“Micro-introducer access” intra-arterial chemotherapy for retinoblastoma in an 8-week-old infant

Abstract

Intra-arterial chemotherapy (IAC) for retinoblastoma has emerged as a standard therapy to facilitate globe salvage in patients with retinoblastoma. However, transfemoral endovascular catheterization of the ophthalmic artery is typically reserved for infants aged 3 months or older due to size of the patient and vascular anatomy. Here, the authors report a successful case of transfemoral intra-arterial chemotherapy delivery performed for group E retinoblastoma in an infant at 8 weeks of age who weighed only 4.1 kg using “micro-introducer sheath” technique to minimize the size of the arteriotomy. The patient received Melphalan, Topotecan, and Carboplatin via infusion through a microcatheter placed in the right ophthalmic artery. The procedure was tolerated well, and the patient went on to have two additional IAC procedures. Follow-up examinations under anesthesia showed tumor regression in response to chemotherapy. While typically reserved for older and larger patients, with proper technical expertise, transfemoral intra-arterial chemotherapy can be considered in such small infants with highly advanced disease. Keywords: Retinoblastoma, Intra-arterial chemotherapy, Endovascular, Ophthalmic artery, Pediatrics