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Intra-arterial Chemotherapy for the Treatment of Intraocular Retinoblastoma
This procedure involves administering melphalan hydrochloride, a chemotherapy agent, through the ophthalmic artery to treat intraocular retinoblastoma. Delivering the chemotherapy directly through the artery supplying the eye (ophthalmic artery) in certain patients with retinoblastoma is a safe and effective treatment alternative to conventional systemic chemotherapy, external beam radiation, and enucleation (surgical removal of the eye).
Our interdisciplinary team consists of Monica Pearl, M.D., an experienced Interventional Neuroradiologist who performs the procedure, Alan Friedman, M.D. of Pediatric Oncology, James Handa, M.D. of Ophthalmology and Philippe Gailloud, M.D. of Interventional Neuroradiology.
How is intra-arterial chemotherapy different from systemic chemotherapy?
Systemic chemotherapy involves injecting anti-cancer medications into a vein or giving them by mouth. This exposes the entire body to significant doses of chemotherapy, which can make the patient sick as it fights the cancer. Intra-arterial chemotherapy delivers the anti-cancer medication directly to the tumor via the ophthalmic artery, thereby transforming the treatment from systemic to local chemotherapy and limiting the complications and adverse events associated with toxicity from systemic chemotherapy.
Who is eligible for this treatment?
Patients considered for this treatment are those with unilateral or bilateral intraocular retinoblastoma who would otherwise be treated by systemic chemotherapy, external beam radiation, or enucleation.
Patients with small, localized intraocular retinoblastoma that can be treated with focal therapy such as laser or crythotherapy. Patients with extraocular disease on MRI, disorders of coagulation or vasculopathy, and abnormal renal function are not eligible to receive this treatment.
The Division of Interventional Neuroradiology has developed a treatment diary that addresses challenges in treating children with retinoblastoma. The book engages the child and parent with "Jane's Story," which explains the importance of documenting how the child feels during the treatment. The story describes the procedure through characters that the child can relate to. The parent then guides the child through the diary and writes the entries with them, providing a chronological record for the physician. Stickers are supplied for recording pain intensity and to add interactivity to the story. The "Treatment Diary" was written by Dr. Monica Pearl, "Jane's Story" was written and illustrated by Lydia Gregg, image © 2011 Johns Hopkins Division of Interventional Neuroradiology.
Animation by Amy Dixon on retinoblastoma treatment:
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