Success of intra-arterial chemotherapy (chemosurgery) for retinoblastoma: effect of orbitovascular anatomy

Arch Ophthalmol. 2012 Feb;130(2):180-5. doi: 10.1001/archophthalmol.2011.386.


Objectives: To review results of orbital angiography performed during intra-arterial chemotherapy (chemosurgery) for treatment of retinoblastoma to assess the association of angiographic variability in orbitovascular anatomy with tumor response and outcomes.

Methods: Medical records and 64 orbital angiograms were reviewed for 56 pediatric patients with retinoblastoma undergoing chemosurgery using a combination of melphalan hydrochloride, topotecan hydrochloride, or carboplatin. The major orbital arteries and capillary blush patterns were graded, and tumor response and recurrence were compared using the log-rank and Fisher exact tests.

Results: Statistically significant variables for tumor response were lacrimal artery prominence (P = .001), previous treatment (P = .003), and lacrimal blush (P = .004). The only statistically significant variable for vitreous seed response was ciliary body blush (P = .03). Statistically significant variables influencing time to recurrence and time to enucleation were choroidal blush absence (P = .01) and lacrimal artery presence (P = .03), respectively.

Conclusions: The success of intra-arterial chemotherapy is dependent on delivery of drug to the target tumor within the eye via the ophthalmic artery. Because of the small volume of drug used (0.50-1.25 mL per treatment) and the selectivity of catheterization, variables affecting orbital blood flow greatly influence drug delivery and the success of chemosurgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Blood Flow Velocity
  • Carboplatin / administration & dosage
  • Child
  • Child, Preschool
  • Female
  • Fluorescein Angiography
  • Humans
  • Infant
  • Infusions, Intra-Arterial
  • Male
  • Melphalan / administration & dosage
  • Ophthalmic Artery / physiology
  • Orbit / blood supply*
  • Regional Blood Flow
  • Retinal Neoplasms / diagnosis
  • Retinal Neoplasms / drug therapy*
  • Retinal Neoplasms / physiopathology
  • Retinoblastoma / diagnosis
  • Retinoblastoma / drug therapy*
  • Retinoblastoma / physiopathology
  • Topotecan / administration & dosage
  • Young Adult


  • Topotecan
  • Carboplatin
  • Melphalan