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Singh A, Raval V, Sedaghat A, Kaliki S. Evolving criteria for group E retinoblastoma (2): Impact on outcomes. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00139-X. [PMID: 38830602 DOI: 10.1016/j.jcjo.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/13/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To assess the impact of evolving criteria for group E retinoblastoma on ocular survival outcomes. DESIGN A retrospective observational study. METHODS Single-institution consecutive case series of patients with advanced intraocular retinoblastoma (groups D and E) were classified based on International Intraocular Retinoblastoma Classification (IIRC) and International Classification of Retinoblastoma (ICRB) criteria. The main outcomes measured were ocular survival, frequency of histopathologic risk factors (HRF), and the need for adjuvant therapy. RESULTS A total of 332 eyes of 298 patients were classified into group D (150, 45%) and E eyes (182, 55%) based on IIRC criteria. ICRB classification resulted in upstaging of 57 group D eyes (17%) to group E. Eyes that were upstaged to group E from D in the ICRB classification (E1) differed significantly, with a greater proportion undergoing primary enucleation (17 of 57, 30%) than those that were not (10 of 93, 11%) (p = 0.003). Similar significant differences were observed between group E2 and E3 eyes (p < 0.0001). Ocular survival according to Kaplan-Meier estimates at 12 months of 79%, 59%, 49%, and 1% differed significantly between all groups (ICRB D, E1, E2, and E3, respectively). CONCLUSION Proposed new subgrouping of group E eyes into E1, E2, and E3 based on clinical criteria is based upon natural history of tumor progression and is predictive of ocular survival. Preservation of the existing lower boundaries for group E by ICRB and IIRC offers the possibility of reanalyzing existing published data.
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Affiliation(s)
- Arun Singh
- Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vishal Raval
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Ahad Sedaghat
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India.
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2
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de Bloeme CM, van Elst S, Galluzzi P, Jansen RW, de Haan J, Göricke S, Moll AC, Bot JCJ, Munier FL, Beck-Popovic M, Puccinelli F, Aerts I, Hadjistilianou T, Sirin S, Koob M, Brisse HJ, Cardoen L, Maeder P, de Jong MC, de Graaf P. MR Imaging of Adverse Effects and Ocular Growth Decline after Selective Intra-Arterial Chemotherapy for Retinoblastoma. Cancers (Basel) 2024; 16:1899. [PMID: 38791976 PMCID: PMC11120425 DOI: 10.3390/cancers16101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
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.
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Affiliation(s)
- Christiaan M. de Bloeme
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Sabien van Elst
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Paolo Galluzzi
- Department of Neuroimaging Unit, Siena University Hospital, 53100 Siena, Italy
| | - Robin W. Jansen
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Joeka de Haan
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
| | - Sophia Göricke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany
| | - Annette C. Moll
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Joseph C. J. Bot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Francis L. Munier
- Unit of Pediatric Ocular Oncology, Jules-Gonin Eye Hospital, University of Lausanne, 1015 Lausanne, Switzerland
| | - Maja Beck-Popovic
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Francesco Puccinelli
- Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Isabelle Aerts
- Pediatricic Department, Institut Curie, PSL Research University, 75005 Paris, France
| | - Theodora Hadjistilianou
- Unit of Ophthalmology and Referral Center for Retinoblastoma, Department of Surgery, Policlinico “Santa Maria alle Scotte”, 53100 Siena, Italy
| | - Selma Sirin
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Mériam Koob
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Hervé J. Brisse
- Imaging Department, Institut Curie, Paris University, 75005 Paris, France
| | - Liesbeth Cardoen
- Imaging Department, Institut Curie, Paris University, 75005 Paris, France
| | - Philippe Maeder
- Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Marcus C. de Jong
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Pim de Graaf
- Cancer Center Amsterdam, Imaging and Biomarkers, 1081 HV Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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Sedaghat A, Raval V, Jia R, Fan X, Singh AD. Advanced intraocular retinoblastoma: evolving criteria for group E disease. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00068-1. [PMID: 38688458 DOI: 10.1016/j.jcjo.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 05/02/2024]
Abstract
With evolving criteria for classifying intraocular retinoblastoma (RB) from International Intraocular Retinoblastoma Classification (IIRC, 2005) to International Classification of Retinoblastoma (ICRB, 2006), there have been changes in the inclusion criteria for groups E eyes that have not been widely recognized. This brief review highlights issues with the current classification systems (ICRB and IIRC) and layouts a theoretical framework arguing for merging of 2 existing classifications into 1 and subdividing the expanded group E RB, thereby preserving the possibility to reanalyze existing published data.
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Affiliation(s)
- Ahad Sedaghat
- Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH
| | - Vishal Raval
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Arun D Singh
- Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH.
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Mohammad M, Mehyar M, Halalsheh H, Shehada R, Al Adawi O, Khzouz J, Jaradat I, Al-Hussaini M, Sultan I, Alnawaiseh I, Yousef YA. The Impact of Tumor Laterality (Unilateral vs. Bilateral) on Presentation and Management Outcome in Patients with Retinoblastoma. J Clin Med 2024; 13:2146. [PMID: 38610910 PMCID: PMC11012679 DOI: 10.3390/jcm13072146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This study compares the outcomes of managing retinoblastoma between patients with unilateral and bilateral presentations. Methods: The study, conducted at the King Hussein Cancer Center in Amman, Jordan, retrospectively analyzed cases of retinoblastoma treated between March 2003 and December 2019. Evaluation criteria included clinical features, disease stage, treatment methods, and overall management outcomes. Results: The study comprised 697 eyes from 478 patients with retinoblastoma, with 52% being males. Bilateral disease was observed in 70% of patients, and a family history of retinoblastoma was more prevalent in cases with bilateral disease (20%) compared to those with unilateral disease (4%). Unilateral cases had a median age at diagnosis of 28 months, whereas bilateral cases were diagnosed at a median age of 6 months. Extra-ocular retinoblastoma was detected in 1% of eyes. According to the International Intraocular Retinoblastoma Classification (IIRC), 88% of unilateral cases presented with advanced disease (IIRC group D/E), compared to 46% in bilateral cases. Primary enucleation was performed in 29% of unilateral cases and 16% of bilateral cases (p-value 0.0007). Eye salvage rates were 31% in unilateral cases and 68% in bilateral cases (p-value < 0.0001). At 120 months of follow-up, 5% of patients died from secondary neoplasms or metastases, 81% were alive, and 14% were lost to follow-up. There was no significant difference in metastasis, secondary neoplasms, or mortality between patients with unilateral and bilateral retinoblastoma. Conclusions: This study highlights the nuanced differences in clinical characteristics and outcomes between unilateral and bilateral retinoblastoma, emphasizing the necessity of customized management and early detection strategies. It demonstrates that while bilateral retinoblastoma benefits from earlier detection and has a higher rate of eye salvage, there is no significant difference in metastasis or mortality rates when compared to unilateral cases. The critical roles of primary enucleation in advanced cases, along with effective communication and patient education, are also underscored to improve treatment adherence. Overall, these findings point to the importance of tailored approaches in optimizing outcomes for the diverse patient population affected by retinoblastoma.
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Affiliation(s)
- Mona Mohammad
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
| | - Mustafa Mehyar
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
| | - Hadeel Halalsheh
- Pediatric Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (H.H.); (I.S.)
- Pediatric Department, University of Jordan, Amman 11941, Jordan
| | - Reham Shehada
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
| | - Omar Al Adawi
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
| | - Jakub Khzouz
- Pathology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (J.K.); (M.A.-H.)
| | - Imad Jaradat
- Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan;
| | - Maysa Al-Hussaini
- Pathology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (J.K.); (M.A.-H.)
| | - Iyad Sultan
- Pediatric Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (H.H.); (I.S.)
| | - Ibrahim Alnawaiseh
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
| | - Yacoub A. Yousef
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
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Rusakevich AM, Nahhas MI, Zhou B, Dannenbaum MJ, Bretana ME, Schefler AC. Angiographic characteristics and treatment approach in patients undergoing intra-arterial chemotherapy for retinoblastoma. Graefes Arch Clin Exp Ophthalmol 2024; 262:1321-1328. [PMID: 38032379 DOI: 10.1007/s00417-023-06279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/11/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE To identify the specific clinical and angiographic variables that determine the success of intra-arterial chemotherapy (IAC) in a patient with retinoblastoma. METHODS Medical records from patients undergoing intra-arterial chemotherapy for the treatment of retinoblastoma between January 2015 and June 2020 within a large academic ocular oncology practice were retrospectively reviewed. Demographics were recorded together with clinical, ocular, and angiographic variables such as the diameter of the ophthalmic artery (OA), angle of ophthalmic artery takeoff, and branching pattern of ophthalmic vasculature. RESULTS Forty-four eyes from 33 patients with retinoblastoma treated with IAC were identified. Over the total 32 mean months of follow-up, these patients received 144 total catheterizations and a mean of 3.2 IAC cycles for each eye. The number of IAC cycles and the chemotherapeutic agent used did not vary significantly with worsening International Classification of Retinoblastoma (ICRB) groups (P > 0.1). Cumulative dose did not vary with the ICRB group for eyes treated with melphalan, topotecan, or carboplatin (P > 0.1). A higher ICRB group was associated with a smaller mean ophthalmic artery diameter across all procedures (P = 0.016), and femoral artery diameter did not vary significantly between ICRB groups (P = 0.906). A higher cumulative dose of IAC was significantly associated with a smaller takeoff angle of the OA (melphalan, P = 0.011; topotecan, P = 0.009; carboplatin, P = 0.031) in patients who underwent successful IAC procedures. Ophthalmic artery diameter and femoral artery diameter did not have a significant association (P > 0.1) with higher IAC doses in successful IACs. Cumulative IAC dose was not significantly associated with ophthalmic vasculature branching pattern, presence of choroidal blush, temporary OA vasospasm reported during the procedure, and OA occlusion upon microcatheter placement. CONCLUSION In this study, neurosurgical angioanatomy appeared to influence the cumulative dose of chemotherapy needed during IAC for retinoblastoma. In the future, these anatomic variables may be used to guide the frequency of monitoring, dosing, and estimation of recurrence risk.
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Affiliation(s)
| | - Michael I Nahhas
- University of Texas Health Science Center at Houston, 6560 Fannin St., Suite 750, Houston, TX, 77030, USA
| | - Brenda Zhou
- Retina Consultants of Texas, Houston, TX, USA
| | - Mark J Dannenbaum
- University of Texas Health Science Center at Houston, 6560 Fannin St., Suite 750, Houston, TX, 77030, USA
| | | | - Amy C Schefler
- Retina Consultants of Texas, Houston, TX, USA.
- University of Texas Health Science Center at Houston, 6560 Fannin St., Suite 750, Houston, TX, 77030, USA.
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Kolyvas P, Mir A, Stirrat T, Brookner B, Pilar N, Monroe E, Ahuja R. Advanced Interventional Treatments in Retinoblastoma Management: A Comprehensive Review. Cardiovasc Intervent Radiol 2024; 47:407-415. [PMID: 38509339 DOI: 10.1007/s00270-024-03692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024]
Abstract
Retinoblastoma is the most common eye malignancy in children that if left untreated can invade intraocular structures, metastasize, and rarely lead to death. Traditionally treated with systemic chemotherapy, Intra-arterial chemotherapy is gaining popularity as it allows for the direct administration of chemotherapy through the ophthalmic artery, thus reducing systemic side effects. Intra-arterial chemotherapy procedures have evolved, with refinements to reduce risks and radiation exposure. Intra-arterial chemotherapy boasts an impressive technical success rate and one year ocular survival even amongst advanced cases. This review offers a thorough examination of the technique, indications, contraindications, outcomes, and alternative options for Intra-arterial chemotherapy.
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Affiliation(s)
- Peter Kolyvas
- Department of Radiology, Georgetown University School of Medicine, Washington, USA.
| | - Aazrin Mir
- Department of Radiology, Georgetown University School of Medicine, Washington, USA
| | - Thomas Stirrat
- Department of Radiology, Georgetown University School of Medicine, Washington, USA
| | - Brittany Brookner
- Department of Radiology, Georgetown University School of Medicine, Washington, USA
| | - Nathanael Pilar
- Department of Radiology, Georgetown University School of Medicine, Washington, USA
| | - Eric Monroe
- Department of Radiology, University of Wisconsin, Madison, USA
| | - Rakesh Ahuja
- McGovern Medical School, Diagnostic and Interventional Radiology, The University of Texas Health Science Center Houston, Houston, USA
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7
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Kritfuangfoo T, Rojanaporn D. Update on chemotherapy modalities for retinoblastoma: Progress and challenges. Asia Pac J Ophthalmol (Phila) 2024; 13:100061. [PMID: 38641204 DOI: 10.1016/j.apjo.2024.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
Retinoblastoma stands as a paradigm of success in treating malignancies among pediatric patients. Over recent decades, the approach to managing retinoblastoma has evolved significantly, transitioning from the preservation of patients' lives to the preservation of eyes and vision while minimizing treatment-related complications. Chemotherapy, administered through diverse routes, has solidified its role as the cornerstone of retinoblastoma treatment. In addition to intravenous chemotherapy (IVC), alternative administration routes, including intraarterial (IAC), intravitreal, intracameral, and periocular delivery, have emerged as promising modalities for retinoblastoma management. Numerous studies have demonstrated outstanding outcomes, achieving nearly 100% salvage rates for eyes classified under groups A-C. However, for advanced intraocular retinoblastoma (groups D and E eyes), IAC appears to offer superior local control rates compared to IVC. Intravitreal injection of chemotherapeutic agents, when administered in a controlled and secure manner, holds promise in averting the need for enucleation and radiotherapy in advanced retinoblastoma cases presenting with vitreous seeds. The optimal chemotherapy strategy remains meticulously tailored based on numerous factors. This review provides a comprehensive update on chemotherapy across various routes, encompassing key considerations, dosages, administration methods, treatment outcomes, and potential complications. Furthermore, it explores emerging potential treatments and outlines future directions aimed at enhancing treatment outcomes.
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Affiliation(s)
- Thanaporn Kritfuangfoo
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand; Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Duangnate Rojanaporn
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
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Raval V, Singh A. Management of retinoblastoma: are we there yet? CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00028-0. [PMID: 38431272 DOI: 10.1016/j.jcjo.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
Since the introduction of intraarterial chemotherapy (IAC) in the last decade, there has been a paradigm shift in the management of retinoblastoma (RB), especially in developed countries. Despite improved globe salvage outcomes with IAC compared with systemic intravenous chemotherapy, IAC has certain limitations, such as poor accessibility and affordability, especially for middle- and low-income countries; the need for expertise; local ocular complications; and possible increased risk of systemic metastasis. This review discusses the important limitations of the current treatment strategy of using IAC, as well as the prospects of new therapeutic targets or routes of drug delivery that may lead to further improvements in the management of RB.
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Affiliation(s)
- Vishal Raval
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Arun Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio..
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Wen X, Fan J, Jin M, Jiang H, Li J, Han M, Zhang C, He X, Luo Y, Yang J, Zhou M, Tan J, Yang X, Ji X, Zhang J, Zhao J, Jia R, Fan X. Intravenous versus super-selected intra-arterial chemotherapy in children with advanced unilateral retinoblastoma: an open-label, multicentre, randomised trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:613-620. [PMID: 37536351 DOI: 10.1016/s2352-4642(23)00141-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Super-selected intra-arterial chemotherapy has increasingly been used as conservative management for retinoblastoma during the past decade. However, the absence of evidence from randomised controlled trials engendered controversy in the administration route of chemotherapy. We aimed to assess the efficacy and safety of intra-arterial chemotherapy compared with intravenous chemotherapy. METHODS This open-label, multicentre, randomised trial was done at six hospitals in China. Patients with new-onset unilateral group D or E retinoblastoma (poorly defined, large, or very large tumours, according to the International Intraocular Retinoblastoma Classification) without high-risk clinical factors were included. Patients were randomly assigned (1:1) to receive intra-arterial chemotherapy (injections of 0·5 mg/kg [or depending on age] melphalan with 20 mg carboplatin [first and third cycles] or with 1 mg topotecan [second and fourth cycles]) or intravenous chemotherapy (0·05 mg/kg [or 1·5 mg/m2] vincristine, 5 mg/kg [or 150 mg/m2] etoposide, and 18·6 mg/kg [or 560 mg/m2] carboplatin for six cycles). After intra-arterial chemotherapy, patients received a subcutaneous injection of 0·1 mL nadroparin calcium twice at a 12 h interval. Both intra-arterial and intravenous chemotherapy cycles were completed every 4 weeks. No masking was done, except of independent statisticians, who were masked to the allocation information. The primary outcome was 2-year progression-free globe salvage rate, defined as the time from randomisation to tumour progression or enucleation, whichever occurred first, and was analysed by intention to treat. We also recorded predefined safety outcomes (myelosuppression and ophthalmic arterial stenosis or occlusion) and severe adverse events likely to be related to study treatment. The study is registered with the Chinese Clinical Trial Registry, ChiCTR-IPR-15006469, and is complete. FINDINGS Between June 1, 2015, and June 1, 2018, 234 patients with newly diagnosed retinoblastoma were screened and 143 eligible patients (median age 23·6 months [IQR 14·0-31·9]) were enrolled and randomly assigned to the intra-arterial chemotherapy group (n=72) or the intravenous chemotherapy group (n=71). At a median follow-up of 35·8 months (IQR 28·4-43·0), the 2-year progression-free globe salvage rate was 53% (38 of 72 patients) in the intra-arterial chemotherapy group and 27% (19 of 71 patients) in the intravenous chemotherapy group (risk ratio 1·97, 95% CI 1·27-3·07, p=0·0020). Myelosuppression was less common in the intra-arterial chemotherapy group than in the intravenous chemotherapy group (37 [51%] of 72 patients vs 50 [70%] of 71 patients; 0·73, 95% CI 0·56-0·96, p=0·021) and less severe (ptrend=0·0070). In the intra-arterial chemotherapy group, two (3%) of 72 patients had ophthalmic artery occlusion and 13 (18%) patients had ophthalmic artery stenosis. INTERPRETATION Our findings show that intra-arterial chemotherapy could significantly improve the globe salvage rate in children with advanced unilateral retinoblastoma compared with intravenous chemotherapy, with mild systemic complications and no difference in overall survival rate. Intra-arterial chemotherapy could be an acceptable first-line treatment in children with advanced unilateral retinoblastoma. FUNDING Scientific Research Program of the National Health and Family Planning Commission of China, the Clinical Research Plan of Shanghai Hospital Development Center, the National Natural Science Foundation of China, and the Science and Technology Commission of Shanghai Municipality.
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Affiliation(s)
- Xuyang Wen
- Department of Ophthalmology, Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayan Fan
- Department of Ophthalmology, Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mei Jin
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hua Jiang
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiakai Li
- Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minglei Han
- Department of Ophthalmology, Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengyue Zhang
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoyu He
- Department of Ophthalmology, Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingxiu Luo
- Department of Ophthalmology, Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Yang
- Department of Ophthalmology, Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhou
- Department of Ophthalmology, Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Tan
- Eye Center of Xiangya Hospital and Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Xinji Yang
- Senior department of Ophthalmology, the third medical center of Chinese PLA General Hospital, Beijing, China
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China; Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Junyang Zhao
- National Center for Pediatric Center Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Mohammad M, Shehada R, Al-Nawaiseh I, Mehyar M, AlHussaini M, Jaradat I, Sultan I, Halalsheh H, Khzouz J, Yousef YA. A comparison of high risk pathological features between primary and secondary enucleation for retinoblastoma. Eur J Ophthalmol 2023; 33:2014-2023. [PMID: 36760120 DOI: 10.1177/11206721231155671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
AIM To compare the risk and pattern of High-Risk Pathologic Features (HRPF) in retinoblastoma between primary and secondary enucleation. METHODS A retrospective analysis of 121 eyes from 118 patients who underwent enucleation at the King Hussein Cancer Center (KHCC) Amman, Jordan, between November 2009 and January 2020. Demographic information, tumor stage, time from diagnosis-to-enucleation, results of pathology, metastasis, and mortality were retrieved. RESULTS Patients in the secondary group (49/121 eyes, 40%) were considerably younger at diagnosis (p = 0.0014), had bilateral disease (p = 0.0001), and had less-progressed disease at presentation (p = 0.016) compared to the primary enucleation. Primarily enucleated eyes were more-likely to have massive choroidal invasion (p = 0.0315) and post-laminar optic nerve invasion (p = 0.027), in spite of the finding that the overall prevalence of HRPF was similar between the two groups (35.5 percent vs. 37.5 percent; p = 0.585). The likelihood of anterior chamber invasion, was considerably higher in secondary enucleated eyes (p = 0.013). We evaluated primary and secondary enucleation for each subgroup (D and E) of the International Intraocular Retinoblastoma Classification (IIRC) and found the prevalence of HRPF was comparable (p = 0.58, 1.0, respectively). The difference in time between diagnosis-to-enucleation in secondary enucleation did not predict HRPF (p = 0.50). There was no discernible difference between primary and secondary enucleated eyes in terms of metastasis or survival (p = 0.156 and 0.44, respectively). CONCLUSION Systemic chemotherapy has the ability to reduce the extent of tumor expansion that has been pathologically identified. Primary and secondary enucleated eyes are comparable in low metastatic risk only when strict examination and management guidelines are followed.
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Affiliation(s)
- Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Reham Shehada
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Ibrahim Al-Nawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Maysa AlHussaini
- Department of Pathology, King Hussein Cancer Centre, Amman, Jordan
| | - Imad Jaradat
- Department of Radiation Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Hadeel Halalsheh
- Department of Pediatric Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Jakub Khzouz
- Department of Pathology, King Hussein Cancer Centre, Amman, Jordan
| | - Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
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11
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Feng ZX, Zhao J, Zhang N, Jin M, Gallie B. Adjuvant Chemotherapy Improves Survival for Children With Massive Choroidal Invasion of Retinoblastoma. Invest Ophthalmol Vis Sci 2023; 64:27. [PMID: 37603354 PMCID: PMC10445210 DOI: 10.1167/iovs.64.11.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/30/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose The purpose of this study was to investigate the effect of adjuvant chemotherapy on outcomes of children with massive choroidal invasion (MCI). Methods In this study, we reviewed the 5-year relapse-free survival (RFS) and overall survival (OS) of children diagnosed with MCI, managed with or without adjuvant chemotherapy. Excluded were children with additional other high-risk features (post-laminar optic nerve invasion, scleral invasion, or overt extraocular disease). Results Of 3566 children diagnosed with retinoblastoma, 2023 had enucleation, and 60 eyes of 60 children had pathology showing MCI without concomitant high-risk features. Enucleation was primary (22, 37%), or secondary (38, 63%) after failed eye salvage. Adjuvant systemic chemotherapy (median = 4, range = 1-8 cycles) was given to 48 of 60 (80%) children; 12 of 60 (20%) children had no adjuvant therapy. Five-year RFS was 88.5% (95% confidence interval [CI] = 79.7%-97.3%) and 5-year OS was 90.1% (95% CI = 81.7%-98.5%). Pre-enucleation chemotherapy did not affect RFS (89.7% vs. 75.0%; P = 0.657). Adjuvant chemotherapy improved RFS (97.2% vs. 55.6%; P < 0.001) and OS (97.2% vs. 66.7%; P < 0.001). In subgroup analysis, adjuvant chemotherapy improved RFS for both primarily enucleated (5-year RFS 100% vs. 50.0%; P = 0.002) and secondarily enucleated children (5-year RFS 95.8% vs. 60.0%; P = 0.005). The number of children treated with adjuvant chemotherapy to prevent one post-enucleation systemic relapse or death is three. Conclusions Adjuvant chemotherapy significantly decreased the risk of tumor relapse and death for children with pathological MCI. For every three children treated with adjuvant chemotherapy, one systemic relapse or death could be prevented.
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Affiliation(s)
- Zhao Xun Feng
- Department of Ophthalmology, University of Ottawa, Ottawa, Canada
| | - Junyang Zhao
- Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Mei Jin
- Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
- Department of Medical Oncology, Beijing Children's Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Beijing, China
| | - Brenda Gallie
- Department of Ophthalmology, Hospital for Sick Children, Toronto, Canada
- Krembil Research Institute and Techna Institute, University Health Network, Toronto, Canada
- Departments Ophthalmology, Medical Biophysics and Molecular Genetics, University of Toronto, Toronto, Canada
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12
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Shemesh R, Sandler H, Dichter S, Fabian ID, Mezer E, Wygnanski-Jaffe T. The Most-Cited Articles on Retinoblastoma: A Fifty-Year Perspective. Vision (Basel) 2023; 7:vision7020033. [PMID: 37092466 PMCID: PMC10123740 DOI: 10.3390/vision7020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/26/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
PURPOSE To summarize the characteristics and trends of interest in retinoblastoma (Rb) in the last 50 years. METHODS The Web of Science Database was used to find all studies focused on Rb published from 1970 to 2018. The term "retinoblastoma" was used to search for the 100 most cited records. RESULTS The mean number of citations was 153.55 ± 88.9. The majority were from the United States (US) (n = 68). Drs. Shields authored 38% of the papers. The number of citations per year was positively correlated with the number of authors, r = 0.26 (p = 0.008). The number of patients was significantly associated with the number of citations per year (p = 0.012). Although papers on radiotherapy were the most common, publications about intra-arterial chemotherapy (IAC) were associated with 88.3% more citations per year (p = 0.031) and papers on intravenous chemotherapy (IVC) were associated with 40.3% more citations per year (p= 0.04). Review and meta-analysis studies had a higher median of citations (10.5) than interventional (6.4) or observational (5.2) studies. CONCLUSIONS This study compiles a comprehensive analysis of the most-cited articles on Rb. Studies with a higher number of citations per year were associated with IAC, which emphasizes the significance of the advances in Rb treatments that allow for the saving of eyes and vision as well as lives. Review studies had more citations than observational or interventional studies. More citations were associated with a larger number of authors or more reported patients per paper. These findings highlight the importance of collaborations to achieve relevant, high-quality research of Rb.
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Affiliation(s)
- Rachel Shemesh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Sheba Medical Center, Goldschleger Eye Institute, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Hunter Sandler
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Sarah Dichter
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Ido Didi Fabian
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Sheba Medical Center, Goldschleger Eye Institute, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Eedy Mezer
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
- Department of Ophthalmology, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Tamara Wygnanski-Jaffe
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- Sheba Medical Center, Goldschleger Eye Institute, Tel-Hashomer, Ramat Gan 52621, Israel
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13
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Ghassemi F, Rahimi M, Riazi-Esfahani H, Khodabandeh A, Masoomian B, Taghizadeh S, Sharifkashani S. Massive Uveal Relapse of Retinoblastoma Presumed to Be Choroidal Tumorous Involvement: Case Series. Case Rep Ophthalmol 2023; 14:340-347. [PMID: 37901645 PMCID: PMC10601821 DOI: 10.1159/000531527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/06/2023] [Indexed: 10/31/2023] Open
Abstract
We report the choroidal and ciliary body invasion by retinoblastoma (RB) in a salvaged eye after complete and successful primary treatment. Case 1: A 25-month-old boy was referred due to group B RB lesions based on the International Classification of RB (ICRB; groups A-E) in the right eye (OD). His left eye (OS) was enucleated because of advanced group E RB. After 47 months of uneventful follow-up (F/U), a new lesion recurred and was treated with transpupillary thermotherapy. Four months later, a fast-growing pigmented subretinal mass was detected that was treated by brachytherapy with the apical dose of 80 Gy. Three weeks later, the lesion regressed completely, and no recurrence happened after 6 years of F/U. Case 2: A 4-month-old girl with a deletion in chromosome 13 was referred for bilateral RB. OD was enucleated because of unresponsive RB and anterior segment involvement. In OS, group B lesions had multiple recurrences after systemic chemotherapy. After a while, a single mass appeared in the nasal periphery which was controlled well with brachytherapy. Four months later, AC involvement was controlled with IAC, intravitreal, and intracameral chemotherapy, but posterior synechia and cataract appeared later. One year after the last treatment, UBM showed a ring-shaped ciliary body mass. Her parents refused enucleation again, and she received intravenous chemotherapy. Two years later, magnetic resonance imaging showed orbital and optic canal involvement with a deformed globe. In conclusion, RB recurrence can appear as local choroidal and ciliary body involvement even after a time of complete remission. The role of B-scan and UBM in early diagnosis and successful treatment is valuable.
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Affiliation(s)
- Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Retina and Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Rahimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Retina and Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khodabandeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Retina and Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Masoomian
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Taghizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shervin Sharifkashani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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14
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Han JW, Lee CS, Hahn SM, Ahn WK, Kim HS, Yun H, Lee SC, Kim BM, Kim DJ, Lyu CJ. The Efficacy of Alternate Systemic Intravenous Chemotherapy and Intra-arterial Chemotherapy Approach for Eye Globe Salvage in Retinoblastoma. Cancer Res Treat 2023; 55:270-278. [PMID: 35609621 PMCID: PMC9873333 DOI: 10.4143/crt.2021.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The advances in the treatment of retinoblastoma have enabled salvaging the globe in advanced stages with intra-arterial chemotherapy (IAC). We developed a strategy of alternate application of systemic intravenous chemotherapy (IVC) and IAC (referred to as alternate systemic IVC and IAC; ASIAC) to reduce central nervous metastases during IAC and examined its efficacy and safety in eye globe salvage in this study. MATERIALS AND METHODS Between January 2010 and February 2021, 43 eyes of 40 patients received ASIAC treatment for retinoblastoma at the Yonsei Cancer Center, Yonsei University Health System. Their medical records were reviewed retrospectively to evaluate the eye salvage rate (ESR), defined from diagnosis to enucleation. High-risk retinoblastoma was defined as group D or E by the International Classification of Retinoblastoma. RESULTS The study enrolled 38 and five cases of high-risk and low-risk retinoblastoma, respectively. In total, 178 IAC and 410 IVC courses were administered, with a median of 4 (interquartile range [IQR], 3.0 to 5.0) IAC and 9 (IQR, 6.0 to 11) IVC courses per eye, respectively. The 5-year ESR was 60.4%±8.7% for the whole cohort, 100% for low-risk retinoblastoma, and 53.6%±9.8% for high-risk retinoblastoma. Among those diagnosed since 2015, the 5-year ESR for high-risk retinoblastoma was 63.5%±14.0%. Fifteen eyes underwent enucleation; no viable tumor was found in three enucleated eyes. There were no deaths in this cohort. CONCLUSION Primary IAC-IVC (i.e., ASIAC) for patients with retinoblastoma was tolerable and effective in salvaging the eye and maintaining survival.
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Affiliation(s)
- Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul,
Korea,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul,
Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul,
Korea
| | - Seung Min Hahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul,
Korea,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul,
Korea
| | - Won Kee Ahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul,
Korea,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul,
Korea
| | - Hyo Sun Kim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul,
Korea,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul,
Korea
| | - Hyeseon Yun
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul,
Korea
| | - Sung Chul Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul,
Korea
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul,
Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul,
Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Yonsei University College of Medicine, Seoul,
Korea,Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul,
Korea
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15
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Lam M, Suh D. Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121939. [PMID: 36553382 PMCID: PMC9777216 DOI: 10.3390/children9121939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities.
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Affiliation(s)
- Matthew Lam
- Creighton University School of Medicine Phoenix Regional Campus, Phoenix, AZ 85012, USA
| | - Donny Suh
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA 92697, USA
- Correspondence:
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16
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Mandal M, Banerjee I, Mandal M. Nanoparticle-mediated gene therapy as a novel strategy for the treatment of retinoblastoma. Colloids Surf B Biointerfaces 2022; 220:112899. [DOI: 10.1016/j.colsurfb.2022.112899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/26/2022] [Accepted: 10/01/2022] [Indexed: 11/05/2022]
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17
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Wang L, Li S, Mei J, Ye L. Immunotherapies of retinoblastoma: Effective methods for preserving vision in the future. Front Oncol 2022; 12:949193. [PMID: 36132125 PMCID: PMC9483150 DOI: 10.3389/fonc.2022.949193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Retinoblastoma is the most common intraocular tumor in children. Patients can be cured by enucleation, but it can lead to vision loss. Chemotherapy is the main method of treatment for RB currently. Unfortunately, chemoresistant and tumor metastasis often happen, resulting in a relatively poor prognosis. Therefore, immunotherapy becomes one of the optimal choices. Targeting not only tumor cells but also the active tumor microenvironment is a novel strategy for RB treatment. Here, we conclude several potential targets for RB immunotherapy, including gangliosides GD2, PD-1 and PD-L1, B7H3, EpCAM and SYK. We also review the techniques for CART, bispecific antibodies and genetically modified Dendritic cells according to the characteristics of different targets and discuss the feasibility of immunotherapy with different targets.
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18
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Tomar AS, Finger PT, Gallie B, Kivelä TT, Mallipatna A, Zhang C, Zhao J, Wilson MW, Brennan RC, Burges M, Kim J, Berry JL, Jubran R, Khetan V, Ganesan S, Yarovoy A, Yarovaya V, Kotova E, Volodin D, Yousef YA, Nummi K, Ushakova TL, Yugay OV, Polyakov VG, Ramirez-Ortiz MA, Esparza-Aguiar E, Chantada G, Schaiquevich P, Fandino A, Yam JC, Lau WW, Lam CP, Sharwood P, Moorthy S, Long QB, Essuman VA, Renner LA, Semenova E, Català-Mora J, Correa-Llano G, Carreras E. High-risk Pathologic Features Based on Presenting Findings in Advanced Intraocular Retinoblastoma: A Multicenter, International Data-Sharing American Joint Committee on Cancer Study. Ophthalmology 2022; 129:923-932. [PMID: 35436535 PMCID: PMC9329269 DOI: 10.1016/j.ophtha.2022.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To determine the value of clinical features for advanced intraocular retinoblastoma as defined by the eighth edition of the American Joint Committee on Cancer (AJCC) cT3 category and AJCC Ophthalmic Oncology Task Force (OOTF) Size Groups to predict the high-risk pathologic features. DESIGN International, multicenter, registry-based retrospective case series. PARTICIPANTS Eighteen ophthalmic oncology centers from 13 countries over 6 continents shared evaluations of 942 eyes enucleated as primary treatment for AJCC cT3 and, for comparison, cT2 retinoblastoma. METHODS International, multicenter, registry-based data were pooled from patients enrolled between 2001 and 2013. High-risk pathologic features were defined as AJCC categories pT3 and pT4. In addition, AJCC OOTF Size Groups were defined as follows: (1) less than half, (2) more than half but less than two thirds, (3) more than two thirds of globe volume involved, and (4) diffuse infiltrating retinoblastoma. MAIN OUTCOME MEASURES Statistical risk of high-risk pathologic features corresponding to AJCC cT3 subcategories and AJCC OOTF Size Groups. RESULTS Of 942 retinoblastoma eyes treated by primary enucleation, 282 (30%) showed high-risk pathologic features. Both cT subcategories and AJCC OOTF Size Groups (P < 0.001 for both) were associated with high-risk pathologic features. On logistic regression analysis, cT3c (iris neovascularization with glaucoma), cT3d (intraocular hemorrhage), and cT3e (aseptic orbital cellulitis) were predictive factors for high-risk pathologic features when compared with cT2a with an odds ratio of 2.3 (P = 0.002), 2.5 (P = 0.002), and 3.3 (P = 0.019), respectively. Size Group 3 (more than two-thirds globe volume) and 4 (diffuse infiltrative retinoblastoma) were the best predictive factors with an odds ratio of 3.3 and 4.1 (P < 0.001 for both), respectively, for high-risk pathologic features when compared with Size Groups 1 (i.e., < 50% of globe volume). CONCLUSIONS The AJCC retinoblastoma staging clinical cT3c-e subcategories (glaucoma, intraocular hemorrhage, and aseptic orbital cellulitis, respectively) as well as the AJCC OOTF Size Groups 3 (tumor more than two thirds of globe volume) and 4 (diffuse infiltrative retinoblastoma) both allowed stratification of clinical risk factors that can be used to predict the presence of high-risk pathologic features and thus facilitate treatment decisions.
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Affiliation(s)
- Ankit Singh Tomar
- Department of Ocular Tumor and Orbital Disease, The New York Eye Cancer Center, New York, New York
| | - Paul T. Finger
- Department of Ocular Tumor and Orbital Disease, The New York Eye Cancer Center, New York, New York
| | - Brenda Gallie
- The Eye Cancer Clinic, Princess Margaret Cancer Centre, and Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Canada
| | - Tero T. Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashwin Mallipatna
- The Eye Cancer Clinic, Princess Margaret Cancer Centre, and Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Canada.,Department of Ocular Oncology, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Chengyue Zhang
- Pediatric Oncology Center, Beijing Children’s Hospital, Beijing, China
| | - Junyang Zhao
- Pediatric Oncology Center, Beijing Children’s Hospital, Beijing, China
| | - Matthew W. Wilson
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, and Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rachel C. Brennan
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, and Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Michala Burges
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, and Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jonathan Kim
- USC Roski Eye Institute, Keck Medical School, University of Southern California, and The Vision Center at Children’s Hospital Los Angeles, Los Angeles, California
| | - Jesse L. Berry
- USC Roski Eye Institute, Keck Medical School, University of Southern California, and The Vision Center at Children’s Hospital Los Angeles, Los Angeles, California
| | - Rima Jubran
- USC Roski Eye Institute, Keck Medical School, University of Southern California, and The Vision Center at Children’s Hospital Los Angeles, Los Angeles, California
| | - Vikas Khetan
- Department of Vitreoretina Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Suganeswari Ganesan
- Department of Vitreoretina Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Andrey Yarovoy
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Vera Yarovaya
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Elena Kotova
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Denis Volodin
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Yacoub A. Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
| | - Kalle Nummi
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tatiana L. Ushakova
- SRI of Pediatric Oncology and Hematology, N.N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation.,Department of Ophthalmology, Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Olga V. Yugay
- SRI of Pediatric Oncology and Hematology, N.N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation
| | - Vladimir G. Polyakov
- SRI of Pediatric Oncology and Hematology, N.N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation.,Department of Ophthalmology, Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Marco A. Ramirez-Ortiz
- Department of Ophthalmology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Guillermo Chantada
- Precision Medicine Coordination Hospital JP Garrahan, and CONICET, National Scientific and Technical Research Council, Buenos Aires, Argentina.,Hemato-Oncology Service, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Paula Schaiquevich
- Precision Medicine Coordination Hospital JP Garrahan, and CONICET, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Adriana Fandino
- Ophthalmology Service, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Winnie W. Lau
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Carol P. Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Phillipa Sharwood
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sonia Moorthy
- KK Women’s and Children’s Hospital, Singapore, Republic of Singapore
| | - Quah Boon Long
- KK Women’s and Children’s Hospital, Singapore, Republic of Singapore
| | - Vera Adobea Essuman
- Ophthalmology Unit, Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Lorna A. Renner
- Department of Child Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ekaterina Semenova
- Department of Ocular Tumor and Orbital Disease, The New York Eye Cancer Center, New York, New York
| | - Jaume Català-Mora
- Retinoblastoma Unit, Department of Ophthalmology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Genoveva Correa-Llano
- Retinoblastoma Unit, Department of Ophthalmology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Elisa Carreras
- Retinoblastoma Unit, Department of Ophthalmology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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Retinoblastoma: emerging concepts in genetics, global disease burden, chemotherapy outcomes, and psychological impact. Eye (Lond) 2022; 37:815-822. [PMID: 35217824 PMCID: PMC8873344 DOI: 10.1038/s41433-022-01980-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/07/2022] [Accepted: 02/08/2022] [Indexed: 11/08/2022] Open
Abstract
In this review we discuss several recent concepts regarding retinoblastoma control and its impact. In a cohort of 482 patients with solitary unilateral retinoblastoma revealed germline mutation in 16% and the likelihood of germline retinoblastoma was greater for younger children (≤1 year versus (vs.) >1 year at presentation) with odds ratio (OR) 2.96 (p = 0.001), and greatest for the youngest infants (≤3 months vs. >3-12 months) (OR 5.52) (p = 0.002). Retinocytoma/retinoma, a benign variant of retinoblastoma, was studied in 78 tumours and demonstrated transformation into retinoblastoma in 9.2% by 5 years and 15.3% by 10 years and 20 years. An international global study on retinoblastoma over 1.5 years revealed 4351 new patients and 85% from low- and middle-income countries, notably with older age at detection and greater risk for metastasis. Management of retinoblastoma in 964 eyes using intravenous chemotherapy showed 20-year globe salvage at 96% in group A, 90% in group B, 90% in group C, 68% in group D, and 32% in group E eyes. The 5-year globe salvage with intra-arterial chemotherapy for 160 eyes (655 infusions) with retinoblastoma showed success in 100% for group B, 80% for group C, 78% for group D, and 55% for group E. The psychological impact of retinoblastoma on the parents revealed depression (73%), anxiety (64%), and/or stress (100%), and on the patient revealed deficits in quality of life issues. Retinoblastoma is a challenging disease and chemotherapy provides reliable tumour control and globe salvage. Continuing efforts to improve quality of life issues is important.
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20
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Retinoblastoma and vision. Eye (Lond) 2022; 37:797-808. [PMID: 34987197 PMCID: PMC10050411 DOI: 10.1038/s41433-021-01845-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/09/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
Abstract
The assessment of vision has a growing importance in the management of retinoblastoma in the era of globe-conserving therapy, both prior to and after treatment. As survival rates approach 98-99% and globe salvage rates reach ever-higher levels, it is important to provide families with information regarding the visual outcomes of different treatments. We present an overview of the role of vision in determining the treatment given and the impact of complications of treatment. We also discuss screening and treatment strategies that can be used to maximise vision.
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Zhao J, Li Q, Feng ZX, Zhang J, Wu S, Jin L, Gallie BL. Tylectomy Safety in Salvage of Eyes with Retinoblastoma. Cancers (Basel) 2021; 13:cancers13225862. [PMID: 34831013 PMCID: PMC8616183 DOI: 10.3390/cancers13225862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary The role of organ-conserving surgery has not been explored in retinoblastoma as it has been in other cancers, such as breast cancer lumpectomy, partial nephrectomy for kidney cancer, and partial orchiectomy for testis cancer. This is largely accounted for by the high mortality of extraocular retinoblastoma compared to intraocular retinoblastoma, and fear of iatrogenic tumor spread with intraocular surgery. We propose the little-known word “tylectomy” (“tulos”, Greek for “lump”) to describe the surgical resection of retinoblastoma. Through review of consecutive patients treated by our team between 2012–2014, we compared survival of patients with eye salvage, including tylectomy, to those who had eye salvage without tylectomy or primary enucleation. We found that patients who had tylectomy had superior survival compared to those who had eye salvage without tylectomy (96% vs. 90%), and comparable survival to those with primary enucleation (96% vs. 95%). Our study supports tylectomy as a safe contribution to retinoblastoma management. Abstract Intraocular surgery is tabooed in retinoblastoma management, due to the concern of lethal extraocular spread. We reviewed the outcomes of consecutive children with intraocular retinoblastoma diagnosed at 29 Chinese centers between 2012–2014. We compared the outcomes of three categories of treatment: eye salvage including tylectomy (Group I), eye salvage without tylectomy (Group II), and primary enucleation (Group III). A total of 960 patients (1243 eyes) were diagnosed: 256 in Group I, 370 in Group II, and 293 in Group III; 41 patients abandoned treatment upfront. The estimated 5-year overall survivals (OS) were, for Group I, 94%, for Group II 89%, and for Group III 95%. The estimated 5-year disease-specific survivals (DSS) were, for Group I, 96%, for Group II 90%, and for Group III 95%. Patients in Group I had a significantly higher 5-year DSS than patients in Group II (p = 0.003) and not significantly different than patients in Group III (p = 0.367). Overall survival was not compromised by the inclusion of tylectomy in eye salvage therapy compared to eye salvage without tylectomy or primary enucleation. Disease-specific survival was better when tylectomy was included in eye salvage treatments. Tylectomy as part of multimodal treatment may contribute to the care of retinoblastoma patients with chemotherapy-resistant tumor, eyes with concomitant ocular complications, or at the risk of treatment abandonment.
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Affiliation(s)
- Junyang Zhao
- Department of Ophthalmology, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou 545001, China; (J.Z.); (J.Z.)
- Pediatric Oncology Center, Beijing Children’s Hospital, Beijing 100045, China
| | - Qiyan Li
- Department of Ophthalmology, Beijing Tongren Hospital, Beijing 100730, China;
| | - Zhao Xun Feng
- Department of Ophthalmology, University of Ottawa, Ottawa, ON K1L 8L6, Canada;
| | - Jianping Zhang
- Department of Ophthalmology, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou 545001, China; (J.Z.); (J.Z.)
| | - Songyi Wu
- Quanzhou Aier Eye Hospital, Quanzhou 362017, China; (S.W.); (L.J.)
| | - Liwen Jin
- Quanzhou Aier Eye Hospital, Quanzhou 362017, China; (S.W.); (L.J.)
| | - Brenda L. Gallie
- Department of Ophthalmology and Vision Science, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Krembil Research Institute and Techna Institutes, University Health Network, Toronto, ON M5T 2S8, Canada
- Departments of Ophthalmology and Vision Science, Molecular Genetics, and Medical Biophysics, University of Toronto, Toronto, ON M5T 3A9, Canada
- Correspondence: ; Tel.: +1-416-294-9729
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Kiefer T, Schlüter S, Bechrakis NE, Bornfeld N, Göricke S, Ketteler P, Ting S, Geismar D, Biewald E. Intraarterial Chemotherapy for Retinoblastoma - Initial Experiences of a German Reference Centre. Klin Monbl Augenheilkd 2021; 238:788-796. [PMID: 34376009 DOI: 10.1055/a-1508-6194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adequate management of retinoblastoma requires a multidisciplinary and individual approach to treatment. Intraarterial chemotherapy (IAC) is one of the most commonly used treatment modalities, and enables supraselective application of chemotherapy via the ophthalmic artery and is now established in almost all treatment centres. However, published treatment success rates are heterogeneous. There are some unanswered issues regarding sight-threatening ocular complications and the long-term occurrence of secondary malignancies and metastatic disease. The objective of the present study is to analyse the results of a German national reference centre. METHODS Retrospective analysis of all children with an indication for at least one IAC from April 2010 to April 2020. IAC was used either as primary or recurrence therapy. Obligatory follow-up was at least 6 months. RESULTS 137 eyes of 127 children with an indication for IAC could be included. 12 eyes with a follow-up of less than 6 months and 37 eyes in which IAC was technically not feasible were excluded. In summary, 88 eyes of 79 children were finally analysed. Mean follow-up was 38 months, ranging from 7 to 117 months. In total, 195 procedures were completed. In 30 eyes (34.1%) IAC was conducted as primary and in 58 (65.9%) as secondary therapy. There was an initial IAC treatment response in 75 eyes (85.2%) with a recurrence-free rate of 61.3%. Eye salvage rate was 68.1% with 28 enucleated eyes in total. Ocular complications were observed in 36 eyes (40.9%), with 19 eyes (21.6%) showing severe sight-threatening and 11 eyes (12.5%) presenting minor non-sight-threatening toxic reactions. During follow-up, 1 child developed a secondary malignancy, 1 child developed metastasis and 1 child died as a consequence of trilateral retinoblastoma. CONCLUSION In summary, IAC is a potent modality for retinoblastoma treatment and has been very successful, even in advanced disease and heavily pretreated eyes. However, ocular complications should be taken in consideration, especially when the only seeing eye is treated. Long term incidences of secondary malignancies and metastatic diseases should be further investigated in prospective studies.
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Affiliation(s)
- Tobias Kiefer
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
| | - Sabrina Schlüter
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
| | | | - Norbert Bornfeld
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
| | - Sophia Göricke
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Deutschland
| | - Petra Ketteler
- Klinik für pädiatrische Hämatologie und Onkologie, Universitätsklinikum Essen, Deutschland
| | - Saskia Ting
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Essen, Deutschland
| | - Dirk Geismar
- Westdeutsches Protonenzentrum Essen (WPE), Klinik für Partikeltherapie, Universitätsklinikum Essen, Deutschland
| | - Eva Biewald
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Deutschland
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Yousef YA, Mohammad M, Mehyar M, Sultan I, Al-Hussaini M, Alhourani J, Halalsheh H, Khzouz J, Jaradat I, Qaddoumi I, Al-Nawaiseh I. The Predictive Value of the Eighth Edition of the Clinical TNM Staging System for the Likelihood of Eye Salvage for Intraocular Retinoblastoma by Systemic Chemotherapy and Focal Therapy. J Pediatr Hematol Oncol 2021; 43:e841-e847. [PMID: 33769386 PMCID: PMC8373642 DOI: 10.1097/mph.0000000000002144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) cTNM staging is emerging as a universal staging for all cancers, including retinoblastoma. METHODS Here we evaluated the predictive value of the eighth edition AJCC/UICC cTNM staging in comparison with the International Intraocular Retinoblastoma Classification for eye globe salvage by primary systemic chemotherapy and focal therapy (CRD) using logistic regression model for the probability of treatment failure. RESULTS The eye salvage rate for 565 treated eyes was 95% (n=139/147) for T1 tumors (98% for T1a and 93% for T1b), 56% (n=230/410) for T2 (81% for T2a and 53% for T2b), and 0% for T3 tumors, and was 98%, 93%, 76%, and 44% for group A, B, C, and D tumors, respectively. As estimated by odds ratios, T2 were 13.6-fold more likely to fail treatment than T1, and T1b, T2a, and T2b were 2.8-, 9.4-, and 35.1-fold more likely to fail treatment than T1a, respectively. Group B, C, and D tumors were 2.8-, 12.7-, and 50.1-fold more likely to fail treatment than group A tumors, respectively. Eye salvage rate was 62% for eyes with focal seeds (3 mm close to the tumor), and 42% for eyes with diffuse seeds (clouds more than 3 mm from tumor edge) (P<0.0001). CONCLUSION Both, the eighth edition cTNM classification and the International Intraocular Retinoblastoma Classification systems, can effectively predict eye salvage rates for retinoblastoma by CRD. Eyes with higher cT stages are more likely to experience treatment failure. Because the cT2b group is very heterogeneous, our findings suggest further division of this group based on the severity of vitreous/subretinal seeds, this should be revised in the next edition of cTNM system.
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Affiliation(s)
- Yacoub A. Yousef
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Mona Mohammad
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Mustafa Mehyar
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Iyad Sultan
- Pediatrics Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Maysa Al-Hussaini
- Pathology and Laboratory Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Joud Alhourani
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | | | - Jakub Khzouz
- Pathology and Laboratory Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Imad Jaradat
- Radiation Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ibrahim Al-Nawaiseh
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
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The Addition of Topotecan to Melphalan in the Treatment of Retinoblastoma with Intra-arterial Chemotherapy. ACTA ACUST UNITED AC 2021; 5:824-830. [DOI: 10.1016/j.oret.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/13/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022]
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Lu Q, Lu Y, Zhu X. Dry Eye and Phacoemulsification Cataract Surgery: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:649030. [PMID: 34307395 PMCID: PMC8295542 DOI: 10.3389/fmed.2021.649030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate whether dry eye deteriorates after phacoemulsification cataract surgery, and to explore the influential factors. Methods: Studies published before February 2020 indexed on PubMed and the Cochrane Central Register of Controlled Trials were retrieved. A meta-analysis, including meta-regression, a sensitivity analysis, and a subgroup analysis, were performed. Results: Twenty studies with 2,247 eyes were included in the meta-analysis, dry eye-related parameters were investigated preoperatively and 1 month postoperatively. Patients with pre-existing meibomian gland dysfunction (MGD) had worsened subjective symptoms of dry eye (1.31, 95% confidence interval (CI) [0.66, 1.95], P < 0.0001), a reduced tear break-up time (BUT) (−2.27, 95% CI [−2.66, −1.88], P < 0.0001), and a worse corneal fluorescein staining (CFS) score (0.75, 95% CI [0.5, 1.0], P < 0.0001) after phacoemulsification cataract surgery, whereas in the general population, the subjective symptoms score and CFS remained unchanged and BUT decreased slightly after surgery. Patients without diabetes showed significantly reduced total tear secretion after phacoemulsification cataract surgery (−1.25, 95% CI [−1.62, −0.88], P < 0.0001). Conclusion: Dry eye generally remained unchanged 1 month after phacoemulsification cataract surgery. Notably, worsened symptoms and signs of dry eye were observed more frequently in patients with pre-existing MGD. Patients without diabetes were more susceptible to reduced tearing postoperatively. Clinical Trial Registration: Identifier: PERSPERO (2020: CRD42020203316).
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Affiliation(s)
- Qiang Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impariment and Restoration, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impariment and Restoration, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impariment and Restoration, Shanghai, China
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26
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Current Indications of Secondary Enucleation in Retinoblastoma Management: A Position Paper on Behalf of the European Retinoblastoma Group (EURbG). Cancers (Basel) 2021; 13:cancers13143392. [PMID: 34298608 PMCID: PMC8303810 DOI: 10.3390/cancers13143392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Although secondary enucleation (SE) is the treatment of choice for retinoblastoma eyes that did not respond favorably to conservative therapies, clear criteria for its indication are, however, currently missing. In this position paper on behalf of the European Retinoblastoma Group (EURbG), we discuss the available literature on SE, including its influence on metastases rate and survival, and propose guidelines to assist decision-making to interrupt eye-preserving therapies depending on the availabilities of advanced diagnostic and therapeutic modalities. Absolute indications to SE may be restricted to eyes with refractory tumor activity resisting all salvage treatments or eyes under apparent tumor control but no visual potential and irreducible complications. In contrast, eyes with an obscured optic nerve head and/or ocular complications amenable to specific surgical or medical management can be considered relative indications, provided that appropriate follow-up can be implemented and that parents are fully aware of a residual risk. Abstract Secondary enucleation (SE) puts an irreversible end to eye-preserving therapies, whenever their prolongation is expected to violate the presumed state of metastatic grace. At present, it must be acknowledged that clear criteria for SE are missing, leading to empiric and subjective indications commonly related to disease progression or relapse, disease persistence masking the optic nerve head or treatment-related complications obscuring the fundus view. This absence of evidence-based consensus regarding SE is explained by the continuously moving frontiers of the conservative management as a result of diagnostic and therapeutic advances, as well as by the lack of studies sufficiently powered to accurately stratify the risk of metastasis in conservatively treated patients. In this position paper of the European Retinoblastoma Group (EURbG), we give an overview of the progressive shift in the indications for SE over the past decades and propose guidelines to assist decision-making with respect to when SE becomes imperative or recommended, with corresponding absolute and relative SE indications. Further studies and validation of biologic markers correlated with the risk of metastasis are expected to set more precisely the frontiers of conservative management and thus consensual criteria for SE in the future.
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Saal-Zapata G, Durand W, Ramos A, Cordero R, Rodríguez R. Retrograde Approach for Intra-arterial Chemotherapy Delivery in Retinoblastoma. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1727584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractIntra-arterial chemotherapy (IAC) is currently, the first-line treatment for retinoblastomas with successful cure rates. In difficult access or unsuccessful catheterization of the ophthalmic artery (OA), the middle meningeal artery is a second alternative followed by the Japanese technique using balloon. Nevertheless, when a well-developed posterior communicating artery is present, a retrograde approach to the OA through this vessel can be performed to deliver the chemotherapeutic drugs.We present a case of an unsuccessful catheterization of the OA through the internal carotid artery due to a challenging configuration of the OA/carotid siphon angle and describe an alternative form of navigation and catheterization through the posterior circulation.To our knowledge, this is the third report of a successful retrograde catheterization of the OA for IAC and constitutes an alternative route to deliver chemotherapy.
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Affiliation(s)
- Giancarlo Saal-Zapata
- Interventional Neurosurgery Division, Clínica Angloamericana, San Isidro, Lima, Perú
| | - Walter Durand
- Interventional Neurosurgery Division, Clínica Angloamericana, San Isidro, Lima, Perú
| | - Alfredo Ramos
- Interventional Neurosurgery Division, Clínica Angloamericana, San Isidro, Lima, Perú
| | - Raúl Cordero
- Oncological Ophthalmology Division, Clínica Angloamericana, San Isidro, Lima, Perú
| | - Rodolfo Rodríguez
- Interventional Neurosurgery Division, Clínica Angloamericana, San Isidro, Lima, Perú
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Shields CL, Dockery PW, Yaghy A, Duffner ER, Levin HJ, Taylor OS, Sajjadi Z, Lally SE, Shields JA, Rosenwasser R, Tjoumakaris S, Jabbour P. Intra-arterial chemotherapy for retinoblastoma in 341 consecutive eyes (1,292 infusions): comparative analysis of outcomes based on patient age, race, and sex. J AAPOS 2021; 25:150.e1-150.e9. [PMID: 34044113 DOI: 10.1016/j.jaapos.2020.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate tumor control and globe salvage following intra-arterial chemotherapy (IAC) for retinoblastoma based on International Classification of Retinoblastoma (ICRB) and patient demographics. METHODS The medical records of 313 patients (341 eyes) treated with IAC were reviewed retrospectively. Chemotherapy agents included melphalan, topotecan, and carboplatin. Comparative analysis was performed for tumor control and globe salvage based on ICRB and patient demographics including age (≤12 vs >12 months), race (white vs nonwhite), and sex. RESULTS Of the 341 eyes treated with 1,292 consecutive infusions of IAC as primary or secondary therapy for retinoblastoma, Kaplan-Meier 5-year estimates of globe salvage was 74%. Of those treated with IAC as primary therapy (n = 160 eyes; 655 infusions), 5-year globe salvage overall was 76%: and more specifically, 100% for groups B and C, 86% for group D, and 55% for group E. Of those treated with IAC as secondary therapy (n = 207 eyes; 859 infusions), 5-year globe salvage was 71%. Comparative analysis by race and sex demonstrated no differences in outcomes, but analysis by age revealed that younger patients had a higher rate of globe salvage (77% vs 72%; P < 0.001). Complications (per catheterization) included retina ischemia (1%), choroidal ischemia (1%), neovascularization of the disk, retina, iris (NVI), glaucoma (about 1% each), and central/peripheral systemic ischemia (<1%). Younger patients showed less NVI (P = 0.028), white patients showed less retinal ischemia (P = 0.037), and no difference by sex. There were no patients with metastatic disease or death. CONCLUSIONS Our results suggest that IAC provides substantial tumor control for advanced and/or recurrent retinoblastoma with a high rate of globe salvage and few complications. There was little difference in outcomes per age, race, and sex.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania.
| | - Philip W Dockery
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Antonio Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Emily R Duffner
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Hannah J Levin
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Olivia S Taylor
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Zaynab Sajjadi
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sara E Lally
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Robert Rosenwasser
- Department of Neurovascular and Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurovascular and Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurovascular and Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Clinical audit of retinoblastoma management: a retrospective single-institution study. Can J Ophthalmol 2021; 57:257-269. [PMID: 34077747 DOI: 10.1016/j.jcjo.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The primary aim of this study was to identify the frequency of death, metastasis, enucleation, and use of external beam radiation therapy (EBRT) among retinoblastoma patients. The secondary aim was to determine whether any events were associated with suboptimal clinical management to identify areas for clinical care improvement. METHODS Patients diagnosed with retinoblastoma between January 1, 2000, and December 31, 2015, at The Hospital for Sick Children were included. Medical records of eligible patients underwent a comprehensive 2-part review. First, a chart review collected diagnostic details, treatment course, and occurrence of 4 events: death, metastasis, use of EBRT, and enucleation. Next, events were reviewed in detail, and a multidisciplinary committee reached consensus on cases managed suboptimally. RESULTS The study included 209 patients (292 eyes). There were 8 deaths, 11 metastases, 177 enucleations (143 primary, 34 secondary), and 8 uses of EBRT. Thirteen patients were reviewed by the multidisciplinary committee, which confirmed that 5 of these patients had events associated with suboptimal clinical management. Three patients developed metastases leading to death (misdiagnosis and mismanagement of trilateral retinoblastoma [1], parental refusal of enucleation [1], and inaccurate histopathology after primary enucleation [1]). One patient developed extraocular extension related to scleral invasion following aggressive focal therapy. One patient underwent secondary enucleation for a Group B eye related to mismanagement of a treatment complication. DISCUSSION Deaths, metastases, and enucleations with documented instances of suboptimal care highlighted a need to enhance medical team and patient communication, histopathology interpretation, laser treatment guidelines, and trilateral retinoblastoma management. Routine clinical audit of retinoblastoma management can identify areas for clinical practice change.
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Raval V, Bowen RC, Soto H, Singh A. Intravenous Chemotherapy for Retinoblastoma in the Era of Intravitreal Chemotherapy: A Systematic Review. Ocul Oncol Pathol 2021; 7:142-148. [PMID: 33981697 DOI: 10.1159/000510506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/27/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose The published data on ocular survival following intravenous chemotherapy of retinoblastoma (RB) seems to be skewed by evolving practice patterns induced by use of intravitreal chemotherapy (iVitc). We aimed to explore potential role of iVitc for vitreous seeding for patients treated with intravenous chemotherapy (IVC). Methods A literature search was performed to identify cases of RB treated with primary IVC prior to advent of iVitc by various search engines (PubMed, Medline, and Google) from 1992 to 2018. Studies were excluded if number of cases were less than 40 or lacked data related to type of recurrence and its treatment. Rates and patterns of recurrence and its management were categorized. Results Out of 15 studies identified, only 10 studies (797 eyes) met the inclusion criteria. The mean age at presentation was 15.3 months (range 0-192.8 months). Unilateral cases represented 25% of the cohort. The ocular survival rate with primary IVC was 63% (500/797 eyes). Of the 297 eyes (37%) that failed IVC therapy, additional 99 eyes could be salvaged with EBRT (599/797 eyes, 75%). Remaining 198 eyes were enucleated (198/797 eyes 25%). K-M survival analysis could not be done due lack of sufficient data. Recurrences that occurred (mean 12.2 months) after completion of primary IVC included relapse of retinal tumor (143 eyes [48%]), vitreous seeding (73 eyes [25%]), subretinal seeding (49 eyes [16%]), or any combination (103 eyes [35%]). Out of 73 eyes with vitreous seeding, additional 66 eyes (90%) would have been salvaged with iVitc, potentially improving ocular survival rates to 71% (500 + 66/797). Conclusions Evolving practice patterns of RB treatment have unfavorably skewed published ocular survival rates following IVC. With incorporation of iVitc, the ocular survival rates with IVC can be potentially improved to be non-inferior to those achieved with intra-arterial chemotherapy.
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Effect of Intravenous Chemotherapy Regimen on Globe Salvage Success Rates for Retinoblastoma Based on Disease Class-A Meta-Analysis. Cancers (Basel) 2021; 13:cancers13092216. [PMID: 34066325 PMCID: PMC8125212 DOI: 10.3390/cancers13092216] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/17/2021] [Accepted: 04/27/2021] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Intravenous chemoreduction (IVCRD) has been the standard of care for treatment of retinoblastoma (RB). Since survival rates exceed 95–98%, the goals of treatment have now shifted to emphasize eye salvage and vision preservation in addition to patient survival. Consequently, there has been a shift towards combining standard IVCRD with intravitreal chemotherapy or altogether replacing IVCRD with intra-arterial chemotherapy. As more data from intravitreal chemotherapy and intra-arterial chemotherapy are being published, there are claims of improved globe salvage rates resulting in more widespread use of these newer treatment modalities. However, there are no published randomized controlled trials comparing these to IVCRD head-to-head. To evaluate the relative efficacy of these new therapies, it is critical to determine the true success rates of IVCRD regimens alone. Therefore, it is both timely and essential to determine the baseline IVCRD success rates so that an evidence-based assessment of new and emerging therapies can be determined. Abstract To evaluate the relative efficacy of novel retinoblastoma treatments, eye classification-specific success rates for current standard-of-care intravenous chemotherapy regimens must be known. This meta-analysis included studies if: (1) patients received intravenous chemotherapy for retinoblastoma, (2) globe salvage data was reported, (3) only intravenous chemoreduction (with/without local consolidation) was used. The outcome measure was globe salvage success without need for salvage radiotherapy, subdivided by disease classification and chemotherapy regimen. Data from 27 studies (1483 eyes) were pooled. By Reese–Ellsworth classification, globe salvage rates were 85% (95%CI:73–92%) for Group I, 78% (95%CI:70–85%) for Group II, 68% (95%CI:56–78%) for Group III, 47% (95%CI:34–60%) for Group IV, and 35% (95%CI:26–45%) for Group V (Va: 35% [95%CI:21–54%]; Vb: 42% [95%CI:29–56%]; those without sub-classification: 31% [95%CI:19–47%]). By International Classification, globe salvage rates were 93% (95%CI:80–97%) for Group A, 83% (95%CI:73–89%) for Group B, 73% (95%CI:54–86%) for Group C, 40% (95%CI:31–51%) for Group D, and 19% (95%CI:5–50%) for Group E. Standard carboplatin-etoposide-vincristine out-performed two-drug regimens (odds ratio (OR) = 1.9 (95%CI:1.3–3.0) for Groups I-IV and OR = 2.1 (95%CI:1.3–3.4) for Group V; p = 0.002 for each). For eyes with diffuse vitreous seeds (Vb), an enhanced regimen out-performed standard chemotherapy (OR = 2.4 [95%CI:1.3–4.7]; p = 0.004). In conclusion, two-drug regimens were less effective for all eyes, whereas enhanced regimens were more effective for eyes with vitreous seeds. Novel therapies can now be compared to these baseline globe salvage rates.
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Patel S, Vogel J, Bradley K, Chuba PJ, Buchsbaum J, Krasin MJ. Rare tumors: Retinoblastoma, nasopharyngeal cancer, and adrenocorticoid tumors. Pediatr Blood Cancer 2021; 68 Suppl 2:e28253. [PMID: 33818883 DOI: 10.1002/pbc.28253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 11/11/2022]
Abstract
The role of surgery, chemotherapy, and radiation therapy for retinoblastoma has evolved considerably over the years with the efficacy of intraarterial chemotherapy and the high incidence of secondary malignant neoplasms following radiation therapy. The use of spot scanning intensity-modulated proton therapy may reduce the risk of secondary malignancies. For pediatric nasopharyngeal carcinoma, the current standard of care is induction chemotherapy followed by chemoradiation therapy. For adrenocortical carcinoma, the mainstay of treatment is surgery and chemotherapy. The role of radiation therapy remains to be defined.
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Affiliation(s)
- Samir Patel
- Divisions of Radiation Oncology and Pediatric Hematology, Oncology and Palliative Care, University of Alberta, Stollery Children's Hospital, Edmonton, Canada
| | - Jennifer Vogel
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristin Bradley
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Paul J Chuba
- Department of Radiation Oncology, St. John Providence Health Systems Webber Cancer Center, Warren, Michigan
| | - Jeffrey Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Cobbs LV, Francis JH, Dunkel IJ, Gobin YP, Brodie SE, Abramson DH. Retinoblastoma management in 13q deletion syndrome patients using super-selective chemotherapies and other cancer-directed interventions. Pediatr Blood Cancer 2021; 68:e28845. [PMID: 33355996 PMCID: PMC9316827 DOI: 10.1002/pbc.28845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to identify best practices for treating 13q deletion syndrome (13q-) patients with retinoblastoma in the era of super-selective ophthalmic artery chemosurgery (OAC) and intravitreal injection therapy (IVIT). METHODS Retrospective study of 21 eyes from 14 patients with retinoblastoma and 13q- who were treated at Memorial Sloan Kettering Cancer Center (MSKCC) between May 2006 and May 2020, with a mean follow up of 3.7 years. Ocular survival, patient survival, and treatment toxicities were assessed. RESULTS Nine of the 12 eyes that underwent OAC/IVIT at MSKCC have been progression free for at least 1 year since their last treatments. Fifteen out of 26 OAC cycles resulted in grade 3-4 hematologic toxicity. There was one death from sepsis in the setting of intravenous chemotherapy (IVC) for metastatic disease that occurred after OAC/IVIT therapy. The 2-year Kaplan-Meier ocular survival estimate for the whole cohort was 75% and for the eyes that received OAC or IVIT at MSKCC 83%. For OAC hematologic toxicities, one platelet transfusion and two filgrastim doses were administered, and one patient was hospitalized for neutropenic fevers. CONCLUSIONS The majority of 13q- eyes treated with OAC/IVIT-based regimens can be cured, and there were no deaths related to complications from OAC or IVIT. 13q- Patients did have increased risk of systemic treatment complications, even from super-selective chemotherapies. Despite these toxicities, only one patient developed febrile neutropenia, one patient required a blood product transfusion, and two patients received filgrastim for both OAC and IVC complications. PRÉCIS: Children with 13q deletion syndrome with retinoblastoma managed with intra-arterial and intravitreal chemotherapy have excellent patient and ocular survival with acceptable toxicity.
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Affiliation(s)
- Lucy V. Cobbs
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jasmine H. Francis
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Ira J. Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Pediatrics, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Y Pierre Gobin
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York,Interventional Neuroradiology, Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Scott E. Brodie
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | - David H. Abramson
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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Greer HR, Orbach DB, Yock TI, Rodriguez-Galindo C, Green AL. Intra-arterial chemotherapy for rhabdomyosarcoma. Pediatr Hematol Oncol 2021; 38:391-396. [PMID: 33439069 DOI: 10.1080/08880018.2020.1871138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Hunter R Greer
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Torunn I Yock
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Adam L Green
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
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The role for intra-arterial chemotherapy for refractory retinoblastoma: a systematic review. Clin Transl Oncol 2021; 23:2066-2077. [PMID: 33826082 DOI: 10.1007/s12094-021-02610-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intra-arterial chemotherapy is a new retinoblastoma treatment associated with high rates of globe salvage that has been widely adopted for primary treatment of retinoblastoma but is less frequently used as secondary treatment for refractory retinoblastoma. This systematic review aims to summarize the reported outcomes of intra-arterial chemotherapy for refractory retinoblastoma. METHODS We conducted a systematic review of studies published on PubMed, Medline, and Embase from 2011 to 2021 reporting globe salvage rates following intra-arterial chemotherapy for secondary treatment of refractory retinoblastoma. RESULTS Our search yielded 316 studies, and 24 met inclusion criteria. The 24 included studies were comprised of 1366 patients and 1757 eyes. Among these, 1184 (67%) eyes received secondary indication treatment, and globe salvage was achieved for 776 of these 1184 eyes (64%). Sixteen studies reported cannulation success rates from 71.8 to 100%. Pooled analysis of subjects revealed 21 patients (2.6%) with metastatic disease and 26 deaths (3%) during study follow-up periods (7-74 months). The most common ocular complications were vitreous hemorrhage (13.2%), loss of eyelashes (12.7%), and periocular edema (10.5%). The most common systemic complications were nausea/vomiting (20.5%), neutropenia (14.1%), fever (8.2%), and bronchospasm (6.2%). CONCLUSIONS Intra-arterial chemotherapy is associated with high rates of globe salvage and low rates of serious complications in patients with refractory retinoblastoma. Unfortunately, current literature is predominantly comprised of retrospective case studies, and further high-quality evidence is necessary to inform clinical practice.
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Abstract
Retinoblastoma is the most common ocular malignancy of childhood. With an estimated 300 cases annually in the United States, retinoblastoma is nevertheless considered a rare tumor. Although retinoblastoma primarily affects younger children, diagnosis during the neonatal age range is less common. However, an understanding of patients at risk is critical for appropriate screening. Early detection and treatment by a multidisciplinary specialty team maximizes the chance for survival and ocular/vision salvage while minimizing treatment-related toxicity. Testing for alterations in the RB1 gene has become standard practice, and informs screening and genetic counseling recommendations for patients and their families.
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Oporto JI, Zúñiga P, Ossandón D, Zanolli M, Pérez V, López JP, Stetcher X, Rodríguez A, Puentes Á, Rustom S, Lobos J. Intra-arterial chemotherapy for retinoblastoma treatment in Chile: Experience and results 2013-2020. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:288-292. [PMID: 34092282 DOI: 10.1016/j.oftale.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish the success rate of salvage intra-arterial chemotherapy (IAC), defined as the percentage of eyes that achieved tumoral remission and avoided enucleation. The second objective was the clinical characterization, catheterization results, and associated local and systemic complications. METHODS Retrospective, interventional case series of 29 patients (35 eyes) with persistent or recurrent retinoblastoma. RESULTS A total of 73 salvage IAC procedures with topotecan and melphalan were carried out. Success rate was 77% at a mean follow-up of 41.4 months. All patients with only one remaining eye avoided enucleation (10 cases). Catheterization was successful in 98.6% of cases. The types of catheterizations were as follows: 71.2% supraselective ophthalmic artery, 12.3% occlusion pump assisted supraselective ophthalmic artery, 16.4% selective external carotid with retrograde flow. 14% of patients suffered local adverse effects: 1 (2.8%) transitory ptosis, 1 (2.8%) transitory oculomotor nerve palsy, 2 (5.7%) aseptic cellulitis and 1 (2.8%) periorbitary pigmentation. 4.1% (3 cases) suffered neutropenia due to medullar chemosuppression. There were no cases of severe anemia or thrombocytopenia. There were no cerebral ischemic events or mortality associated to the procedure. CONCLUSION IAC with melphalan and topotecan is a safe and effective treatment option for persistent or recurrent retinoblastoma, able to reduce enucleation rates.
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Affiliation(s)
- J I Oporto
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Zúñiga
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - D Ossandón
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; Hospital de San Juan de Dios, Santiago, Chile.
| | - M Zanolli
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - V Pérez
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; Hospital de San Juan de Dios, Santiago, Chile
| | - J P López
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - X Stetcher
- Clínica Alemana de Santiago-Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - A Rodríguez
- Hospital de San Juan de Dios, Santiago, Chile
| | - Á Puentes
- Hospital de San Juan de Dios, Santiago, Chile
| | - S Rustom
- Hospital de San Juan de Dios, Santiago, Chile
| | - J Lobos
- Hospital de San Juan de Dios, Santiago, Chile
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Soliman S, Feng ZX, Gallie B. Primary laser therapy as monotherapy for discrete retinoblastoma. Br J Ophthalmol 2021; 106:878-883. [PMID: 33536230 DOI: 10.1136/bjophthalmol-2020-317885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/26/2020] [Accepted: 01/19/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND/AIM Laser photocoagulation is less invasive than chemotherapy (systemic, intra-arterial or periocular) and brachytherapy. We studied the safety and efficacy of laser as primary monotherapy for discrete retinoblastoma with well-defined borders and attached retina. METHODS A single-institution retrospective non-comparative review (2004-2018) of discrete retinoblastoma tumours managed with primary laser (532 or 810 nm wavelength, 0.5-1 s duration and power titrated until desired tumour whitening). Efficacy was evaluated by tumour long-term stability avoiding non-laser therapies. Safety was evaluated by frequency of laser-related complications and uncontrollable tumour progression. RESULTS Eligible were 112 tumours in 55 eyes of 44 patients. Laser monotherapy (median 2 sessions) achieved initial remission in 95/112 (85%) tumour. Initial encircling only laser photocoagulation was associated with tumour progression (9/11, one tumour had vitreous seeding) compared with direct or combined photocoagulation techniques (0/94 and 0/7 tumours, respectively, p<0.001). Direct laser had no vitreous seeding, haemorrhage or injury to vital structures. Tumour recurrences developed in 52/112 (46%) tumour but repeat laser achieved long-term stability, except five tumour recurrences that required invasive therapy. Receiver operating characteristic analysis identified threshold largest basal diameter of 3 disc diameters (DD) for successful laser monotherapy, where 92/106 (87%) of tumours ≤3 DD and 0/6>3 DD achieved long-term stability with laser monotherapy (p<0.001). Overall, 35/55 (64%) eyes and 24/44 (55%) patients achieved long-term stability with laser monotherapy. No eye was enucleated for uncontrollable tumour progression. CONCLUSIONS Discrete retinoblastoma ≤3 DD can be effectively and safely managed with laser monotherapy, sparing a significant proportion of patients/eyes from more invasive therapies.
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Affiliation(s)
- Sameh Soliman
- Ophthalmology, Alexandria University Faculty of Medicine, Alexandria, Egypt .,Ophthalmology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zhao Xun Feng
- Ophthalmology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brenda Gallie
- Ophthalmology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Ophthalmology, The University of Toronto, Toronto, Ontario, Canada
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Applications of iodine-125 plaque radiotherapy for residual or recurrent retinoblastoma. Can J Ophthalmol 2021; 56:317-324. [PMID: 33493457 DOI: 10.1016/j.jcjo.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the role of iodine-125 plaque radiotherapy (IPR) as a secondary treatment for localized (solitary or multiple) residual (partially regressed) or recurrent (regrowth after ≥6 months stability) retinoblastoma in the era of systemic and/or regional chemotherapy. DESIGN A single-institute retrospective, noncomparative, interventional case series managed between July 2014 and June 2019. PARTICIPANTS Thirteen consecutive eyes of 12 patients with 14 residual or recurrent retinoblastoma tumors treated with IPR. Patients who had to follow up <1 year post-IPR were excluded except for those who had enucleation. METHODS Data collected included pre-IPR treatments, tumor characteristics at IPR, and post-IPR anatomical outcome (local tumor control and globe salvage) and functional outcome (radiation complications). RESULTS Local tumor control was achievable in 12 of 14 tumors. Local recurrences were observed in 2 of 5 tumors that exhibited fish-flesh regression after IPR (p = 0.04). Globe salvage was possible in 11 eyes (12 tumors). Only 2 eyes were legally blind and the remaining 9 eyes had vision >20/125. Radiation-induced complications included radiation retinopathy (4/11), radiation papillopathy (1/11), diffuse vitreous hemorrhage (4/11). Eyes with fish-flesh-regressed tumours tended to show more complications, but were statistically insignificant (p = 0.09, Fisher exact test). There was no association of time to IPR (early <6 months vs late >6 months) with occurrence of tumor recurrence or complications (p > 0.05). CONCLUSION IPR offers satisfactory local tumor control and globe salvage in localized recurrent/residual retinoblastoma. Fish-flesh tumor regression after IPR should be closely monitored for further recurrences.
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González ME, Gaviria ML, López M, Escudero PA, Bravo A, Vargas SA. Eye Salvage with Intra-Arterial and Intra-Vitreal Chemotherapy in Patients with Retinoblastoma: 8-Year Single-Institution Experience in Colombia. Ocul Oncol Pathol 2021; 7:215-223. [PMID: 34307335 DOI: 10.1159/000511980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/01/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Intra-arterial chemotherapy (IAC) is useful for eye preservation in advanced retinoblastoma (Rb). Intra-vitreal chemotherapy (IvitC) is the latest treatment for vitreous seeds. Methods The present study is a retrospective assessment of 100 eyes, treated with primary or secondary IAC alone or with IvitC. We evaluated demographic and clinical variables, eye salvage, associated adverse events, and patient survival. Data were analyzed using descriptive statistics. Kaplan-Meier survival curves and Cox hazard ratios were utilized to assess the effect of demographic and clinical variables over eye salvage. Results Bilateral Rb was observed in 61% of patients, and 57% of eyes received secondary treatment. Forty eyes needed intra-arterial plus IvitC and 62 presented advanced disease (group D and E). Three- and 5-year ocular survival probabilities were 75 and 68%. We found a higher risk in group D and E eyes and those requiring 2 or more routes for ophthalmic artery catheterization. Patients coming from other countries also showed increased risk. Using primary or secondary treatment, or IvitC, did not affect this risk. Overall rates of survival and eye salvages were 98.8 and 73%, and we had a 100% catheterization success and none ophthalmic arterial occlusions. Conclusions In an upper middle-income country such as Colombia, a specialized institution counting with therapeutic alternatives and a multidisciplinary team can reach rates of patient survival and eye salvage similar to those of high-income countries.
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Affiliation(s)
- María Elena González
- Ocular Oncology Service, Hospital San Vicente Fundación, Universidad de Antioquia, Medellín, Colombia
| | - Martha Lia Gaviria
- Paediatric Ophthalmology Service Hospital San Vicente Fundación, Universidad de Antioquia, Medellín, Colombia
| | - Mariana López
- Ophthalmology Service, Hospital San Vicente Fundación, Medellín, Colombia
| | - Pablo Andrés Escudero
- Department of Interventional Neuroradiology, Hospital San Vicente Fundación, Medellín, Colombia
| | - Andrés Bravo
- Medical School, Universidad CES, Medellín, Colombia
| | - Sergio Alberto Vargas
- Department of Interventional Neuroradiology, Hospital San Vicente Fundación, Medellín, Colombia
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Amin S, AlJboor M, Toro MD, Rejdak R, Nowomiejska K, Nazzal R, Mohammad M, Al-Hussaini M, Khzouz J, Banat S, AlJabari R, Jaradat I, Mehyar M, Sultan I, AlNawaiseh I, Yousef YA. Management and Outcomes of Unilateral Group D Tumors in Retinoblastoma. Clin Ophthalmol 2021; 15:65-72. [PMID: 33447011 PMCID: PMC7802086 DOI: 10.2147/opth.s282741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose Retinoblastoma presents most commonly as advanced unilateral disease, particularly in developing countries for which primary enucleation has been the preferred method of treatment. However, with the evolution of newer treatment modalities including intravitreal chemotherapy, intra-arterial chemotherapy and newer chemotherapeutic combinations, a trend towards more conservative approaches is being observed. Our aim is to evaluate outcomes of group D eyes following conservative and non-conservative treatment options. Patients and Methods The ocular oncology database was used to identify eyes with unilateral retinoblastoma that fulfilled the International Intraocular Retinoblastoma Classification (IIRC) group D criteria from August 2010 to August 2018 and these were retrospectively reviewed. Overall, 39 eyes were identified. Results Nineteen (49%) eyes underwent primary enucleation and 20 (51%) received eye-conserving treatment. Eye salvage was possible in 15 (75%) eyes in the attempted salvage group. None of the patient revealed signs of metastasis. All eyes received conventional chemotherapy (carboplatin, vincristine, etoposide) and focal laser therapy. Additional treatment modalities offered included intravitreal chemotherapy, intra-arterial chemotherapy and topotecan. Three (11%) eyes in the primary enucleation group showed high-risk features on histopathology and none developed metastasis. Conclusion The results of the study seem promising and conservative measures can be adopted in selected unilateral group D eyes.
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Affiliation(s)
- Saima Amin
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mays AlJboor
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mario D Toro
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, Lublin, Poland.,Faculty of Medical Sciences, Collegium Medicum Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Robert Rejdak
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Nowomiejska
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, Lublin, Poland
| | | | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Jakub Khzouz
- Department of Pathology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Sara Banat
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Reem AlJabari
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Imad Jaradat
- Department of Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Ibrahim AlNawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
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Rossi SM, Murray T, McDonough L, Kelly H. Loco-regional drug delivery in oncology: current clinical applications and future translational opportunities. Expert Opin Drug Deliv 2020; 18:607-623. [PMID: 33253052 DOI: 10.1080/17425247.2021.1856074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Drug-based treatment regimens for cancer are often associated with off-target toxic side effects and low penetration of the drug at the tumor site leading to patient morbidity and limited efficacy. Loco-regional drug delivery has the potential to increase efficacy while concomitantly reducing toxicity.Areas covered: Clinical applications using loco-regional delivery include intra-arterial drug delivery in retinoblastoma, direct intra-tumoral (IT) injection of ethanol for ablation in hepatocellular carcinoma (HCC) and the use of HIPEC in peritoneal carcinomas. In recent years, there has been a significant increase in both approved products and clinical trials, with a particular emphasis on drug delivery platforms such as drug-eluting beads for HCC and hydrogel platforms for intravesical delivery in bladder cancer.Expert opinion: Development of loco-regional drug-delivery systems has been slow, limited by weak clinical data for early applications and challenges relating to dosing, delivery and retention of drugs at the site of action. However, there is increasing focus on the potential of loco-regional drug delivery when combined with bespoke drug-delivery platforms. With the growth in immunotherapies, the use of IT delivery to drive priming of the anti-tumor response has opened up a new field of opportunity for loco-regional drug delivery.
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Affiliation(s)
- Seona M Rossi
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Timothy Murray
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Liam McDonough
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Helena Kelly
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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Zhu XY, Li J, Guan WB, Chen CL, Ji XD, Zhao PQ. Pathologic comparisons of enucleated eyes with retinoblastoma after superselective ophthalmic arterial chemotherapy with or without intravenous chemotherapy. Int J Ophthalmol 2020; 13:1794-1799. [PMID: 33215012 DOI: 10.18240/ijo.2020.11.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/19/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To describe and compare pathologic findings in eyes enucleated after superselective ophthalmic arterial chemotherapy (SOAC) or SOAC with intravenous chemotherapy (IVC) for retinoblastoma. METHODS Medical records between January 1st, 2014 and June 30th, 2017 were retrospectively analyzed, and pathologic findings were recorded. This study included 36 eyes from 22 (61.1%) male and 14 (38.9%) female patients. Nineteen of 36 (52.8%) eyes received SOAC (mean=3, range=1-7) as primary treatment, and 17 of 36 (47.2%) eyes received SOAC (mean=3.7, range=1-10) after IVC (mean=6.1, range=2-11). Tumor extension including choroidal invasion (n=9, 25%), optic nerve invasion (n=5, 13.9%) and anterior segment invasion (n=5, 13.9%) were recorded. RESULTS Histopathologic evidence of ischemic damage in the retina and choroid was found in 28 (77.8%) eyes. Thrombosed blood vessels were identified in 9 (25%) eyes, including orbital artery in the retrobulbar orbit (n=1), intrascleral vessels (n=4), and chorioretinal vessels (n=6). Fibrotic changes were found in extraocular muscles (n=5, 13.9%) and optic nerve (n=5, 13.9%). Varying degrees of scleral degeneration were found in all eyes. In statistical analysis, there was no significant difference in clinical and pathologic changes between SOAC group and SOAC with IVC group except for optic nerve invasion (P=0.047). CONCLUSION SOAC for retinoblastoma can result in ocular toxicity, and SOAC with IVC do not increase the toxicity but reduced the incidence of optic nerve invasion.
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Affiliation(s)
- Xiu-Yu Zhu
- Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jing Li
- Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Wen-Bin Guan
- Department of Pathology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Chun-Li Chen
- Department of Ophthalmology, Tianjin Medical University Eye Hospital & Tianjin Medical University Eye Institute, Tianjin 300074, China
| | - Xun-Da Ji
- Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Pei-Quan Zhao
- Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
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Global Retinoblastoma Treatment Outcomes: Association with National Income Level. Ophthalmology 2020; 128:740-753. [PMID: 33007338 DOI: 10.1016/j.ophtha.2020.09.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare metastasis-related mortality, local treatment failure, and globe salvage after retinoblastoma in countries with different national income levels. DESIGN International, multicenter, registry-based retrospective case series. PARTICIPANTS Two thousand one hundred ninety patients, 18 ophthalmic oncology centers, and 13 countries on 6 continents. METHODS Multicenter registry-based data were pooled from retinoblastoma patients enrolled between January 2001 and December 2013. Adequate data to allow American Joint Committee on Cancer staging, eighth edition, and analysis for the main outcome measures were available for 2085 patients. Each country was classified by national income level, as defined by the 2017 United Nations World Population Prospects, and included high-income countries (HICs), upper middle-income countries (UMICs), and lower middle-income countries (LMICs). Patient survival was estimated with the Kaplan-Meier method. Logistic and Cox proportional hazards regression models were used to determine associations between national income and treatment outcomes. MAIN OUTCOME MEASURES Metastasis-related mortality and local treatment failure (defined as use of secondary enucleation or external beam radiation therapy). RESULTS Most (60%) study patients resided in UMICs and LMICs. The global median age at diagnosis was 17.0 months and higher in UMICs (20.0 months) and LMICs (20.0 months) than HICs (14.0 months; P < 0.001). Patients in UMICs and LMICs reported higher rates of disease-specific metastasis-related mortality and local treatment failure. As compared with HICs, metastasis-related mortality was 10.3-fold higher for UMICs and 9.3-fold higher for LMICs, and the risk for local treatment failure was 2.2-fold and 1.6-fold higher, respectively (all P < 0.001). CONCLUSIONS This international, multicenter, registry-based analysis of retinoblastoma management revealed that lower national income levels were associated with significantly higher rates of metastasis-related mortality, local treatment failure, and lower globe salvage.
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Retinoblastoma: Etiology, Modeling, and Treatment. Cancers (Basel) 2020; 12:cancers12082304. [PMID: 32824373 PMCID: PMC7465685 DOI: 10.3390/cancers12082304] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
Retinoblastoma is a retinal cancer that is initiated in response to biallelic loss of RB1 in almost all cases, together with other genetic/epigenetic changes culminating in the development of cancer. RB1 deficiency makes the retinoblastoma cell-of-origin extremely susceptible to cancerous transformation, and the tumor cell-of-origin appears to depend on the developmental stage and species. These are important to establish reliable preclinical models to study the disease and develop therapies. Although retinoblastoma is the most curable pediatric cancer with a high survival rate, advanced tumors limit globe salvage and are often associated with high-risk histopathological features predictive of dissemination. The advent of chemotherapy has improved treatment outcomes, which is effective for globe preservation with new routes of targeted drug delivery. However, molecularly targeted therapeutics with more effectiveness and less toxicity are needed. Here, we review the current knowledge concerning retinoblastoma genesis with particular attention to the genomic and transcriptomic landscapes with correlations to clinicopathological characteristics, as well as the retinoblastoma cell-of-origin and current disease models. We further discuss current treatments, clinicopathological correlations, which assist in guiding treatment and may facilitate globe preservation, and finally we discuss targeted therapeutics for future treatments.
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Ganesan B, Parameswaran S, Sharma A, Krishnakumar S. Clinical relevance of B7H3 expression in retinoblastoma. Sci Rep 2020; 10:10185. [PMID: 32576886 PMCID: PMC7311428 DOI: 10.1038/s41598-020-67101-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/22/2020] [Indexed: 01/18/2023] Open
Abstract
Retinoblastoma (RB) is the most common paediatric intraocular tumour. Currently, chemotherapy is widely used to reduce the chance of metastasis as well as for vision salvage. The limitations of chemotherapy for RB include chemoresistance and cytotoxicity. Recently, immunotherapy is considered for treating chemoresistant cancers. Although, several molecular targets are available for immunotherapy in different cancers, we were interested in B7H3, as it was differentially expressed between retinoblastoma and retina in our earlier proteomics study. Hence, in this study we validated the previous finding by Western blotting and immunohistochemistry on primary RB tumor samples. The results suggest significantly increased expression of B7H3 in RB tumor samples compared to retina by western blotting. Immunohistochemistry revealed spatial, inter and intratumoral heterogeneity in the primary RB tumor sections. Correlation of the B7H3 expression with clinical and histopathological data revealed significantly increased expression of B7H3 in poorly differentiated, non-neural invasive tumors and lower expression in neural invasion and severe anaplastic areas of the tumors. B7H3 expression did not significantly vary between low-risk and high-risk tumors. The study also revealed considerably reduced infiltration of T lymphocytes in RB. We conclude that B7H3 is prominently expressed in primary RB tumors and could be used for targeted therapy.
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Affiliation(s)
| | - Sowmya Parameswaran
- Radheshyam Kanoi Stem Cell Laboratory, Vision Research Foundation, Chennai, India
| | - Ashwani Sharma
- Department of Chemistry & Biology, Indian Institute of Science Education and Research (IISER), Tirupati, India
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A Multicenter, International Collaborative Study for American Joint Committee on Cancer Staging of Retinoblastoma: Part II: Treatment Success and Globe Salvage. Ophthalmology 2020; 127:1733-1746. [PMID: 32526306 DOI: 10.1016/j.ophtha.2020.05.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the ability of the American Joint Committee on Cancer (AJCC) 8th edition to predict local tumor control and globe salvage for children with retinoblastoma (RB). DESIGN International, multicenter, registry-based retrospective case series. PARTICIPANTS A total of 2854 eyes of 2097 patients from 18 ophthalmic oncology centers from 13 countries over 6 continents. METHODS International, multicenter, registry-based data were pooled from patients enrolled between January 2001 and December 2013. All RB eyes with adequate records to allow tumor staging by the AJCC 8th edition criteria and follow-up to ascertain treatment outcomes were included. MAIN OUTCOME MEASURES Globe-salvage rates were estimated by AJCC clinical (cTNMH) categories and tumor laterality. Local treatment failure was defined as use of enucleation or external beam radiation therapy (EBRT), with or without plaque brachytherapy or intra-arterial chemotherapy (IAC). RESULTS Unilateral RB occurred in 1340 eyes (47%). Among the 2854 eyes, tumor categories were cT1 to cT4 in 696 eyes (24%), 1334 eyes (47%), 802 eyes (28%), and 22 eyes (1%), respectively. Of these, 1275 eyes (45%) were salvaged, and 1179 eyes (41%) and 400 eyes (14%) underwent primary and secondary enucleation, respectively. The 2- and 5-year Kaplan-Meier cumulative globe-salvage rates without the use of EBRT by cTNMH categories were 97% and 96% for category cT1a tumors, 94% and 88% for cT1b tumors, 68% and 60% for cT2a tumors, 66% and 57% for cT2b tumors, and 32% and 25% for cT3 tumors, respectively. Risk of local treatment failure increased with increasing cT category (P < 0.001). Cox proportional hazards regression analysis confirmed a higher risk of local treatment failure in categories cT1b (hazard ratio [HR], 3.5; P = 0.004), cT2a (HR, 15.1; P < 0.001), cT2b (HR, 16.4; P < 0.001), and cT3 (HR, 45.0; P < 0.001) compared with category cT1a. Use of plaque brachytherapy and IAC improved local tumor control in categories cT1a (P = 0.031) and cT1b (P < 0.001). CONCLUSIONS Multicenter, international, internet-based data sharing validated the 8th edition AJCC RB staging to predict globe-salvage in a large, heterogeneous, real-world patient population with RB.
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Abstract
Retinoblastomas represent 6% of all malignant tumors in children under 5 years old, which untreated lead to blindness in the affected eye and death due to metastases. The main symptoms are leukocoria and strabismus, which if possible, always necessitate a clarification within 1 week for exclusion of a retinoblastoma. The most frequent differential diagnoses are Coats' disease and persistent fetal vasculature (PFV) as well as other intraocular tumors, in particular astrocytomas. Systemic chemotherapy, if necessary in combination with laser hyperthermia, local chemotherapy and brachytherapy are the most important methods for eye-preserving treatment. Advanced cases mostly necessitate enucleation.
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Case D, Kumpe D, Roark C, Seinfeld J. Neuroangiography: Review of Anatomy, Periprocedural Management, Technique, and Tips. Semin Intervent Radiol 2020; 37:166-174. [PMID: 32419729 DOI: 10.1055/s-0040-1709171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Neuroangiography (NA) is a minimally invasive procedure used to diagnose patients with neurovascular diseases. Noninvasive imaging has improved dramatically in recent years and is utilized more frequently; however, further evaluation with NA is still required in certain cases. NA indications include intracranial (cerebral aneurysms, arteriovenous malformations, dural arteriovenous fistula, cerebral vasculitis, cerebral vasospasm, ischemic stroke, nontraumatic subarachnoid hemorrhage, intracerebral hemorrhage, Moyamoya, vein of Galen malformation, intracranial tumors, and pseudotumor cerebri) and extracranial (internal and common carotid artery stenosis, vertebral artery stenosis, carotid artery blowout, vertebral artery blowout, epistaxis, oropharyngeal bleeding, and carotid body tumor) pathologies which can help with diagnosis and potential subsequent endovascular treatment. A thorough understanding of normal and variant cervical/cranial vascular anatomy is required. In addition, periprocedural management, catheter technique, equipment needed, and underlying disease pathology are paramount to successful and safe outcomes. This article will review basic neurovascular anatomy, periprocedural management, NA technique, and tips for safe and successful outcomes.
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Affiliation(s)
- David Case
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - David Kumpe
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Christopher Roark
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Joshua Seinfeld
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
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Liu CC, Mohmood A, Hamzah N, Lau JH, Khaliddin N, Rahmat J. Intra-arterial chemotherapy for retinoblastoma: Our first three-and-a-half years' experience in Malaysia. PLoS One 2020; 15:e0232249. [PMID: 32357178 PMCID: PMC7194412 DOI: 10.1371/journal.pone.0232249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/10/2020] [Indexed: 12/04/2022] Open
Abstract
Aim To report our first three-and-a-half years’ experience with intra-arterial chemotherapy (IAC) in managing retinoblastoma (RB). Methods Single institution, retrospective, interventional case series of 14 retinoblastoma patients managed with IAC from December 2014 to June 2018. Demographics were described. Outcomes measures were tumor response, treatment complications and globe salvage. Results Subjects’ mean age at the first administration of IAC was 31.4 months. 57.1% of the eyes were Group D and E retinoblastoma, while 79% were bilateral disease. 93% of the eyes were as secondary treatment. Of 32 IAC cannulations performed, 23 (71.8%) were successful and received chemotherapy drug melphalan. Each eye received a mean of 1.8 (range 1–4) IAC injections. 53% of the eyes showed regression post treatment. After a mean follow up period of 19 months, globe salvage rate was 38%. Most of the adverse effects experienced were localized and transient. Conclusion IAC has provided an added recourse in the armamentarium of retinoblastoma treatment in our center. IAC treatment is a viable alternative in the treatment of retinoblastoma to salvage globe, for eyes that would conventionally require enucleation especially in bilateral disease.
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Affiliation(s)
- Chee Chung Liu
- University Malaya Eye Research Centre, University of Malaya, Kuala Lumpur, Malaysia
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- * E-mail: (CCL); (JR)
| | - Adzleen Mohmood
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- Department of Ophthalmology, University Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Norhafizah Hamzah
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Jia Him Lau
- Department of Radiology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Nurliza Khaliddin
- University Malaya Eye Research Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Jamalia Rahmat
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- * E-mail: (CCL); (JR)
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