Abstract:

Background: article describes methodology of a selective ophtalmic arterieal infusion (SOAI) ir organ-preserving treatment of children with an intraocular retinoblastoma and demonstrates various ways of delivery of chemotherapeutic agent to a tumor.

Aim: was to increase efficacy of SOAI in treatment of children with intraocular retinoblastoma Material and methods: 289 SOAI procedures to 127 children (143 eyes) have been performed from 2013 to 2017. 2 methods of a SOAI were applied: 1) the microcatheter technique (n=223) - superselective catheterization of an eye artery or collateral branches of an external carotid artery (ECA) at blood flow hemodynamic redistribution; 2) the microballoon technique - balloon-occluder on ipsilateral internal carotid artery (ICA) for prevention of chemoinfusion of brain arteries (n=58). Results: technical success was 96,5%(279 procedures). From 223 procedures with using of a microcatheter infusion was carried out in: a. ophthalmica - 156(70%), a.meningea media - 44 (20%), a.infraorbitalis - 20(11%), a. temp. superficialis - 2, a.facialis - 1. From 58 procedures with using of microballoon - 56 were successful. We didn't manage to put a balloon more distally than the place of an entry of an eye artery in 2 cases. Unsuccessful attempts - 10 cases: failure of catheterization of a femoral artery - in 2, a kinking of the ICA - in 2, a vascular collapse as a result of reaction to injection of contrast agent and/or mechanical impact on ICA - in 2, lack of contrasting of a retina - in 3, an occlusion of an ICA - in 1.

Conclusion: possession and use of various techniques for chemotherapeutic agent delivery to an eye tumor allows to achieve the maximum effect and doesn't depend on anatomy options and blood flow hemodynamic redistribution in main vessels of an eye.

References

1.     Abramson D.H., Dunkel I.J., Brodie S.E., et al. A phase I/II study of direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma initial results. Ophthalmology. 2008;115:1398-404, 1404.e1. Epub 2008 Mar 14.

2.     Abramson D.H., Dunkel I.J., Brodie S.E., et al. Bilateral superselective ophthalmic artery chemotherapy for bilateral retinoblastoma: tandemtherapy. Arch Ophthalmol 2010;128:370-72. AJNR Am J Neuroradiol. 33:1608-14.

3.     Abramson D.H., Dunkel I.J., Brodie S.E., et al.Superselective ophthalmic artery chemotherapy as primary treatment for retinoblastoma (chemosurgery). Ophthalmology. 2010; 117:1623-29.

4.     Abramson D.H. Super selective ophthalmic artery delivery of chemotherapyfor intraocular retinoblastoma: ‘chemosurgery’ the first Stallard lecture. Br J Ophthalmol. 2010; 94: 396-99.

5.     Gobin YP., Dunkel I.J., Marr B.P, et al.Intra-arterial chemotherapy for the management of retinoblastoma: four-year experience. Arch Ophthalmol. 2011;129: 732-37.

6.     Reese A.B., Hyman G.A., Merriam G.R. Jr, et al. Treatment of retinoblastoma by radiation and triethylenemelamine. AMA Arch Ophthalmol 1954; 53:505-13с.

7.     Hyman G.A., Reese A.B. Combination therapy of retinoblastoma with triethylene melamine and radiotherapy. J Am Med Assoc.1956; 162:1368-73.

8.     Meyer F., Zur anatomie der orbitalarteien. Morphologia Jahr. 1887; 12: 414-458.

9.     Hayreh S.S. The ophthalmic artery. III. Branches. British Journal of Ophthalmology. 1962; 46(4):212-247.

10.   Hayreh S.S. The ophthalmic artery: II. Intraorbital course. British Journal of Ophthalmology. 1962; 46(4): 212-247.

11.   Perrini P, Cardia A., Fraser K., Lanzino G. A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses. Journal of Neurosurgery. 2007; 106(1):142-150.

12.   Lang J. and Kageyama I. The ophthalmic artery and its branches, measurements and clinical importance. Surgical and Radiologic Anatomy. 1990; 12(2):83-90.

13.   Hayrehand S.S., Dass R. Theophthalmicartery: I.Origina and intra—cranial and intra—canalicular course. The British Journal of Ophthalmology. 1962; 46(2):65-98.

14.   Louw L. Different ophthalmic artery origins: embryology and clinical significance. Clinical Anatomy. 2015; 28(5): 576- 83.

15.   Hayreh S. S. Orbital vascular anatomy. Eye. 2006; 20(10):1130 -1144.

16.   Naeini R.M., De J., Satow T., Benndorf G. Unilateral agenesis of internal carotid artery with ophthalmic artery arising from posterior communicating artery. American Journal of Roentgenology. 2005; 184(2):571-573.

17.   Shimada K., Kaneko Y, Sato I., Ezure H., Murakami G. Classification of the ophthalmic artery that arises from the middle meningeal artery in Japanese adults. Okajimas Folia Anatomica Japonica. 1995; 72(2-3):163-176.

18.   Lasjaunias P, Vignaud J., Hasso A. N. Maxillary artery blood supply to the orbit: normal and pathological aspects. Neuroradiology. 1975; 9(2): 87-97.

19.   Geibprasert S., Pongpech S., Armstrong D., Krings T. Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know. American Journal of Neuroradiology. 2009; 30(8): 1459-1468.

20.   Klufas M.A., Gobin YP., Marr B., Brodie S.E., Dunkel I. J., Abramson D. H. Intra-arterial chemotherapy as a treatment for intraocular retinoblastoma: alternatives to direct ophthalmic artery catheterization. American Journal of Neuroradiology. 2012; 33(8):1608-1614.

21.   Picard L., Vignaud J., Lombardi G., Roland J. Radiological anatomy of the origin of the ophthalmic artery. Modern Problems in Ophthalmology. 1975; 4:164-169.

22.   Hassler W., Zentner J., Voigt K. Abnormal origin of the ophthalmic artery from the anterior cerebral artery: neuroradiological and intraoperative findings. Neuroradiology. 1989; 31(1): 85-87.

23.   Islak C., OgE G., Numan F., Cokyuksel O., Kuday C. Persistent nonmigrated ventral primitive ophthalmic artery. Report on one case. Journal of Neuroradiology. 1994; 21(1):46-49.

24.   Hannequin P, Peltier J., Destrieux C., Velut S., Havet E., Le Gars D. The interoptic course of a unique precommunicating anterior cerebral artery with aberrant origin of Anatomy Research International 7 an ophthalmic artery: an anatomic case report. Surgical and Radiologic Anatomy. 2013; 35(3): 269-271.

25.   Li Y, Horiuchi T., Yako T., Ishizaka S., Hongo K. Anomalous origin of the ophthalmic artery from the anterior cerebral artery. Neurologia Medico-Chirurgica. 2011; 51(8):579-581.

26.   Ogawa A., Tominaga T., Yoshimoto T., Kiyosawa M. Intraorbital ophthalmic artery aneurysm: case report. Neurosurgery. 1992; 31(6): 1102-1104.

27.   Kam C. K., Alvarez H., Lasjaunias P Double internal carotid origin of the ophthalmic artery with ruptured aneurysm of the posterior communicating artery. A case report. Interventional Neuroradiology. 2003; 9(4): 383-388.

28.   Uchino A., Saito N., Kurita H., Ishihara S. Double ophthalmic arteries arising from the internal carotid artery. Surgical and Radiologic Anatomy. 2013; 35(2): 173-175.

29.   Louw L., Steyl J., Loggenberg E. Imaging of dual ophthalmic arteries: identification of the central retinal artery. Journal of Clinical Imaging Science. 2014; 4(1): 40.

30.   Nakata H., Iwata Y Agenesis of the left internal carotid artery with an ophthalmic artery arising from the posterior communicating artery. No Shinkei Geka. 1987; 15(1):57- 62.

31.   Priman J., Christie D. H. A case of abnormal internal carotid artery and associated vascular anomalies. The Anatomical Record. 1959; 134(1):87-95.

32.   Sade B., Tampieri D., Mohr G. Ophthalmic artery originating from basilar artery: a rare variant. American Journal of Neuroradiology. 2004; 25(10):1730-1731.

33.   Schumacher M., Wakhloo A. K. An orbital arteriovenous malformation in a patient with origin of the ophthalmic artery from the basilar artery. American Journal of Neuroradiology. 1994; 15(3):550-553. 

Abstract:

Aim: a case report of a 5-year experience of regional (arterial chemoembolization) treatment of a patient with isolated liver metastases of skin melanoma.

Materials and Methods: in 1994, the patient performed excision of melanoma in the right scapular region. Patient didn't undergo another treatment. During examination in 2006 metastasis in the liver was revealed. Patient recieved five rounds of chemotherapy Aranoza, Temodal, Kanglite. Metastatic tumer, sized 16,5 х14,5 х18,5 cm, occupied right liver lobe with deformation of it. After gaining this data - patient received 2 courses of liver chemoembolization in 2008.

Results: during the 5 years follow-up - progression of tumor lesion is not noticed.

Conclusion: the optimal transarterial chemoembolization creates possibilities for an efficient delivery of drugs and tumor embolization particles in the affected organ, particularly in the liver. In addition to surgery (with resectable formations) and systemic chemotherapy, above capabilities regional transarterial therapy can provide long term as new palliative treatment of patients with metastatic melanoma.

References

1.     Davydov M.I., Axel E.M. Mortality in Russia and the CIS countries from cancer in 2009 [Mortality of population in Russian Federation and CIS from malignant neoplasms in 2009]. Vestnik RCRC im. N.N. Blokhin RAMS. 2011; 22(3) 1: 57 [In Russ].

2.     Tuomaala S., Eskelin S., Tarkkanen A., Kivela T. Population-based assessment of clinical characteristics predicting outcome of conjunctival melanoma in whites. Invest. Ophthalmol. Vis Sci 43: 3399-3408, 2002.

3.     Becker J.C., Terheyden P., Kampgen E., Wagner S., Neumann C., Schadendorf D., Steinmann A., Wittenberg G., Lieb W., BrockerE.B. Treatment of disseminated ocular melanoma with sequential fotemustine, interferon alpha, and inter-leukin 2. Br. J. Cancer 2002;87: 8400-845.

4.     Bedikian A.Y, Legha S.S., Mavligit G., Carrasco C.H., Khorana S., Pager C., Papadopoulos N., Benjamin R.S. Treatment of uveal melanoma metastatic to the liver. Cancer 76: 1665-1670, 1995.

5.     Aubin J.M., Rekman J., Vandenbroucke-Menu F., Lapointe R., Fairfull-Smith R.J., Mimeault R., Balaa F.K., Martel G. Systematic review and meta-analysis of liver resection for metastatic melanoma. Br. J. Surg. 2013 Aug;100(9):1138-47. doi: 10.1002/bjs.9189. Epub 2013 Jun 17.

6.     Ramia J.M., Garcfa-Bracamonte B., de la Plaza R., Ortiz P., Garcfa-Parreno J., Vanaclocha F. Surgical treatment of melanoma liver metastases. Cir. Esp. 2013 Jan;91 (1 ):4-8. doi: 10.1016/j.ciresp.2012.10.002. Epub 2012 Dec 6.

7.     Gragoudas E.S., Egan K.M., Seddon J.M., Glynn R.J., Walsh S.M., Finn S.M., Munzenrider J.E., Spar M.D. Survival of patients with metastases from uveal melanoma. Ophthalmology. 1991 ; 98:383-389.

8.     Agarwala S.S., Eggermont A.M., O'Day S., Zager J.S. Metastatic melanoma to the liver: A contemporary and comprehensive review of surgical, systemic, and regional therapeutic options. Cancer. 2013 Dec 2. doi: 10.1002/cncr.28480.

9.     Pyrhonen S. The treatment of metastatic uveal melanoma. Eur. J. Cancer 34(Suppl 3): S27-30, 1998.

10.   Mavligit G.M., Charnsangavej C., Carrasco C.H., Patt YZ., Benjamin R.S., Wallace S. Regression of ocular melanoma metastatic to the liver after hepatic arterial chemoembolization with cisplatin and polyvinyl sponge. JAMA. 1988; 260:974 -976.

11.   Stuart K. Chemoembolization in the management of liver tumors. Oncologist. 2003;8 : 425-437.

12.   Ahrar J., Gupta S., Ensor J., Ahrar K., Madoff D.C., Wallace M.J., Murthy R., Tam A., Hwu P, Bedikian A.Y Response, survival, and prognostic factors after hepatic arterial chemoembolization in patients with liver metastases from cutaneous melanoma. Cancer Invest. 2011 Jan;29(1 ):49-55. doi: 10.3109/07357907.2010.535052.

13.   Brown R.E., Gibler K.M., Metzger T., Trofimov I., Krebs H., Romero F.D., Scoggins C.R., McMasters K.M., Martin R.C. 2nd. Imaged guided transarterial chemoembolization with drug-eluting beads loaded with doxorubicin (DEBDOX) for hepatic metastases from melanoma: early outcomes from a multi-institutional registry. Am. Surg. 2011 Jan;77(1):93-8.

14.   Sharma K.V., Gould J.E., Harbour J.W., Linette G.P., Pilgram T.K., Dayani PN., Brown D.B. Hepatic arterial chemoembolization for management of metastatic melanoma. AJR Am. J. Roentgenol. 2008 Jan; 190(1): 99-104.

15.   Patel K., Sullivan K., Berd D., Mastrangelo M.J., Shields C.L., Shields J.A., Sato T. Chemoembolization of hepatic artery with BCNU for metastatic uveal melanoma: results of a phase II study. Melanoma Res 15(4): 297-304, 2005. 

16.   Vogl T., Eicheler K., Zangos S., Herzog C., Hammerstingl R., Balzer J., Gholami A. Preliminary experience with transarterial chemoembolization (TACE) in liver metastases of uveal malignant melanoma: local tumor control and survival. J. Cancer Res. Clin. Oncol. 133: 177-184, 2007.