Extra-Ocular Vascular and Cardiorespiratory Events During Intra-Arterial Chemotherapy in Children With Retinoblastoma: Incidence, Predictive Risk Factors, Management, and Impact on Further Treatment.

Abstract

Background: The purpose of this study was to report on the incidence of extra-ocular vascular and cardiorespiratory adverse events in patients treated with intra-arterial chemotherapy (IAC) for retinoblastoma and identify risk factors for their occurrence.

Procedure: This is a single-center retrospective study including 195 patients and 578 IACs performed at the Centre Hospitalier Universitaire Vaudois (CHUV) between 2008 and 2018. All patient's medical records of the study cohort were reviewed and securely stored in the REDCap database. Generalized estimating equations were used to identify risk factors for the occurrence of adverse events.

Results: Extra-ocular vascular events in IAC patients were observed in 14% of patients, were transient, and occured mainly during the procedure. Potential risk factors were younger age, increased procedure time, ophthalmic artery (OA) access via the external carotid artery (ECA), as well as bridge IAC. Cardiorespiratory events were observed in 25% of patients, and were all transient and manageable without consequences. Younger age was the only associated risk factor.

Conclusions: Extra-ocular and cardiorespiratory events during IAC are frequent, but are manageable by a trained team of pediatric interventional neuro-radiologists and anesthesiologists at a tertiary center, aware of these specific treatment-related risks. In addition, catheterization via the ECA should be avoided, when possible. Further studies are needed to ascertain the increased risk of extra-ocular vascular events via the ECA route.