Vascular aspects and complications of intraarterial chemotherapy in children with retinoblastoma : a ten-year experience

Intra-arterial chemotherapy (IAC) through the ophthalmic artery by catheterization of the iliac artery has been developed as novel treatment option in 2008 for patients with retinoblastoma, with the aim to avoid enucleation and/or radiotherapy. Although very efficient, various side effects can be observed. Many studies described safety and efficacy of IAC(10–12)(16–21). However, little has been said on catheterization-related non ocular vascular problems encountered during IAC for the treatment of retinoblastoma. The majority of studies are based on retrospective case analysis, small cohorts of patients and short median follow-up(24)(28)(29), especially concerning the evaluation of systemic and vascular events(28)(29). To our knowledge, there is no study that assessed specifically systemic non-ocular vascular complications in children who underwent IAC for the treatment of retinoblastoma. Therefore, the aim of the current study is to review our patient cohort treated with IAC at the CHUV between 2008 and 2018, focusing on systemic vascular aspects of the received treatment, and to assess the type, number and grade of systemic vascular events following IAC. In this study, we reviewed 581 IAC procedures, in 196 patients and 215 eyes that were performed at the CHUV between 2008 and 2018. We found that vascular events in patients treated with IAC occurred in 14% of the procedures, mainly peri-procedural, were transient, without major events (such as strokes), and recover completely without sequelae at follow-up. Anesthesia related events were very frequent and diverse, occurring in 25% of procedures which is more than reported in retinoblastoma literature so far (24) or during cardiac catheterization (30,31). They are mainly related to the anatomy and procedure and are manageable by an experienced anesthesiologist. The analysis of this study being far from complete, further analysis of data is planned and will focus on the identification of risk factors that could explain and potentially predict the development of certain type of vascular and /or anesthesia related events