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.

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Abstract:

Aim. Was to describe the efficiency of conservative treatment of retinoblastoma (RB) by an association of local chemotherapy (LCT) as an alternative method for external beam radiation (EBR) therapy and enucleation. Also to reduce the local and systemic side effects of chemotherapy.

Materials and methods. Seven children (11 eyes) had intraocular RB. All of them underwent LCT at the Institute of pediatric oncology and hematology of the N.N. Blokhin Russian Cancer Research Center between February and 2011. There were two methods of LC -selective intra-arterial chemotherapy (Institute of clinical oncology of the N. N. Blokhin Russian Cancer Research Center) and intravitrea chemotherapy by melphalan.LCT was made after systemic chemotherapy in4of8 patients with advanced RB with clinica stages T2a or group С (n = 1), T2b or group D (n = 3), T2c or group E (n = 3) as an alternative to EBR therapy Other 4 of 8 patients were treated with LCT as alternative to enucleation because of new retinal, subretinal tumors and vitreous seeding after initial treatment - systemic chemotherapy with laser treatment or in combination with brachytherapy and/or EBR therapy. LCT was combined with brachytherapy (106Ru + 10^о) in one case (S. Fyodorov Eye Microsurgery Complex)

Results. Due to using of alternative conservative RB treatment we have saved 8 children with 10 of 11 eyes with indications for EBR therapy or enucleation. There were not systemic side effects of LCT. Ophthalmic complications were minimal, including lid and face hyperemia after intra-arterial chemotherapy.

Conclusion. LCT with melphalan has shown high effectiveness as a method of globe-conserving treatment of locally spread RB with a minimum of immediate complications. A small number of observations and the maximum period of observation 7 months do not allow to reliably estimate the long-term results of treatment that requires further research.  

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