망막모세포종에 대한 일차 및 대안 경로를 통한 동맥 내 화학요법의 안구 보존 결과: 인도네시아 단일 기관 경험.

PURPOSE: To evaluate the efficacy and safety of intra-arterial chemotherapy (IAC) delivered via the internal carotid artery (ICA) and external carotid artery (ECA) anastomoses at a single Indonesian center.

MATERIALS AND

METHODS

A retrospective chart review was conducted of consecutive retinoblastoma cases treated with IAC between June 2022 and September 2025. Procedures were performed under general anesthesia via ultrasound-guided femoral arterial access. ICA catheterization using a diagnostic catheter was followed by ophthalmic artery (OA) cannulation with a microcatheter. Alternative access routes included the vertebrobasilar circulation and ECA branches (middle meningeal, internal maxillary, and zygomatico-orbital arteries). Melphalan (4-5 mg) was the primary agent for International Classification of Retinoblastoma Groups B-C, whereas topotecan and carboplatin were added for recurrent or advanced disease (Groups D-E). Recorded outcomes included the number of sessions, access route, procedure-related complications, globe salvage, and enucleation. Ocular survival was analyzed using Kaplan-Meier methods, and predictors of enucleation were assessed using multivariable Cox proportional hazards modeling.

RESULTS

Twenty-four eyes of 24 patients (median age, 13.7 months) underwent 65 IAC sessions (45 via ICA and 20 via ECA). Globe salvage was achieved in 19 of 24 eyes (79.2%) at 6 months, and 14 of 24 eyes (58.3%) remained enucleation-free at 39 months. Ocular survival was lower for ECA compared with ICA access (p = 0.01). On multivariable analysis, the ECA route independently predicted enucleation (hazard ratio, 6.24; 95% confidence interval, 1.09-35.76; p = 0.04). No severe ischemic perioperative complications were observed.

CONCLUSION

In this cohort, IAC provided favorable globe salvage with an acceptable safety profile. However, ECA access was associated with an increased risk of enucleation; therefore, direct OA access via the ICA is preferable when feasible. Larger prospective studies are warranted.