Developing an Intra-Arterial Chemotherapy Program for Retinoblastoma: Successes, Challenges, and Opportunities

Monday, March 31, 2025

4:50 PM – 4:55 PM CT

Location: Music City Center, 205 A

Abstract Presenter(s)

Pavan K. Kottamasu, MD, MBA

Integrated IR Resident Physician
University of Rochester Medical Center, United States

Author/Co-author(s)

MP

Marc Porter, MD

Radiology Resident
University of Rochester Medical Center, Department of Imaging Sciences, United States
CP

Christian L. Pecoraro, MD

Integrated IR Resident Physician
University of Rochester Medical Center, United States
JX

Jingbing Xue, MD, PhD

Interventional Radiology Attending Physician
University of Rochester Medical Center, United States
VK

Vikas Khetan, MD

Ophthalmology Attending Physician
University of Rochester Medical Center, United States
AS

Ashwani K. Sharma, MD

Interventional Radiology Attending Physician
University of Rochester Medical Center, United States

Learning Objectives:

Learn the available treatments for retinoblastoma (RB) and understand the role of intra-arterial chemotherapy (IAC) in the treatment paradigm.

Understand the considerations for preparation for IAC cases, including patent selection, variant anatomy, and chemotherapeutic selection.

Describe our pre-, intra-, and post-procedural IAC protocols.

Review general outcomes for IAC in treatment of RB.

Discuss tips and tricks to building a successful IAC program.

Background:
Retinoblastoma (RB) is the most common intraocular malignancy of young children with an estimated incidence of 11.8 cases per million children less than 5 years of age in the US {1}.

Intra-arterial chemotherapy (IAC) is an emerging treatment for RB with favorable outcomes. The benefits of IAC include more localized delivery of the chemotherapeutic agent, decreased systemic side effects, and decreased risk of second non-ocular cancers, particularly in patients with heritable retinoblastoma.

The overall goal of IAC is globe preservation. While IAC does not completely eradicate the disease, it delays the need for enucleation with prosthetic globe implantation, as it allows the native globe to continue growing until the patient’s orbit reaches maturity {2-3}.

Clinical Findings/Procedure Details:
This exhibit will highlight common encountered obstacles during development of an IAC program, the importance of multidisciplinary collaboration, and the common technical failures that can occur during IAC delivery, including non-visualization or narrowing of the ophthalmic artery, variant anatomy, and most importantly, vasospasm of the ophthalmic artery during chemotherapy delivery. We will discuss our most frequently asked questions from parents prior to IAC treatment, the pre-medications and supplies we have prepared on our back table, and our protocol for post-procedure management. We will share several of our cases demonstrating the efficacy of IAC with pre- and post-procedural imaging and discuss future directions for our service line.

Conclusion and/or Teaching Points:
The development of our IAC program fills a procedural gap that was initially lacking in our region. Communication, collaboration, and preparation are critical when developing a successful IAC program. Most importantly, multidisciplinary group meetings that include the patient’s parents ensure that all members of the team are synchronized in all phases of the patient’s care.