Retinoblastoma: Intra-Ophthalmic Artery Chemotherapy

Intra-arterially delivered chemotherapy was first utilized for retinoblastoma in 1958. The treatment has since evolved with advances in endovascular neurosurgery which allows direct cannulation of the ophthalmic artery where high doses of chemotherapy are delivered to the eye affected by retinoblastoma while minimizing systemic exposure. This technique, known as super-selective intra-ophthalmic artery chemotherapy (SSIOAC), was initially described by Abramson and Gobin in 2008 in a phase I/II clinical trial for eyes with advanced disease, which would have otherwise required enucleation. Since then, SSIOAC has been performed by treatment centers in over 40 countries, with many reporting significantly increased ocular salvage rates compared with conventional treatment with intravenous chemotherapy. However, reports of local and systemic toxicities—namely the development of metastatic disease and death following prolonged efforts to save advanced, non-seeing eyes—have raised concerns regarding the safety of SSIOAC and precluded its unanimous adoption as a standard of care.