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MR Imaging of Adverse Effects and Ocular Growth Decline after Selective Intra-Arterial Chemotherapy for
Christiaan M de Bloeme1,2, Sabien van Elst1,2, Paolo Galluzzi3
1Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands.
Abstract:
This retrospective multicenter study examines therapy-induced orbital and ocular MRI findings in retinoblastoma patients following selective intra-arterial chemotherapy (SIAC) and quantifies the impact of SIAC on ocular and optic nerve growth. Patients were selected based on medical chart review, with inclusion criteria requiring the availability of posttreatment MR imaging encompassing T2-weighted and T1-weighted images (pre- and post-intravenous gadolinium administration). Qualitative features and quantitative measurements were independently scored by experienced radiologists, with deep learning segmentation aiding total eye volume assessment. Eyes were categorized into three groups: eyes receiving SIAC (Rb-SIAC), eyes treated with other eye-saving methods (Rb-control), and healthy eyes. The most prevalent adverse effects post-SIAC were inflammatory and vascular features, with therapy-induced contrast enhancement observed in the intraorbital optic nerve segment in 6% of patients. Quantitative analysis revealed significant growth arrest in Rb-SIAC eyes, particularly when treatment commenced ≤ 12 months of age. Optic nerve atrophy was a significant complication in Rb-SIAC eyes. In conclusion, this study highlights the vascular and inflammatory adverse effects observed post-SIAC in retinoblastoma patients and demonstrates a negative impact on eye and optic nerve growth, particularly in children treated ≤ 12 months of age, providing crucial insights for clinical management and future research.
Insights
Selective intra-arterial chemotherapy (SIAC) for retinoblastoma can cause inflammatory and vascular issues. Early SIAC treatment (≤12 months) significantly hinders ocular and optic nerve growth, leading to atrophy.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Radiology
Background:
- Retinoblastoma is the most common intraocular malignancy in children.
- Selective intra-arterial chemotherapy (SIAC) is an eye-sparing treatment for retinoblastoma.
- Understanding SIAC's long-term effects on ocular structures is crucial for patient management.
Purpose of the Study:
- To evaluate orbital and ocular magnetic resonance imaging (MRI) findings after SIAC in retinoblastoma patients.
- To quantify the impact of SIAC on eye and optic nerve growth.
- To identify adverse effects associated with SIAC treatment.
Main Methods:
- Retrospective multicenter study of retinoblastoma patients with posttreatment MRI.
- Inclusion criteria: availability of T2-weighted and T1-weighted post-contrast MRI.
- Eyes categorized into SIAC-treated, control (other eye-saving methods), and healthy groups.
- Qualitative assessment by radiologists and quantitative analysis using deep learning for eye volume.
Main Results:
- The most common adverse effects of SIAC were inflammatory and vascular changes.
- Therapy-induced contrast enhancement in the intraorbital optic nerve occurred in 6% of patients.
- SIAC significantly inhibited ocular and optic nerve growth, especially when initiated ≤12 months of age.
- Optic nerve atrophy was a notable complication in SIAC-treated eyes.
Conclusions:
- SIAC for retinoblastoma is associated with vascular and inflammatory complications.
- SIAC negatively impacts ocular and optic nerve growth, particularly in infants treated early.
- Findings provide insights for optimizing SIAC treatment protocols and follow-up care.
