P
authors.lastname: Galluzzi
authors.affiliation: Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.).
authors.forename: I
authors.identifier: 0000-0001-6016-6609
authors.initials: I
authors.lastname: Grazzini
authors.affiliation: From the Department of Molecular and Developmental Medicine (E.B., S.R.), University of Siena, Siena, Italy.
authors.forename: S
authors.identifier: 0000-0001-6505-848X
authors.initials: S
authors.lastname: Rossi
authors.affiliation: Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.) sandrabracco64@gmail.com.
authors.forename: S
authors.identifier: 0000-0002-4721-1425
authors.initials: S
authors.lastname: Bracco
mesh_terms: D063405:Anatomic Variation; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002342:Carotid Artery, External / Q000033:anatomy & histology / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods*; D009880:Ophthalmic Artery / Q000033:anatomy & histology / Q000502:physiology; D019572:Retinal Neoplasms / Q000188:drug therapy*; D012175:Retinoblastoma / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents