Intra-Arterial Chemotherapy for Retinoblastoma

What is intra-arterial chemotherapy?

Intra-arterial chemotherapy is a very precise and targeted way to deliver chemotherapy to kids with retinoblastoma, a cancer that happens in the eye. A specialized team, including a neurointerventional radiologist, with experience in both retinoblastoma and intra-arterial chemotherapy performs this procedure. Our experts thread a catheter from the femoral artery in a child’s groin all the way up to the eye.

This method of chemotherapy delivers a high dose of strong medication directly to the eye, which gives the care team the best chance to control the tumor.

Why perform intra-arterial chemotherapy?

Retinoblastoma can grow in many different parts of the eye. If it grows in the vitreous, or the jelly-like part of the eye, doctors can inject chemotherapy easily. If the retinoblastoma grows under the retina, intra-arterial chemotherapy is a highly effective method of treatment. Typically, kids get this treatment 2 to 7 times, with about a month between procedures.

What to expect during intra-arterial chemotherapy

Many cases of retinoblastoma take a year or more to control. Kids with the condition will have most of their procedures done under anesthesia, which puts them into a sleep-like state. Our pediatric anesthesia experts are specially trained in the unique needs of children.

After the anesthesia starts working the care team puts a catheter into the femoral artery. Surgeons access this major artery near the child’s groin. The team uses fluoroscopy, a type of imaging that uses continuous X-rays, to create a live view of the artery on a TV monitor. Our experts move the catheter through the patient’s bloodstream, guided by the image on the screen. They thread the catheter up into the aorta, past the heart, into the carotid artery and past the brain. They then find the tiny ophthalmic artery, which supplies the eye, and slowly deliver the chemotherapy into that area. The procedure takes between 1 and 3 hours, depending on how complex the child’s anatomy is.

Once we deliver the medicine, the team carefully removes the catheter. They also use a special patch to close the blood vessel. During this time, it is very important for the child to stay extremely still to avoid bleeding. Kids take pain medicine, which combines with the effects of the anesthesia to keep them calm. We monitor the blood vessels in the leg and groin to make sure no bleeding or blood clots occur.

After the procedure, kids stay in the hospital for at least one night so the care team can monitor their brain activity and make sure no blood vessels are damaged.

What to expect after intra-arterial chemotherapy

Kids usually can go home after just a night in the hospital. Most receive anti-inflammatory eye drops and possibly antibiotics. Children will have some bruising at the site where the team entered the femoral artery. Additionally, the chemotherapy is designed to kill the tumor, but it also can damage blood vessels inside the eye, creating some inflammation after the procedure.

Often, kids can have a blanching (whitening) or redness on the eyelid or the forehead. Sometimes they also lose some eyelashes or eyebrow after the procedure, but they typically grow back.

While these are all possible effects of intra-arterial chemotherapy, most kids return to school and their normal routines the next day. From start to finish, your child’s Children’s Colorado care team makes the experience as positive as possible.

Why choose us for intra-arterial chemotherapy?

It takes a whole group of experts to deliver comprehensive care for retinoblastoma. For this rare cancer, Children’s Colorado has built a program of just those experts. A team of highly skilled ophthalmologists, neuroradiologists, neurointerventionalists, medical oncologists, pathologists, child life specialists, social workers and many others come together to make sure we treat each child with incredible care and compassion. As the only academic medical center in a 500-mile radius, we have built a program that excels at treating this disease with evidence-based care. Thanks to our experience, skill and detailed approach, our success rates rival the best centers in the United States.