OPTHAMOLOGY

Before and after images show the impact of intra-arterial chemotherapy for retinoblastoma in a pediatric patient.

Challenge met

Intra-arterial chemotherapy for retinoblastoma now offered at U-M

issue 20 | winter 2014

For children with retinoblastoma, the threat to a patient's life, eye and vision pose a challenge in treatment. Management options have included enucleation (removal of the eye); systemic chemotherapy alone or in combination with local laser treatment; or cryotherapy or external beam radiotherapy, depending on the extent of disease, involvement of the other eye and age of the patient.

At U-M, intra-arterial chemotherapy is made possible by the combined expertise of (left to right) neurointerventional radiologist Neeraj Chaudhary, M.D., MRCS, FRCR; pediatric oncologist Raymond Hutchinson, M.D.; ocular oncologist Hakan Demirci, M.D.; pediatric ophthalmologist Steven Archer, M.D.; and neurointerventional radiologist Joseph Gemmete, M.D.; along with (not shown) pediatric neurovascular surgeons Aditya Pandey, M.D., Cormac Maher, M.D., and Hugh Garton, M.D.

Now, U-M has become the first institution in Michigan, and one of a few in the country, to offer a new option for retinoblastoma. Called intra-arterial (IA) chemotherapy, or "chemosurgery," the approach allows delivery of chemotherapy agents directly to the site of the tumor, using neurointerventional techniques that navigate the ophthalmic artery and other neighboring vessels.

TARGETED TREATMENT

The treatment relies on precise navigation of a catheter from a femoral artery access through the internal carotid artery, into the ophthalmic artery and the tumor region. Typically the ophthalmic artery supplying the retina is cannulated for chemotherapy drug delivery directly into the retinal vessels and hence into the tumor. Alternative access into retinal vessels is also possible when the ophthalmic artery is non-navigable.

Until recently, patients have had to travel to hospitals in New York or Philadelphia for this treatment, which allows the patient to avoid the effects of systemic chemotherapy. IA chemotherapy should allow more patients to avoid enucleation and to retain some vision in the affected eye.

Early identification of retinoblastoma is key to patient outcomes. Pediatricians and ophthalmologists should have a high level of suspicion for retinoblastoma, especially in infants and young children with white pupils, crossed eyes or decreased vision. Most patients experience no pain or irritation.

U-M's neurointerventional team can also provide minimally invasive care for a broad range of other pediatric conditions involving the brain and spinal cord, and head, neck and facial vascular malformations.