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Controversies in the Management of Choroidal Invasion in Retinoblastoma. Int Ophthalmol Clin 2022; 62:27-37. [PMID: 36170219 DOI: 10.1097/iio.0000000000000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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2
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Villanueva G, Sampor C, Moreno F, Alderete D, Moresco A, Pinto N, Szijan I, Schaiquevich P, Felice MS, Rose A, Zubizarreta P, Sgroi M, Fandiño A, Chantada G. Subsequent malignant neoplasms in the pediatric age in retinoblastoma survivors in Argentina. Pediatr Blood Cancer 2022; 69:e29710. [PMID: 35451226 DOI: 10.1002/pbc.29710] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Retinoblastoma survivors in low- and middle-income countries are exposed to high-intensity treatments that potentially place them at higher risk of early subsequent malignant neoplasms (SMNs). METHODS We followed 714 (403 [56.4%] nonhereditary and 311 [43.5%] hereditary) retinoblastoma survivors diagnosed from August 1987 to December 2016, up to the age of 16 years. We quantified risk of SMNs with cumulative incidence (CI) and standardized incidence ratios (SIR) analysis. Multivariate regression Cox model was used to determine the association of treatments and risk of SMNs. RESULTS Median follow-up was of 9 years (range: 0.18-16.9) and 24 survivors (3.36%) developed 25 SMNs (n = 22 hereditary, n = 2 nonhereditary). SMNs included sarcomas (osteosarcomas, Ewing sarcomas, rhabdomyosarcomas; n = 12), leukemias (n = 5), and central nervous system tumors (CNS; n = 3). All cases of acute myeloid leukemia (AML) and most of Ewing sarcomas occurred within 5 years of retinoblastoma diagnosis. The type of SMN was the main indicator of mortality (five of five patients with leukemias, six of 12 with sarcomas, and zero of three with CNS tumors died). Compared to the general population, radiation increased the risk of Ewing sarcoma in hereditary survivors by 700-fold (95% CI = 252-2422.6) and chemotherapy increased the risk of AML by 140-fold (95% CI = 45.3-436). The CI of SMNs for hereditary survivors was 13.7% (95% CI = 8.4-22.1) at 15 years. CONCLUSION Retinoblastoma survivors from Argentina are at higher risk of developing SMNs early in life compared to the general Argentinean population, especially those treated with radiation plus chemotherapy. AML and Ewing sarcoma presented within 5 years of retinoblastoma diagnosis are associated with chemotherapy and radiation exposure.
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Affiliation(s)
- Gabriela Villanueva
- Hematology and Oncology Department, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Claudia Sampor
- Hematology and Oncology Department, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Florencia Moreno
- Instituto Nacional del Cáncer, Registro Onco-pediatrico Hospitalario Argentino (ROHA), Buenos Aires, Argentina
| | - Daniel Alderete
- Hematology and Oncology Department, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Angelica Moresco
- Department of Genetics, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Natalia Pinto
- Department of Radiotherapy, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Irene Szijan
- Cátedra de Genética, Facultad de Farmacia y Bioquímica, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Paula Schaiquevich
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - María Sara Felice
- Hematology and Oncology Department, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Adriana Rose
- Hematology and Oncology Department, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Pedro Zubizarreta
- Hematology and Oncology Department, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Mariana Sgroi
- Ophthalmology Department, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Adriana Fandiño
- Ophthalmology Department, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Guillermo Chantada
- Hematology and Oncology Department, Hospital JP Garrahan, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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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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Prajantawanich K, Sanpakit K, Narkbunnam N, Vathana N, Takpradit C, Phuakpet K, Pongtanakul B, Atchaneeyasakul LO, Sinlapamongkolkul P, Buaboonnam J. Clinical outcomes and prognosis of Thai retinoblastoma patients. Pediatr Int 2021; 63:671-677. [PMID: 33022851 DOI: 10.1111/ped.14498] [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: 03/25/2020] [Revised: 09/18/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Retinoblastoma (RB) outcomes in Thailand are unfavorable compared to those of developed countries. This study aims to determine whether the clinical outcomes of patients with RB significantly improved after the implementation of new therapeutic approaches and which clinical factors affect survival and globe-saving outcomes. METHODS The medical records of patients newly diagnosed with RB and treated at Siriraj Hospital between January 2005 and December 2018 were reviewed retrospectively. Clinical data, treatments, and outcomes were collected and analyzed. RESULTS In 194 eyes (144 patients), leukocoria was the most common presenting feature (76.8%); 129 (66.5%) eyes were staged in group E of the International Classification of Intraocular Retinoblastoma. Of the 149 enucleated eyes, 35 had high-risk histopathological features, mostly choroidal invasion; 45 eyes (23.2%) could be salvaged. The 5-year overall survival rate was 90.3%, an improvement compared to the previous study. The 5-year enucleation-free survival rates of Groups A and B, C, D and E were 100%, 83.1%, 36.7% and 16.6% respectively. Factors associated with a lower survival rate were interval from symptom onset to diagnosis >3 months (hazard ratio (HR): 5.8: 95% confidence interval (CI): 1.637, 20.579) and buphthalmos (HR: 12.57: 95% CI: 3.936, 40.153). Factors associated with high-risk features were secondary glaucoma (HR: 11.016: 95% CI: 1.24, 98.10) and pseudohypopyon (HR: 14.110: 95% CI: 2.16, 92.05). CONCLUSIONS Survival rates and globe-saving rates appear to have improved; however, advanced-stage presentation remains the major hindrance. Further studies with a larger cohort and longer follow-up are warranted.
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Affiliation(s)
- Kaewpanpat Prajantawanich
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kleebsabai Sanpakit
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattee Narkbunnam
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nassawee Vathana
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chayamon Takpradit
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kamon Phuakpet
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bunchoo Pongtanakul
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - La-Ongsri Atchaneeyasakul
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Jassada Buaboonnam
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Dittner-Moormann S, Reschke M, Abbink FCH, Aerts I, Atalay HT, Fedorovna Bobrova N, Biewald E, Brecht IB, Caspi S, Cassoux N, Castela G, Diarra Y, Duncan C, Ebinger M, Garcia Aldana D, Hadjistilianou D, Kepák T, Klett A, Kiratli H, Maka E, Opocher E, Pawinska-Wasikowska K, Rascon J, Russo I, Rutynowska-Pronicka O, Sábado Álvarez C, Pacheco SSR, Svojgr K, Timmermann B, Vishnevskia-Dai V, Eggert A, Ritter-Sovinz P, Bechrakis NE, Jenkinson H, Moll A, Munier FL, Popovic MB, Chantada G, Doz F, Ketteler P. Adjuvant therapy of histopathological risk factors of retinoblastoma in Europe: A survey by the European Retinoblastoma Group (EURbG). Pediatr Blood Cancer 2021; 68:e28963. [PMID: 33720495 DOI: 10.1002/pbc.28963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/17/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Advanced intraocular retinoblastoma can be cured by enucleation, but spread of retinoblastoma cells beyond the natural limits of the eye is related to a high mortality. Adjuvant therapy after enucleation has been shown to prevent metastasis in children with risk factors for extraocular retinoblastoma. However, histological criteria and adjuvant treatment regimens vary and there is no unifying consensus on the optimal choice of treatment. METHOD Data on guidelines for adjuvant treatment in European retinoblastoma referral centres were collected in an online survey among all members of the European Retinoblastoma Group (EURbG) network. Extended information was gathered via personal email communication. RESULTS Data were collected from 26 centres in 17 countries. Guidelines for adjuvant treatment were in place at 92.3% of retinoblastoma centres. There was a consensus on indication for and intensity of adjuvant treatment among more than 80% of all centres. The majority of centres use no adjuvant treatment for isolated focal choroidal invasion or prelaminar optic nerve invasion. Patients with massive choroidal invasion or postlaminar optic nerve invasion receive adjuvant chemotherapy, while microscopic invasion of the resection margin of the optic nerve or extension through the sclera are treated with combined chemo- and radiotherapy. CONCLUSION Indications and adjuvant treatment regimens in European retinoblastoma referral centres are similar but not uniform. Further biomarkers in addition to histopathological risk factors could improve treatment stratification. The high consensus in European centres is an excellent foundation for a common European study with prospective validation of new biomarkers.
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Affiliation(s)
- Sabine Dittner-Moormann
- Department of Pediatric Hematology and Oncology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Madlen Reschke
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Floor C H Abbink
- Amsterdam UMC, Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Isabelle Aerts
- Institut Curie, PSL Research University and University of Paris, Paris, France
| | | | | | - Eva Biewald
- Department of Ophthalmology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Ines B Brecht
- Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Shani Caspi
- Pediatric Oncology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Nathalie Cassoux
- Institut Curie, PSL Research University and University of Paris, Paris, France
| | - Guilherme Castela
- Centro Hospitalar e Universitário de Coimbra, University of Coimbra, Coimbra, Portugal
| | - Yelena Diarra
- Department of Pediatric Hematology and Oncology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Catriona Duncan
- Royal London Hospital and Great Ormond Street Hospital, London, England
| | - Martin Ebinger
- Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | | | | | - Tomáš Kepák
- University Hospital Brno and St. Anna University Hospital/ICRC, Masaryk University, Brno, Czech Republic
| | - Artur Klett
- East-Tallinn Central Hospital, Tallinn, Estonia
| | | | - Erika Maka
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Enrico Opocher
- Royal London Hospital and Great Ormond Street Hospital, London, England.,Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy
| | | | - Jelena Rascon
- Centre for Pediatric Oncology and Hematology, Vilnius University, Vilnius, Lithuania
| | - Ida Russo
- Department of Pediatric Hematology/Oncology, IRCCS, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | | | | | - Karel Svojgr
- Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany.,German Consortium for Translational Cancer Research (DKTK), Essen, Germany German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Angelika Eggert
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Ritter-Sovinz
- Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria
| | - Nikolaos E Bechrakis
- Department of Ophthalmology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | | | - Annette Moll
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Maja Beck Popovic
- Department of Pediatric Hematology and Oncology, University Hospital CHUV, University of Lausanne, Lausanne, Switzerland
| | | | - François Doz
- Institut Curie, PSL Research University and University of Paris, Paris, France
| | - Petra Ketteler
- Department of Pediatric Hematology and Oncology, University Duisburg-Essen, University Hospital Essen, Essen, Germany.,German Consortium for Translational Cancer Research (DKTK), Essen, Germany German Cancer Research Center (DKFZ), Heidelberg, Germany
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Ioakeim-Ioannidou M, MacDonald SM. Evolution of Care of Orbital Tumors with Radiation Therapy. J Neurol Surg B Skull Base 2020; 81:480-496. [PMID: 33072488 DOI: 10.1055/s-0040-1713894] [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] [Indexed: 12/29/2022] Open
Abstract
Orbital tumors are rare lesions comprising 0.1% of all tumors and less than 20% of all ocular diseases. These lesions in children and adults differ significantly in their incidence, tumor type, and treatment management. Although surgery and systemic therapies are commonly used in the management of these diseases, radiation therapy has become a widely used treatment for both benign and malignant tumors of the orbit. Radiotherapy is used as a definitive treatment to provide local control while avoiding morbidity associated with surgery for some tumors while it is used as an adjuvant treatment following surgical resection for others. For many tumors, radiation provides excellent tumor control with preservation of visual function. This article is dedicated for presenting the most common applications of orbital radiotherapy. A brief overview of the commonly available radiation therapy modalities is given. Dose constraint goals are reviewed and acute and long-term side effects are discussed. Orbital tumors covered in this article include optic glioma, ocular melanoma, retinoblastoma, orbital rhabdomyosarcoma, orbital lymphoma, and lacrimal gland tumors. Background information, indications for radiotherapy, and goals of treatment for each case example are described.
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Affiliation(s)
- Myrsini Ioakeim-Ioannidou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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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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8
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Pérez V, Sampor C, Rey G, Parareda-Salles A, Kopp K, Dabezies AP, Dufort G, Zelter M, López JP, Urbieta M, Alcalde-Ruiz E, Catala-Mora J, Suñol M, Ossandon D, Fandiño AC, Croxatto JO, de Dávila MTG, Reaman G, Ravindranath Y, Chantada GL. Treatment of Nonmetastatic Unilateral Retinoblastoma in Children. JAMA Ophthalmol 2019; 136:747-752. [PMID: 29799944 DOI: 10.1001/jamaophthalmol.2018.1501] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Multi-institutional collaborative studies that include large patient populations for the management of retinoblastoma with histopathological risk factors could provide important information for patient management. Objective To evaluate the implementation of a strategy for the management of nonmetastatic unilateral retinoblastoma in children based on standardized diagnostic and treatment criteria. Design, Setting, and Participants This single-arm prospective study applied a strategy based on a single-center experience. The setting was a multicenter study in Latin America (Grupo de America Latina de Oncologia Pediatrica [GALOP]). Participants were children with nonmetastatic unilateral retinoblastoma (staged with the International Retinoblastoma Staging System). The study opened on July 1, 2008, and closed on December 31, 2014. Follow-up was updated until June 30, 2017. Interventions Stage 0 patients (without enucleation) were given conservative therapy without a protocol. Stage I patients (with enucleation and no residual tumor) were divided into a high-risk group (retrolaminar invasion and/or scleral invasion) and a low-risk group (all remaining patients). High-risk children received adjuvant chemotherapy with 4 alternating cycles of regimen 1 (cyclophosphamide [65 mg/kg/d] [plus sodium-2-mercaptoethane sulfonate], idarubicin hydrochloride [10 mg/m2/d], and vincristine sulfate [0.05 mg/kg/d]) and 4 cycles of regimen 2 (carboplatin [500 mg/m2/d, days 1 and 2] and etoposide [100 mg/m2/d, days 1-3]). Low-risk children did not receive adjuvant therapy. Children with buphthalmia received neoadjuvant and adjuvant chemotherapy for a total of 8 cycles. Main Outcomes and Measures Probability of event-free survival (extraocular relapse and death from any cause were considered events). Results Among 187 children registered in the study, 175 were evaluable (92 [52.5%] female; median age, 22 months; age range, 3-100 months). Forty-two were stage 0 children, 84 were stage I low-risk children, and 42 were stage I high-risk children; there were 7 children in the buphthalmia group. With a median follow-up of 46 months, the 3-year probability of event-free survival was 0.97 (95% CI, 0.94-0.99), and the probability of overall survival was 0.98 (95% CI, 0.94-1.00). Stage 0 patients had no events, stage I low-risk patients had 1 event (orbital relapse treated with second-line therapy), stage I high-risk patients had 2 events (1 central nervous system relapse and 1 death from sepsis), and the buphthalmia group had 1 event (orbital relapse, followed by central nervous relapse and death). Conclusions and Relevance Adjuvant therapy may be effective for high-risk unilateral retinoblastoma but is toxic, and neoadjuvant chemotherapy for buphthalmus appears feasible.
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Affiliation(s)
- Verónica Pérez
- Pediatric Oncology Service, Hospital San Juan de Dios, Santiago, Chile
| | - Claudia Sampor
- Hematology-Oncology Service, Hospital J. P. Garrahan, Buenos Aires, Argentina
| | - Guadalupe Rey
- Oncology Service, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | | | - Katherine Kopp
- Hematology-Oncology Service, Hospital Calvo Mackenna, Santiago, Chile
| | - Agustín P Dabezies
- Hematology-Oncology Service, Hospital Pereyra Rossell, Montevideo, Uruguay
| | - Gustavo Dufort
- Hematology-Oncology Service, Hospital Pereyra Rossell, Montevideo, Uruguay
| | - Marta Zelter
- Ophthalmology Service, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | - Juan P López
- Ophthalmology Service, Hospital Calvo Mackenna, Santiago, Chile
| | - Marcelo Urbieta
- Oncology Service, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | | | | | - Mariona Suñol
- Pathology Service, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Diego Ossandon
- Ophthalmology Service, Hospital San Juan de Dios, Santiago, Chile
| | - Adriana C Fandiño
- Ophthalmology Service, Hospital J. P. Garrahan, Buenos Aires, Argentina
| | - J Oscar Croxatto
- Ophthalmic Pathology Department, Fundación Oftalmologica Malbran, Buenos Aires, Argentina
| | | | - Gregory Reaman
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Washington, DC
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Xiao W, Ye H, Zeng H, Tang L, Chen R, Gao Y, Mao Y, Yang H. Associations among Socioeconomic Factors, Lag Time, and High-Risk Histopathologic Features in Eyes Primarily Enucleated for Retinoblastoma. Curr Eye Res 2019; 44:1144-1149. [PMID: 31173510 DOI: 10.1080/02713683.2019.1623898] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose/Aim: To determine the associations among socioeconomic factors, delay in management, and high-risk histopathologic features in eyes primarily enucleated for retinoblastoma. Materials and Methods: A single-site survey was conducted from January 2016 through January 2018. Eyes primarily enucleated for unilateral retinoblastoma were reviewed for the presence of high-risk histopathologic features. Information on clinical characteristics, socioeconomic factors, and lag time were collected during hospitalization. Results: Of the 138 children analyzed, 60 (43.5%) carried high-risk histopathologic features. Compared to children with a standard risk, those with a high risk had a longer median lag time before treatment (21.5 vs 15.0 days, P = .007), but their overall lag time (54.0 vs 50.0 days, P = .062) and delay in the initial visit (7.0 vs 10.0 days, P = .782) were comparable. Logistic regression analysis showed that children with a lag time ≥ 30 days were at a significantly higher risk of extraocular invasion (odds ratio [OR] = 2.38 and 95% confidence interval [CI] = 1.08-5.37 for treatment delay; OR = 2.12 and 95% CI = 1.01-4.62 for overall delay). Neither high-risk histopathologic features nor lag time was associated with any demographic or major socioeconomic factors, including sex, age at diagnosis or enucleation, ethnicity, household income, parents' education level, medical insurance coverage, and left-behind status. Conclusions: For children with advanced unilateral retinoblastoma, there is no statistical difference in overall lag time between standard and high-risk groups. Major socioeconomic parameters have little impact on the delay and histopathologic outcomes, thus implying that children with varied socioeconomic status may be at a similar risk of advanced tumor invasion.
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Affiliation(s)
- Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Huijing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Huiqi Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Lijuan Tang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Yang Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Yuxiang Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
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10
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Munier FL, Beck-Popovic M, Chantada GL, Cobrinik D, Kivelä TT, Lohmann D, Maeder P, Moll AC, Carcaboso AM, Moulin A, Schaiquevich P, Bergin C, Dyson PJ, Houghton S, Puccinelli F, Vial Y, Gaillard MC, Stathopoulos C. Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. "Alive, with good vision and no comorbidity". Prog Retin Eye Res 2019; 73:100764. [PMID: 31173880 DOI: 10.1016/j.preteyeres.2019.05.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.
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Affiliation(s)
- Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland.
| | - Maja Beck-Popovic
- Unit of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Guillermo L Chantada
- Hemato-Oncology Service, Hospital JP Garrahan, Buenos Aires, Argentina; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - David Cobrinik
- The Vision Center and The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA; USC Roski Eye Institute, Department of Biochemistry & Molecular Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tero T Kivelä
- Department of Ophthalmology, Ocular Oncology and Pediatric Ophthalmology Services, Helsinki University Hospital, Helsinki, Finland
| | - Dietmar Lohmann
- Eye Oncogenetics Research Group, Institute of Human Genetics, University Hospital Essen, Essen, Germany
| | - Philippe Maeder
- Unit of Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Annette C Moll
- UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Angel Montero Carcaboso
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Alexandre Moulin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paula Schaiquevich
- Unit of Clinical Pharmacokinetics, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Ciara Bergin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paul J Dyson
- Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015, Lausanne, Switzerland
| | - Susan Houghton
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Francesco Puccinelli
- Interventional Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yvan Vial
- Materno-Fetal Medicine Unit, Woman-Mother-Child Department, University Hospital of Lausanne, Switzerland
| | - Marie-Claire Gaillard
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
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Buaboonnam J, Narkbunnam N, Vathana N, Takpradit C, Phuakpet K, Pongtanakul B, Tongsai S, Atchaneeyasakul LO, Sanpakit K. Outcomes of pediatric retinoblastoma treated with ICEV regimen: A single-center study. Pediatr Hematol Oncol 2019; 36:73-81. [PMID: 30983466 DOI: 10.1080/08880018.2019.1600083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Retinoblastoma is the most common intraocular malignancy in children. The aim of this study was to investigate the efficacy and toxicity of combination ifosfamide, carboplatin, etoposide, and vincristine (ICEV) in advanced-stage pediatric retinoblastoma [International Classification of Retinoblastoma (ICRB) group D or E], and in ICRB group C in the second eye in simultaneously treated bilateral retinoblastoma. The medical records of retinoblastoma patients treated with concurrent ICEV regimen and focal therapy were retrospectively reviewed. The ICEV treatment protocol was, as follows: ifosfamide 1800 mg/m2 on Days 1-3; MESNA 600 mg/m2 on Days 1-3; carboplatin 560 mg/m2 on Day 1; etoposide 150 mg/m2 on Days 1-3; and vincristine 1.5 mg/m2 on Day 1. Of 16 retinoblastoma patients, 13 had bilateral disease. Seven first eyes in bilateral disease that were enucleated prior to ICEV therapy were excluded. Twenty-two eyes were finally included (six group C, six group D, and ten group E). Median follow-up was 3.4 years, and the median number of ICEV courses was 7. Fifteen globes could be salvaged, 12 responded to ICEV (six group C, five group D, and one group E), and three unresponsive eyes could be salvaged with external beam radiation therapy (EBRT). Enucleation-free and relapse-free survival was 68.2 and 54.5%, respectively. The results of this study suggest ICEV as an alternative therapeutic approach for globe salvage in pediatric retinoblastoma, especially in ICRB groups C and D with manageable acute toxicity. Further study in larger cohort is needed to confirm the effectiveness of treatment.
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Affiliation(s)
- Jassada Buaboonnam
- a Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Nattee Narkbunnam
- a Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Nassawee Vathana
- a Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Chayamon Takpradit
- a Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Kamon Phuakpet
- a Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Bunchoo Pongtanakul
- a Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Sasima Tongsai
- b Division of Clinical Epidemiology, Office for Research and Development, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - La-Ongsri Atchaneeyasakul
- c Department of Ophthalmology, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Kleebsabai Sanpakit
- a Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
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Hu H, Zhang W, Wang Y, Huang D, Shi J, Li B, Zhang Y, Zhou Y. Characterization, treatment and prognosis of retinoblastoma with central nervous system metastasis. BMC Ophthalmol 2018; 18:107. [PMID: 29685116 PMCID: PMC5914066 DOI: 10.1186/s12886-018-0772-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 04/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retinoblastoma is the most common primary intraocular tumor and more and more attention has been paid to the developing countries. This study was aimed to evaluate the clinical features, treatment, and prognosis of retinoblastoma patients with central nervous system (CNS) metastasis in Beijing Tongren Hospital, one of the largest tertiary eye centers in China. METHODS Clinical data of 31 consecutive retinoblastoma patients with CNS metastases, who were diagnosed at the Department of Pediatrics in Beijing Tongren Hospital between September 2005 and December 2015, were retrospective analyzed. RESULTS The median age at presentation was 29 months (range from 5 to 108 months). Magnetic resonance imaging (MRI) results indicated that 16 patients (56.6%, 16/31) presented with meningeal involvement, 12 (38.7%, 12/31) presented with intracranial mass, 11 (35.5%, 11/31) presented with thickened optic nerve, and 5 (16.1%, 5/31) presented with concurrent meningeal and spinal cord membrane involvement. Retinoblastoma cells were detected in the cerebrospinal fluid (CSF) of 12 patients (44.4%, 12/27). Laboratory examinations on the blood and CSF were performed for 11 patients who had received six cycles of systemic chemotherapy, indicated that the serum level of neurone-specific enolase (NSE) after chemotherapy was significantly lower than that before chemotherapy (P < 0.05). At the end of the follow-up, 25 patients were dead with a median survival time of 6 months (1 d - 21 months), and 6 cases were alive and continued to receive treatment. CONCLUSION Our results were basically consistent with previous reports in the developing countries, and it could be guidance for clinical treatment, prognosis and prevention of CNS metastases in retinoblastoma.
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Affiliation(s)
- Huimin Hu
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China
| | - Weiling Zhang
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China
| | - Yizhuo Wang
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China
| | - Dongsheng Huang
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China.
| | - Jitong Shi
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Bin Li
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China
| | - Yi Zhang
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China
| | - Yan Zhou
- Department of Pediatrics, Beijing Tongren Hospital, West South road 2, Yizhuang Economic and Technological Development Zone, Daxing District, Beijing, 100176, China
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Stathopoulos C, Gaillard MC, Puccinelli F, Maeder P, Hadjistilianou D, Beck-Popovic M, Munier FL. Successful conservative treatment of massive choroidal relapse in 2 retinoblastoma patients monitored by ultrasound biomicroscopy and/or spectral domain optic coherence tomography. Ophthalmic Genet 2017; 39:242-246. [DOI: 10.1080/13816810.2017.1393826] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christina Stathopoulos
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Marie-Claire Gaillard
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Francesco Puccinelli
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Philippe Maeder
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Maja Beck-Popovic
- Unit of pediatric Hemato-Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Francis L. Munier
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
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van As JW, van den Berg H, van Dalen EC. Platinum-induced hearing loss after treatment for childhood cancer. Cochrane Database Syst Rev 2016; 2016:CD010181. [PMID: 27486906 PMCID: PMC6466671 DOI: 10.1002/14651858.cd010181.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Platinum-based therapy, including cisplatin, carboplatin, oxaliplatin or a combination of these, is used to treat a variety of paediatric malignancies. Unfortunately, one of the most important adverse effects is the occurrence of hearing loss or ototoxicity. There is a wide variation in the reported prevalence of platinum-induced ototoxicity and the associated risk factors. More insight into the prevalence of and risk factors for platinum-induced hearing loss is essential in order to develop less ototoxic treatment protocols for the future treatment of children with cancer and to develop adequate follow-up protocols for childhood cancer survivors treated with platinum-based therapy. OBJECTIVES To evaluate the existing evidence on the association between childhood cancer treatment including platinum analogues and the occurrence of hearing loss. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 8), MEDLINE (PubMed) (1945 to 23 September 2015) and EMBASE (Ovid) (1980 to 23 September 2015). In addition, we searched reference lists of relevant articles and the conference proceedings of the International Society for Paediatric Oncology (2008 to 2014), the American Society of Pediatric Hematology/Oncology (2008 to 2015) and the International Conference on Long-Term Complications of Treatment of Children and Adolescents for Cancer (2010 to 2015). Experts in the field provided information on additional studies. SELECTION CRITERIA All study designs, except case reports, case series (i.e. a description of non-consecutive participants) and studies including fewer than 100 participants treated with platinum-based therapy who had an ototoxicity assessment, examining the association between childhood cancer treatment including platinum analogues and the occurrence of hearing loss. DATA COLLECTION AND ANALYSIS Two review authors independently performed the study selection. One review author performed data extraction and risk of bias assessment, which was checked by another review author. MAIN RESULTS We identified 13 eligible cohort studies including 2837 participants with a hearing test after treatment with a platinum analogue for different types of childhood cancers. All studies had methodological limitations, with regard to both internal (risk of bias) and external validity. Participants were treated with cisplatin, carboplatin or both, in varying doses. The reported prevalence of hearing loss varied considerably between 0% and 90.1%; none of the studies provided data on tinnitus. Three studies reported a prevalence of 0%, but none of these studies provided a definition for hearing loss and there might be substantial or even complete overlap in included participants between these three studies. When only studies that did provide a definition for hearing loss were included, the prevalence of hearing loss still varied widely between 1.7% and 90.1%. All studies were very heterogeneous with regard to, for example, definitions of hearing loss, used diagnostic tests, participant characteristics, (prior) anti-tumour treatment, other ototoxic drugs and length of follow-up. Therefore, pooling of results was not possible.Only two studies included a control group of people who had not received platinum treatment. In one study, the prevalence of hearing loss was 67.1% (95% confidence interval (CI) 59.3% to 74.1%) in platinum-treated participants, while in the control participants it was 7.4% (95% CI 6.2% to 8.8%). However, hearing loss was detected by screening in survivors treated with platinum analogues and by clinical presentation in control participants. It is uncertain what the effect of this difference in follow-up/diagnostic testing was. In the other study, the prevalence of hearing loss was 20.1% (95% CI 17.4% to 23.2%) in platinum-treated participants and 0.4% (95% CI 0.12% to 1.6%) in control participants. As neither study was a randomized controlled trial or controlled clinical trial, the calculation of a risk ratio was not feasible as it is very likely that both groups differed more than only the platinum treatment.Only two studies evaluated possible risk factors using multivariable analysis. One study identified a significantly higher risk of hearing loss in people treated with cisplatin 400 mg/m(2) plus carboplatin 1700 mg/m(2) as compared to treatment with cisplatin 400 mg/m(2) or less, irrespective of the definition of hearing loss. They also identified a significantly higher risk of hearing loss in people treated with non-anthracycline aminoglycosides antibiotics (using a surrogate marker) as compared to people not treated with them, for three out of four definitions of hearing loss. The other study reported that age at treatment (odds ratio less than 1 for each single-unit increase) and single maximum cisplatin dose (odds ratio greater than 1 for each single-unit increase) were significant predictors for hearing loss, while gender was not. AUTHORS' CONCLUSIONS This systematic review shows that children treated with platinum analogues are at risk for developing hearing loss, but the exact prevalence and risk factors remain unclear. There were no data available for tinnitus. Based on the currently available evidence we can only advise that children treated with platinum analogues are screened for ototoxicity in order to make it possible to diagnose hearing loss early and to take appropriate measures. However, we are unable to give recommendations for specific follow-up protocols including frequency of testing. Counselling regarding the prevention of noise pollution can be considered, such as the use of noise-limiting equipment, avoiding careers with excess noise and ototoxic medication. Before definitive conclusions on the prevalence and associated risk factors of platinum-induced ototoxicity can be made, more high-quality research is needed. Accurate and transparent reporting of findings will make it possible for readers to appraise the results of these studies critically.
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Affiliation(s)
- Jorrit W van As
- Princess Máxima Center for Pediatric Oncologyc/o Cochrane Childhood CancerHeidelberglaan 25UtrechtNetherlands3584 CS
| | - Henk van den Berg
- Emma Children's Hospital, Amsterdam UMC, University of AmsterdamDepartment of Paediatric OncologyPO Box 22660AmsterdamNetherlands1100 DD
| | - Elvira C van Dalen
- Princess Máxima Center for Pediatric OncologyHeidelberglaan 25UtrechtNetherlands3584 CS
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Malik M, Prabhakar R, Sharma DN, Rath GK. Retinoblastoma with Cerebrospinal Fluid Metastasis Treated with Orbital and Craniospinal Irradiation Using IMRT. Technol Cancer Res Treat 2016; 5:497-501. [PMID: 16981792 DOI: 10.1177/153303460600500506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 4-year-old male child presented with history of leucocoria, photophobia, and progressive visual deterioration in the left eye. Clinical examination and computed tomography revealed a unilateral retinoblastoma involving the left globe. He underwent enucleation of the left eye and was referred for adjuvant radiotherapy in view of optic nerve infiltration up to the line of resection. However, he did not report for treatment and presented six months later with a recurrent mass in the left orbit with intracranial extension. Cerebrospinal fluid (CSF) cytology was positive for malignant retinoblastoma cells. He received multiagent chemotherapy with vincristine, carboplatin, and etoposide along with intrathecal methotrexate. Although the recurrent orbital mass reduced significantly with chemotherapy, malignant cells persisted in the CSF. He was subsequently treated using intensity modulated radiation therapy (IMRT) to treat the left orbital mass along with craniospinal axis irradiation. Computed tomography done at three and nine months after completion of radiotherapy showed complete disappearance of orbital tumor. CSF cytology also showed no evidence of malignant cells.
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Affiliation(s)
- Monica Malik
- Department of Radiation Oncology, All India Institute of Medical Sciences, A-16, Nizamuddin East, New Delhi-110013, India.
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16
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Ye H, Du Y, Chen R, Luo X, Mao Y, Ai S, Ma W, Ding Y, Li Q, Yang H. The Potential Benefit of Three vs. Six Cycles of Carboplatin, Etoposide, and Vincristine in Postenucleation High-Risk Patients with IRSS Stage I Retinoblastoma. Curr Eye Res 2016; 41:1507-1512. [PMID: 27158739 DOI: 10.3109/02713683.2015.1130230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the clinical effects of different cycles of carboplatin, etoposide, and vincristine (CEV) regimens of adjuvant chemotherapy in postenucleation high-risk patients with IRSS Stage I retinoblastoma (RB). METHODS A retrospective analysis of 53 RB patients hospitalized in the Zhongshan Ophthalmic Center of Sun Yat-sen University was performed. All patients had unilateral involvement, received enucleation treatment, were diagnosed as RB by pathology, and had high-risk pathological factors. Patients either refused postoperative chemotherapy or received three or six cycles of CEV regimen chemotherapy. The clinical information, treatment, and results of patients in all groups were compared. RESULTS A total of 19 cases refused postenucleation chemotherapy, 18 cases received three cycles, and 16 cases received six cycles of the CEV regimen chemotherapy. The 5-year disease-free survival rate and the overall survival (OS) rate in the chemotherapy group were higher than those in the non-chemotherapy group (97.1% vs. 63.2%, p = 0.001) and were not different between the three-cycle chemotherapy group and the six-cycle chemotherapy group (94.4% vs. 100%, p = 0.35). CONCLUSION After eye enucleation for patients with high-risk unilateral RB, the CEV regimen chemotherapy was associated with a higher survival rate. The three-cycle CEV regimen adjuvant chemotherapy was effective and is expected to replace the six-cycle CEV regimen chemotherapy.
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Affiliation(s)
- Huijing Ye
- a State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Yi Du
- b Department of Ophthalmology , The First Affiliated Hospital of Guangxi Medical University , Nanning , Guangxi , China
| | - Rongxin Chen
- a State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Xin Luo
- c Affiliated Hospital of Zunyi Medical College , Zunyi , Guizhou , China
| | - Yuxiang Mao
- a State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Siming Ai
- a State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Wenfang Ma
- a State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Yungang Ding
- a State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Qian Li
- a State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
| | - Huasheng Yang
- a State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou , China
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18
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Soliman SE, Dimaras H, Souka AA, Ashry MH, Gallie BL. Socioeconomic and psychological impact of treatment for unilateral intraocular retinoblastoma. J Fr Ophtalmol 2015; 38:550-8. [PMID: 25982424 DOI: 10.1016/j.jfo.2015.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/12/2015] [Accepted: 03/20/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE To identify the socioeconomic and psychosocial impacts of clinical treatment decisions for advanced unilateral intraocular retinoblastoma. DESIGN Retrospective observational case series. METHODS SETTING institutional study at Alexandria Main University Hospital. STUDY POPULATION records of 66 unilateral retinoblastoma cases treated from May 2005 to May 2013 were retrospectively reviewed. Sixty cases were eligible (International Intraocular Retinoblastoma Classification [IIRC] group C, D or E). PROCEDURES two treatment groups were compared: enucleation vs. salvage treatment. Salvage treatment eyes were further subdivided based on IIRC group. Six socioeconomic parameters (financial burden, financial impact, psychological, social, medical and tumor impacts) were scored. Parameter scores ranged from 0 to 3, for overall score range 0 (no adverse impact) to 18 (severe adverse impact). MAIN OUTCOME MEASURES derived Socioeconomic scores were correlated with treatment and outcomes. RESULTS The enucleation group (28 eyes) had a median overall Socioeconomic score of 4/18, significantly lower than the salvage treatment group (32 eyes), median score 11/18 (P<0.01). Socioeconomic score varied with IIRC group. Attempted eye salvage failed in 25 children, due to uncontrolled tumor (44%) and socioeconomic impact of cumulative therapies (56%). Treatment duration and Socioeconomic score were higher for the 5 children in the salvage treatment group who developed metastatic disease compared to those without metastasis (P<0.01). CONCLUSIONS The socioeconomic and psychosocial impacts of attempted ocular salvage for unilateral intraocular retinoblastoma are severe, in comparison to primary enucleation. Primary enucleation is a good treatment for unilateral retinoblastoma.
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Affiliation(s)
- S E Soliman
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt; Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, 555 University Avenue, Room 7265, Toronto ON M5G 1X8, Canada.
| | - H Dimaras
- Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, 555 University Avenue, Room 7265, Toronto ON M5G 1X8, Canada; Division of Visual Science, Toronto Western Research Institute, Toronto, Canada
| | - A A Souka
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - M H Ashry
- Community Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - B L Gallie
- Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, 555 University Avenue, Room 7265, Toronto ON M5G 1X8, Canada; Division of Visual Science, Toronto Western Research Institute, Toronto, Canada; Department of Ophthalmology & Visual Science, Hospital for Sick Children, Toronto, Canada; Princess Margaret Cancer Centre, Toronto, Canada; Departments of Ophthalmology & Visual Sciences, Medical Biophysics and Molecular Genetics, University of Toronto, Toronto, Canada
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Abstract
Retinoblastoma is the most common neoplasm of the eye in childhood, and represents 3% of all childhood malignancies. Retinoblastoma is a cancer of the very young; two-thirds are diagnosed before 2 years of age and 95% before 5 years. Retinoblastoma presents in 2 distinct clinical forms: (1) a bilateral or multifocal, heritable form (25% of all cases), characterized by the presence of germline mutations of the RB1 gene; and (2) a unilateral or unifocal form (75% of all cases), 90% of which are nonhereditary. The treatment of retinoblastoma is multidisciplinary and is designed primarily to save life and preserve vision.
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Affiliation(s)
- Carlos Rodriguez-Galindo
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, 450 Brookline Avenue, D3-133, Boston, MA 02215, USA.
| | - Darren B Orbach
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02215, USA
| | - Deborah VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02215, USA
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Künkele A, Wilm J, Holdt M, Lohmann D, Bornfeld N, Eggert A, Temming P, Schulte JH. Neoadjuvant/adjuvant treatment of high-risk retinoblastoma: a report from the German Retinoblastoma Referral Centre. Br J Ophthalmol 2015; 99:949-53. [DOI: 10.1136/bjophthalmol-2014-306222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/26/2014] [Indexed: 11/04/2022]
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Grossniklaus HE. Retinoblastoma. Fifty years of progress. The LXXI Edward Jackson Memorial Lecture. Am J Ophthalmol 2014; 158:875-91. [PMID: 25065496 PMCID: PMC4250440 DOI: 10.1016/j.ajo.2014.07.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/14/2014] [Accepted: 07/14/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE To review the progress made in understanding the genetic basis, molecular pathology, and treatment of retinoblastoma since the previous Jackson lecture on the topic was published 50 years ago. DESIGN Perspective based on personal experience and the literature. METHODS The literature regarding retinoblastoma was reviewed since 1963. Advances in understanding the biology and treatment of retinoblastoma provided context through the author's clinical, pathologic, and research experiences. RESULTS Retinoblastoma was first identified in the 1500s and defined as a unique clinicopathologic entity in 1809. Until the mid-1900s, knowledge advanced sporadically, with technological developments of ophthalmoscopy and light microscopy, and with the introduction of surgical enucleation, chemotherapy, and radiation therapy. During the last 50 years, research and treatment have progressed at an unprecedented rate owing to innovations in molecular biology and the development of targeted therapies. During this time period, the retinoblastoma gene was discovered; techniques for genetic testing for retinoblastoma were developed; and plaque brachytherapy, chemoreduction, intra-arterial chemotherapy, and intraocular injections of chemotherapeutic agents were successfully introduced. CONCLUSIONS Nearly all patients with retinoblastoma in developed countries can now be cured of their primary cancer--a remarkable achievement for a childhood cancer that once was uniformly fatal. Much of this success is owed to deciphering the role of the Rb gene, and the benefits of targeted therapies, such as chemoreduction with consolidation as well as intra-arterial and intravitreal chemotherapies. Going forward, the main challenge will be ensuring that access to care is available for all children, particularly those in developing countries.
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Affiliation(s)
- Hans E Grossniklaus
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, Georgia.
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Baroni LV, Sampor C, Fandiño A, Solernou V, Demirdjian G, de Davila MTG, Chantada GL. Anterior segment invasion in retinoblastoma: is it a risk factor for extraocular relapse? J Pediatr Hematol Oncol 2014; 36:e509-12. [PMID: 24732059 DOI: 10.1097/mph.0000000000000167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a retrospective review of patients with retinoblastoma and anterior segment invasion (ASI) as risk factors for extraocular relapse. Only those with ASI combined with postlaminar optic nerve invasion and/or scleral invasion received adjuvant chemotherapy and those with tumor at the resection margin received orbital radiotherapy. Those with only uveal invasion did not receive adjuvant therapy. Of 479 evaluable patients, 67 patients had pathologically confirmed ASI, including 52 with anterior chamber invasion and 47 with iris or ciliary body invasion. ASI occurred with other pathology risk factors (25 had concomitant posterior uveal invasion, 36 had postlaminar optic nerve invasion, 11 with cut-end invasion, and 25 with scleral invasion). The 5-year disease-free survival (pDFS) was 0.9 (95% CI, 0.8-0.95) for children with ASI with no significant differences among children with other pathology risk factors with and without ASI. ASI was not significantly associated with extraocular relapse in multivariate analysis. There were no significant differences in pDFS for patients with anterior chamber invasion and those with iris-ciliary body invasion (pDFS 0.89 [95% CI, 0.65-0.96] vs. 0.93 [95% CI, 0.61-0.98]). To conclude, ASI was seen with other pathology risk factors and it did not add a significant risk for extraocular relapse.
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Affiliation(s)
- Lorena V Baroni
- Services of *Hemato-oncology †Ophthalmology ‡Pathology §Technological Coordination, Hospital JP Garrahan, Buenos Aires, Argentina
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Chen KS, Shi MD, Chien CS, Shih YW. Pinocembrin suppresses TGF-β1-induced epithelial-mesenchymal transition and metastasis of human Y-79 retinoblastoma cells through inactivating αvβ3 integrin/FAK/p38α signaling pathway. Cell Biosci 2014; 4:41. [PMID: 25949790 PMCID: PMC4422197 DOI: 10.1186/2045-3701-4-41] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/21/2014] [Indexed: 01/18/2023] Open
Abstract
Background Pinocembrin is the most abundant flavonoid in propolis. In this study, we investigated the antimetastatic effect of pinocembrin on TGF-β1-induced epithelial-mesenchymal transition (EMT) and metastasis of human Y-79 retinoblastoma cells. Results Firstly, the results showed that pinocembrin significantly suppresses the TGF-β1-induced abilities of the invasion and migration of Y-79 cells under non-cytotoxic concentration. Pinocembrin decreased TGF-β1-induced expression of vimentin, N-cadherin, αv and β3 integrin in Y-79 cells. Molecular data also showed pinocembrin inhibits the activation of focal adhesion kinase (FAK) and p38α signal involved in the downregulation of enzyme activities, protein and messenger RNA levels of matrix metalloproteinase-2/9 (MMP-2/-9) induced by TGF-β1. Next, pinocembrin also strongly inhibited the degradation of inhibitor of kappaBα (IκBα) and the nuclear levels of nuclear factor kappa B (NF-κB). Also, a dose-dependent inhibition on the binding ability of NF-κB was further observed under pinocembrin treatment. Conclusions Presented results indicated that pinocembrin inhibits TGF-β1-induced epithelial-mesenchymal transition (EMT) and metastasis of Y-79 cells by inactivating the αvβ3 integrin/FAK/p38α signaling pathway. Thus, our findings point to the anticancer potential of pinocembrin against retinoblastoma cells.
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Affiliation(s)
- Kun-Shiang Chen
- Department of Optometry, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan
| | - Ming-Der Shi
- Department of Medical Technology, Kaohsiung Veterans General Hospital Tainan Branch, Tainan 71051, Taiwan ; Department of Medical Laboratory Science and Biotechnology and Graduate Institute of Biological Technology, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan
| | - Chi-Sheng Chien
- Department of Orthopaedic Surgery, Chi Mei Medical Center, Tainan 71067, Taiwan
| | - Yuan-Wei Shih
- Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan ; Department of Biological Science and Technology and Graduate Institute of Biomedical Science, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan
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Abstract
BACKGROUND There are no standardized diagnostic or treatment guidelines for patients with advanced unilateral retinoblastoma. MATERIALS AND METHODS Patients with advanced unilateral retinoblastoma were prospectively treated after enucleation using a risk-based protocol. Patients were assigned to low risk (LR), intermediate risk (IR), or high risk (HR) based on pathology. LR patients underwent observation. IR patients received 4 courses of chemotherapy with vincristine, doxorubicin, and cyclophosphamide (VDC). In the HR group, patients received 3 courses of VDC alternating with 3 courses of vincristine, carboplatin, and etoposide (VCE) and irradiation when indicated. RESULTS Fifty patients with advanced unilateral retinoblastoma were treated (LR, n=36; IR, n=7; HR, n=7). All eyes were Reese-Ellsworth group V. All bone scans (n=81), lumbar punctures (n=16), and bone marrow aspirates (n=16) were negative. Chemotherapy was well tolerated. Grades 3/4 hematologic toxicities were seen in all patients; grades 3/4 nonhematologic toxicities were seen in half the patients. Only one patient in the HR group received radiation therapy. All patients were alive at the time of analysis with no signs of disease recurrence. Median follow-up was 3.4 years (range, 0.8 to 6.4 y). CONCLUSIONS Patients with nonmetastatic unilateral retinoblastoma undergoing primary enucleation can be cured with a graduated intensity approach based on pathology.
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Chantada GL, Fandiño AC, Schvartzman E, Raslawski E, Schaiquevich P, Manzitti J. Impact of chemoreduction for conservative therapy for retinoblastoma in Argentina. Pediatr Blood Cancer 2014; 61:821-6. [PMID: 24243706 DOI: 10.1002/pbc.24857] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/18/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few studies were reported from developing countries regarding patient outcome and ocular survival in children with bilateral retinoblastoma treated with chemoreduction compared to external beam radiotherapy (EBRT). PROCEDURE We undertook a retrospective study of three treatment eras: (1) (1988-1995) n = 68 when EBRT was used as primary conservative therapy; (2) (1995-2003) n = 46 when carboplatin-based systemic chemoreduction was introduced and (3) (2003-2009) (n = 83) when additional periocular chemotherapy was added for advanced tumors and pre-enucleation chemotherapy was given for those with massive buphthalmia. RESULTS The probability of 5-year disease-free survival was 0.94 (95% confidence interval [CI] 0.91-0.98%) without significant differences among the three eras. Chemoreduction reduced the use of EBRT from 84.6% to 68.7% in eras 1 and 3, respectively (P = 0.008), which was more evident in cases with less advanced disease. Chemoreduction also significantly improved the 5-year probability of preservation of eyes with advanced disease from 0.13 (95% CI 0.04-0.27) during era 1 to 0.49 (95% CI 0.34-0.62) in era 3 (P < 0.0001). Chemoreduction was not associated with changes in the probability of extraocular relapse, which was reduced after the introduction of pre-enucleation chemotherapy. Second malignancies occurred in nine cases, acute myeloid leukemia being the most fatal one. Trilateral retinoblastoma occurred in three cases and all of them had been exposed to chemotherapy. CONCLUSIONS Chemoreduction reduced the need for EBRT in eyes with less advanced disease and improved the preservation of eyes with advanced disease while its effects on secondary malignancies or trilateral disease remain unclear.
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Study on Clinical Therapeutic Effect Including Symptoms, Eye Preservation Rate, and Follow-up of 684 Children with Retinoblastoma. Eur J Ophthalmol 2013; 23:532-8. [PMID: 23483499 DOI: 10.5301/ejo.5000245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2012] [Indexed: 11/20/2022]
Abstract
Purpose Retinoblastoma is the most common type of primary malignant intraocular tumor in children. The purpose of this study is to summarize the clinical experience of diagnosis and treatment for retinoblastoma, aiming to provide appropriate knowledge for surveillance and therapy for retinoblastoma. Methods We performed retrospective analysis of 684 children (885 eyes) with advanced retinoblastoma diagnosed in the department of Pediatrics in Tongren Hospital, Beijing, China, between September 2005 and May 2010. Results The average age at first diagnosis was 2.2 ± 1.7 years with overall median age 1.91 years. Leucocoria was the most common sign at the initial diagnosis (70.47%, 482/684). A total of 21 cases (3.06%) had positive family history. According to International Retinoblastoma Classification, 551 cases (80.57%, 723 eyes) were A-E stage and 81.47% (589/723) were D-E stages of retinoblastoma; extraocular stage was present in 101 cases (120 eyes, 14.76%); metastatic stage was present in 32 cases (44 eyes, 4.67%). Pathology diagnosis was performed in 494 cases of unilateral or bilateral enucleation; 91 cases were grade I, 260 cases were grade II, 94 cases were grade III, 49 cases were grade IV. The median follow-up time was 27 months until June 2010. Total survival rate was 95.13%. A total of 34 cases were lost to follow-up and 34 cases were abandoned. Conclusions Children developed retinoblastoma at a young age. Early diagnosis is difficult. Key factors of clinical treatment and long survival rate were diagnosis and treatment at the early stage with multidisciplinary methods.
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Sethi RV, Shih HA, Yeap BY, Mouw KW, Petersen R, Kim DY, Munzenrider JE, Grabowski E, Rodriguez-Galindo C, Yock TI, Tarbell NJ, Marcus KJ, Mukai S, MacDonald SM. Second nonocular tumors among survivors of retinoblastoma treated with contemporary photon and proton radiotherapy. Cancer 2013; 120:126-33. [PMID: 24122173 DOI: 10.1002/cncr.28387] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/14/2013] [Accepted: 08/16/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND The leading cause of death among patients with hereditary retinoblastoma is second malignancy. Despite its high rate of efficacy, radiotherapy (RT) is often avoided due to fear of inducing a secondary tumor. Proton RT allows for significant sparing of nontarget tissue. The current study compared the risk of second malignancy in patients with retinoblastoma who were treated with photon and proton RT. METHODS A retrospective review was performed of patients with retinoblastoma who were treated with proton RT at the Massachusetts General Hospital or photon RT at Boston Children's Hospital between 1986 and 2011. RESULTS A total of 86 patients were identified, 55 of whom received proton RT and 31 of whom received photon RT. Patients were followed for a median of 6.9 years (range, 1.0 years-24.4 years) in the proton cohort and 13.1 years (range, 1.4 years-23.9 years) in the photon cohort. The 10-year cumulative incidence of RT-induced or in-field second malignancies was significantly different between radiation modalities (proton vs photon: 0% vs 14%; P = .015). The 10-year cumulative incidence of all second malignancies was also different, although with borderline significance (5% vs 14%; P = .120). CONCLUSIONS Retinoblastoma is highly responsive to radiation. The central objection to the use of RT, the risk of second malignancy, is based on studies of patients treated with antiquated, relatively nonconformal techniques. The current study is, to the authors' knowledge, the first to present a series of patients treated with the most conformal of the currently available external-beam RT modalities. Although longer follow-up is necessary, the preliminary data from the current study suggest that proton RT significantly lowers the risk of RT-induced malignancy.
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Aerts I, Sastre-Garau X, Savignoni A, Lumbroso-Le Rouic L, Thebaud-Leculée E, Frappaz D, Coze C, Thomas C, Gauthier-Villars M, Lévy-Gabriel C, Brisse HJ, Desjardins L, Doz F. Results of a Multicenter Prospective Study on the Postoperative Treatment of Unilateral Retinoblastoma After Primary Enucleation. J Clin Oncol 2013; 31:1458-63. [DOI: 10.1200/jco.2012.42.3962] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The objective of this prospective study was to assess overall survival and event-free survival in patients with intraocular unilateral retinoblastoma (Reese-Ellsworth group V) treated by primary enucleation with or without adjuvant therapy depending on histopathologic risk factors. Patients and Methods Patients (n = 123) were divided into three groups on the basis of risk factors for extraocular relapse and metastasis assessed on centralized histologic examination of enucleated eyes. Group 1 (n = 70) had minimal or no choroidal involvement and/or prelaminar or no optic nerve involvement and received no adjuvant therapy. Group 2 (n = 52) had massive choroidal involvement and/or intra- or retrolaminar optic nerve involvement and/or anterior segment involvement and received four courses of adjuvant chemotherapy. Group 3 (n = 1) had invasion of the surgical margin of the optic nerve and/or microscopic extrascleral involvement and received six courses of adjuvant chemotherapy with intrathecal thiotepa, consolidation chemotherapy, and autologous stem-cell rescue. Genetic testing was also performed. Results Median follow-up for the 123 patients was 71 months. No disease progression, relapse, or distant metastasis occurred during follow-up. No second malignancies occurred. This requires confirmation with longer follow-up. Secondary bilateralization occurred in two patients with identified RB1 germline mutation. Adjuvant chemotherapy was well tolerated, with limited toxicity. Molecular testing found constitutional RB1 gene mutations in only nine of 100 evaluated patients. Conclusion The survival rate of 100% was excellent, including 57% of patients who received no adjuvant therapy, suggesting that chemotherapy could be de-escalated in some patients, especially those with massive choroidal involvement.
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Affiliation(s)
- Isabelle Aerts
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Xavier Sastre-Garau
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Alexia Savignoni
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Livia Lumbroso-Le Rouic
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Estelle Thebaud-Leculée
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Didier Frappaz
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Carole Coze
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Caroline Thomas
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Marion Gauthier-Villars
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Christine Lévy-Gabriel
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Hervé J. Brisse
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - Laurence Desjardins
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
| | - François Doz
- Isabelle Aerts, Xavier Sastre-Garau, Alexia Savignoni, Livia Lumbroso-Le Rouic, Marion Gauthier-Villars, Christine Lévy-Gabriel, Hervé J. Brisse, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Sorbonne Paris Cité, Paris; Estelle Thebaud-Leculée, Centre Oscar Lambret, Lille; Didier Frappaz, Institut d'Hémato-oncologie Pédiatrique, Lyon; Carole Coze, Hôpital de la Timone, Centre Hospitalier Universitaire (CHU) Marseille; and Caroline Thomas, CHU Nantes
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Varan A, Kiratli H, Aydın B, Tarlan B, Poyraz CB, Akyüz C, Büyükpamukçu M. The treatment of retinoblastoma with four-drug regimen including cisplatin, etoposide, vincristine, and cyclophosphamide. Pediatr Hematol Oncol 2012; 29:529-37. [PMID: 22759219 DOI: 10.3109/08880018.2012.700387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Over an 11-year period, 59 patients (83 eyes) were treated with four-drug chemotherapy (cisplatin, etoposide, cyclophosphamide, and vincristine) at Hacettepe University, Departments of Ophthalmology and Pediatric Oncology. We evaluated the clinical features, treatment modalities, and outcome of these patients with a median follow-up of 55 months (range 9-130 months). Enucleation was performed as a first-line treatment for 30 eyes due to iris neovascularization and neovascular glaucoma, tumor in the anterior chamber regardless of the tumor stage, and for the patients with the Reese-Ellsworth (RE) group Vb. Chemotherapy was given regardless of tumor stages according to the RE groups in all 59 patients (83 eyes). Fifty-three eyes were treated with chemoreduction (CRD) and focal treatment. The rates of globe preservation were 87% for bilateral tumors and 35% for unilateral tumors in the CRD group. The 5-year overall (OS) and enucleation-free survival (EnFS) was 86.9% and 40%, respectively, for the whole group. At 3rd year, ocular survival rate for the eyes with vitreal or subretinal seeding was 58% and without seeding was 66% (P = .78). Seeding or subretinal collection may not indicate poor prognosis under intensive chemotherapy. The intensive four-drug chemotherapy protocol might have satisfactory results in the retinoblastoma (RBL) patients.
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Affiliation(s)
- Ali Varan
- Department of Pediatric Oncology, Institute of Oncology, Hacettepe University, Ankara, Turkey.
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Chantada GL. Retinoblastoma: Lessons and challenges from developing countries. Ellsworth Lecture 2011. Ophthalmic Genet 2011; 32:196-203. [PMID: 21770696 DOI: 10.3109/13816810.2011.592173] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kandalam M, Mitra M, Subramanian K, Biswas J. Molecular pathology of retinoblastoma. Middle East Afr J Ophthalmol 2011; 17:217-23. [PMID: 20844677 PMCID: PMC2934713 DOI: 10.4103/0974-9233.65498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Retinoblastoma (RB) is an embryonic neoplasm of retinal origin. For many years, scientists have sought the fundamental origins of tumorigenesis, with the ultimate hope of discovering a cure. Indeed, these efforts have led to a significant understanding that multiple molecular and genetic aberrations, such as uncontrolled proliferation and the inhibition of apoptosis that contribute to the canonical characteristics of tumor biology. Despite these advances, a thorough understanding, such as the precise cells, which are the targets of neoplastic transformation, especially in solid tumors, is currently lacking. The focus of this review is to emphasize the molecular defects involved in the RB tumor progression and mechanisms associated with inhibition of tumor cell apoptotic processes. This review also discusses the importance of target molecules characterization and their potential therapeutic or prognostic use in RB disease.
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Affiliation(s)
- Mallikarjuna Kandalam
- Department of Ocular Pathology, Vision Research Foundation, Sankara Nethralaya, Chennai, India
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Successful treatment of metastatic retinoblastoma with high-dose chemotherapy and autologous stem cell rescue in South America. Bone Marrow Transplant 2011; 47:522-7. [DOI: 10.1038/bmt.2011.108] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ali AAE, Elsheikh SMA, Elhaj A, Osman N, Abuidris D, Eltayeb EA, Mahgoub M, Hamdoun A, Babiker MM, Mohamedani AA, Elwali NEMA, Qaddoumi I. Clinical presentation and outcome of retinoblastoma among children treated at the National Cancer Institute (NCI) in Gezira, Sudan: a single Institution experience. Ophthalmic Genet 2011; 32:122-5. [PMID: 21366428 DOI: 10.3109/13816810.2010.546822] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Retinoblastoma (RB) is a rare and unique cancer that affects the eyes of very young children. There are few reports on RB in Sudan. MATERIALS AND METHODS We performed a retrospective study of data from patients diagnosed with retinoblastoma between January 1999 and December 2009 at the National Cancer Institute in Gezira (NCI-Gezira). RESULTS Of the 519 cases of childhood cancer treated at NCI-Gezira during the study period, 25 (4.8%) were retinoblastoma. Of these 25 patients with retinoblastoma, there were 13 boys and 19 cases were unilateral. The median age at diagnosis was 36 months (range, 8-60 months). The disease was localized in 9 patients, regional in 5 patients, and metastatic in 11 patients. The most frequent symptoms were enlarged eye (n = 14) and leukocoria (n = 8). Nine patients (36%) have been lost to follow-up; 9 were alive at last follow-up (7 in remission, 2 progressed); and 7 have died (5 from disease and 2 from unrelated causes). Twenty-two eyes were enucleated in 16 patients (6 bilateral and 10 unilateral). Pathologic examination of the enucleated eyes could only be completed in 11 patients. Diagnostic imaging in the form of computerized tomography scans or ultrasonography of the brain and orbit was done for 10 patients (40%). CONCLUSIONS Although these findings are not surprising, and similar to reports from other developing countries, we hope our work will provide a foundation for strategies to improve outcome for retinoblastoma in our center such as proper training, public awareness, team approach, and twinning.
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Affiliation(s)
- Amel A E Ali
- Department of Oncology, National Cancer Institute-University of Gezira, Wad- Sudan.
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Chantada GL, Qaddoumi I, Canturk S, Khetan V, Ma Z, Kimani K, Yeniad B, Sultan I, Sitorus RS, Tacyildiz N, Abramson DH. Strategies to manage retinoblastoma in developing countries. Pediatr Blood Cancer 2011; 56:341-8. [PMID: 21225909 DOI: 10.1002/pbc.22843] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 08/30/2010] [Indexed: 11/06/2022]
Abstract
Survival of retinoblastoma is >90% in developed countries but there are significant differences with developing countries in stage at presentation, available treatment options, family compliance, and survival. In low-income countries (LICs), children present with advanced disease, and the reasons are socioeconomic and cultural. In middle-income countries (MICs), survival rates are better (>70%), but there is a high prevalence of microscopically disseminated extraocular disease. Programs for eye preservation have been developed, but toxicity-related mortality is higher. Although effective treatment of microscopically extraocular disease improved the outcome, worldwide survival will be increased only by earlier diagnosis and better treatment adherence.
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Chantada GL, Fandiño AC, Guitter MR, Raslawski EC, Dominguez JL, Manzitti J, de Dávila MTG, Zubizarreta P, Scopinaro M. Results of a prospective study for the treatment of unilateral retinoblastoma. Pediatr Blood Cancer 2010; 55:60-6. [PMID: 20486172 DOI: 10.1002/pbc.22503] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Few prospective studies about the management of unilateral retinoblastoma with pathology risk factors (PRFs) have been published. METHODS Patients (n = 114) were divided into four groups: Group 1 (initial chemoreduction) (n = 17). Groups 2 and 3, included patients initially enucleated with no, or lower risk PRFs: (n = 65) and with higher risk PRFs (n = 30), respectively. The later included postlaminar optic nerve involvement (PLONI) (n = 23), tumor at resection margin of optic nerve (n = 5) or isolated scleral invasion (n = 2). Group 3 received adjuvant chemotherapy including a total eight cycles of carboplatin and etoposide, alternating with cyclophosphamide, idarubicin, and vincristine. Orbital radiotherapy (45 Gy) was given to patients with invasion to the resection margin. Group 4 included patients with metastatic disease (n = 2). They were given neoadjuvant therapy followed by surgery and high-dose chemotherapy and autologous stem cell rescue. RESULTS Five-year event-free survival is 0.94 (1 for Group 1, 0.94 for Group 2, 0.96 for Group 3, and 0 for Group 4). Events included. Group 2: Systemic relapse (n = 2) and combined orbital and CNS relapse (n = 1). Relapsing patients had PLONI (n = 2) and isolated focal choroidal invasion (n = 1). Group 3: CNS relapse (n = 1) in a patient with tumor at the resection margin of optic nerve. Group 4: CNS relapse (n = 2). Only one relapsed patient survived. Eight of 17 eyes treated conservatively were preserved. CONCLUSIONS The survival of patients with unilateral retinoblastoma was excellent and 60% were spared from adjuvant treatment. Our intensive regimen was likely to be effective for prevention of metastasis in patients with higher risk PRFs.
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Dunkel IJ, Chan HSL, Jubran R, Chantada GL, Goldman S, Chintagumpala M, Khakoo Y, Abramson DH. High-dose chemotherapy with autologous hematopoietic stem cell rescue for stage 4B retinoblastoma. Pediatr Blood Cancer 2010; 55:149-52. [PMID: 20486181 DOI: 10.1002/pbc.22491] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stage 4b retinoblastoma (central nervous system metastatic disease) has been lethal in virtually all cases reported. Here we describe a series of eight patients treated with intensive chemotherapy, defined as the intention to include high-dose chemotherapy with autologous hematopoietic stem cell rescue. PROCEDURE Induction chemotherapy included cyclophosphamide and/or carboplatin with a topoisomerase inhibitor. High-dose chemotherapy regimens were carboplatin and thiotepa with or without etoposide (n = 3) or carboplatin, etoposide, and cyclophosphamide (n = 2). RESULTS Seven patients had leptomeningeal disease and one patient had only direct extension to the CNS via the optic nerve. Three patients had stage 4b disease at the time of original diagnosis of the intra-ocular retinoblastoma; five had later onset at a median of 12 months (range 3-69 months). One patient died of toxicity (septicemia and multi-organ system failure) during induction and two had disease progression prior to high-dose chemotherapy. Five patients received high-dose chemotherapy at a median of 6 months (range 4-6) post-diagnosis of stage 4b disease. Two patients survive event-free at 40 and 101 months; one was irradiated following recovery from the high-dose chemotherapy. CONCLUSIONS Intensive multimodality therapy may be beneficial for some patients with stage 4b retinoblastoma. Longer follow-up will determine whether it has been curative.
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Affiliation(s)
- Ira J Dunkel
- Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
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Mallikarjuna K, Sundaram CS, Sharma Y, Deepa PR, Khetan V, Gopal L, Biswas J, Sharma T, Krishnakumar S. Comparative proteomic analysis of differentially expressed proteins in primary retinoblastoma tumors. Proteomics Clin Appl 2010; 4:449-63. [DOI: 10.1002/prca.200900069] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 10/12/2009] [Accepted: 11/08/2009] [Indexed: 12/17/2022]
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Abstract
BACKGROUND Retinoblastoma (RB) is a childhood ocular malignancy associated with mutations in RB1, a tumor susceptibility gene. Inactivation of both copies of the RB1 gene in a retinal cell is followed by the sequential acquisition of additional genetic changes that define the course to tumor formation. METHODS To identify the genetic events that cooperate with loss of the RB1 gene function, we performed a whole genome sampling assay based on single nucleotide polymorphism genotyping. We used DNA isolated from 25 sporadic, unilateral RB tumors and matched blood samples. RESULTS Genomic profiles were analyzed to identify regions of loss of heterozygosity or amplification. Two major subclasses of RB tumors were defined by the presence (n = 18) or absence (n = 7) of loss of heterozygosity of chromosome 13. Loss of heterozygosity in most cases was the result of copy-neutral events caused by mitotic recombination and mitotic nondisjunction. Tumors harbored novel regions of amplification at 1q44, 3p25, 11q14, 11q25, 14q23, 15q21, 16p13, 17p11.2, 19q13, and 20q13, whereas regions of loss included 6q22, 7q21, and 21q2. CONCLUSION Whole genome sampling assay-based analysis of unilateral RB tumors revealed novel regions as significant. These minimum critical regions that are lost or amplified are expected to harbor genes that aid the process of tumorigenesis.
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Chantada GL, Dunkel IJ, Qaddoumi I, Antoneli CBG, Totah A, Canturk S, Nawaiseh I, Fandiño A, Pífano I, Peksayar G, Ribeiro KB, Abramson DH. Familial retinoblastoma in developing countries. Pediatr Blood Cancer 2009; 53:338-42. [PMID: 19434730 DOI: 10.1002/pbc.21970] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although screening for familial retinoblastoma has been shown to be beneficial we suspected that such screening programs may be less than optimal in developing countries (DC). METHODS Retrospective cohort study comparing patients with familial retinoblastoma from five centers in DC (Argentina, Brazil, Turkey, Jordan, and Venezuela) versus a reference center in the USA. RESULTS Ninety-two (32 from the USA and 60 from DC) patients were included. Forty-one (44.6%) patients avoided enucleation, 42 (45.7%) had 1 eye removed, and 9 (9.8%) underwent bilateral enucleation. Eleven (11.9%) had major pathology risk factors at enucleation. There were no cases of metastatic disease at diagnosis. Detection via screening was significantly less common in DC than in the USA (23.3% vs. 71.8%, P < 0.0001). Patients in DC were diagnosed at a significantly later age and with more advanced intraocular disease that led to increased risk of bilateral enucleation. Patients detected by screening in DC were significantly younger at diagnosis, had less advanced intraocular disease, better ocular preservation rates and survival results than those whose retinoblastoma was not detected via early screening. Five-year pEFS was 0.92 for the patients treated in the USA and 0.81 for the patients in DC (P = 0.42). Seven events occurred (extraocular relapse four in patients from DC and second malignancies in three). CONCLUSIONS Patients with familial retinoblastoma are less likely to be diagnosed by screening in DC and had higher morbidity and mortality caused by recurrent extraocular retinoblastoma.
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Some clinical findings at presentation can predict high-risk pathology features in unilateral retinoblastoma. J Pediatr Hematol Oncol 2009; 31:325-9. [PMID: 19415010 DOI: 10.1097/mph.0b013e3181923cc5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS To identify clinical features at presentation to help in detecting patients with retinoblastoma and pathology risk factors (PRFs) preoperatively, and therefore selecting a high-risk population that could benefit from preoperative treatment. METHODS A retrospective analysis of a prospectively filled form of 182 consecutive patients with unilateral retinoblastoma treated with initial enucleation from 1988 to 2006. Univariate and multivariate analyses were carried out. Major choroidal invasion and postlaminar optic nerve and scleral extension were considered PRFs. Within this subgroup, a higher-risk cohort (microscopical residual disease caused by trans-scleral invasion or invasion to the resection margin of the optic nerve) was analyzed separately. RESULTS One hundred sixty-four patients had completely resected and 18 had microscopical residual disease. Seventy three had at least 1 PRF (massive invasion to the choroid in 25, to the postlaminar optic nerve in 41, intrascleral in 10, to the resection margin of the optic nerve in 12, and trans-scleral in 6). Seventy-one patients had glaucoma and 19 had buphthalmia. Intraocular pressure, glaucoma, and buphthalmia correlated significantly with the occurrence of both PRF and microscopical residual disease in multivariate analysis. Buphthalmia was the most specific factor but the sensitivity was lower. Glaucoma and buphthalmia had a high negative predictive value. CONCLUSIONS Patients presenting with glaucoma and/or buphthalmia have a significantly higher risk for the occurrence of PRF, including those resulting in microscopically residual disease.
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Balaguer J, Wilson MW, Billups CA, Mancini J, Haik BG, Qaddoumi I, Khoury JD, Rodriguez-Galindo C. Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatments. Pediatr Blood Cancer 2009; 52:351-6. [PMID: 19021223 PMCID: PMC4643656 DOI: 10.1002/pbc.21845] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The impact of chemotherapy, focal therapies, radiation and co-existing ocular morbidities on histology of eyes with retinoblastoma enucleated following chemoreduction is not well known. PROCEDURE Twenty-five eyes (23 patients) with retinoblastoma enucleated after failing eye-salvage therapy were evaluated. Reasons for enucleation (tumor progression, subretinal or vitreous seeds) and co-morbid conditions (neovascular glaucoma, cataract, vitreous hemorrhage and retinal detachment) were documented. All specimens were reviewed for evidence of ciliary body, choroidal, optic nerve, and scleral invasion. RESULTS The median age at diagnosis was 14 months (range, 1-37 months). Twenty eyes were classified as Reese-Ellsworth Group IV-V at diagnosis. Twenty-four eyes had recurrent disease at enucleation; one eye was enucleated for neovascular glaucoma and vitreous hemorrhage. Co-existing ocular morbidities at enucleation included vitreous hemorrhage (n = 6), retinal detachment (n = 9), neovascular glaucoma (n = 9) and cataracts (n = 3). Histologic findings included choroidal invasion (n = 7), ciliary body invasion (n = 4), optic nerve invasion (n = 6) and scleral invasion (n = 3). The median time from diagnosis to enucleation was 11 months. Co-existing retinal detachment and vitreous hemorrhage significantly increased the likelihood of optic nerve invasion (P = 0.014 and P = 0.011, respectively). Prolonged time to enucleation was significantly associated with the likelihood of choroidal (P = 0.010) and ciliary body (P = 0.021) invasion as well as invasion of multiple sites. CONCLUSION In eyes with retinoblastoma enucleated after chemoreduction, co-existing ocular morbidities and time to enucleation are predictive of extra-retinal extension.
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Affiliation(s)
- Julia Balaguer
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew W. Wilson
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN,Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN,Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, TN
| | | | - John Mancini
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, TN
| | - Barrett G. Haik
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN,Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, TN
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN,Department of Pediatrics, Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, TN
| | - Joseph D. Khoury
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carlos Rodriguez-Galindo
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN,Department of Pediatrics, Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, TN
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Chantada GL, Guitter MR, Fandiño AC, Raslawski EC, de Davila MTG, Vaiani E, Scopinaro MJ. Treatment results in patients with retinoblastoma and invasion to the cut end of the optic nerve. Pediatr Blood Cancer 2009; 52:218-22. [PMID: 18937327 DOI: 10.1002/pbc.21735] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is little information on the outcome of patients with retinoblastoma and tumor at the resection margin of the optic nerve. PROCEDURE Retrospective evaluation of three successive prospective protocols. Twenty-six consecutive patients were analyzed (International Staging System-IRSS-stage 2 = 21, stage 3 = 5) from three successive prospective protocols (1988-2006). Patients with stage 2 were enucleated upfront and those with stage 3 had neoadjuvant chemotherapy followed by enucleation and adjuvant therapy. Both groups received adjuvant chemotherapy and orbital radiotherapy after enucleation. Patients in protocol 1 received 1 year of the lower-dose chemotherapy regimen including cyclophosphamide, vincristine and doxorubicin along with intrathecal chemotherapy. Patients of protocols 2 and 3 received a more intense and shorter intravenous regimen including carboplatin and etoposide alternating with cyclophosphamide, idarubicin and vincristine with no intrathecal treatment. The components of protocol 2 and 3 were similar except for the dose of carboplatin which was 10% lower in protocol 3. RESULTS Thirteen were treated in protocol 1 and 13 in protocols 2 and 3. The probability of event-free survival was 0.70 at 5 years. Events included: CNS relapse = 3, second malignancies = 3, death in complete remission = 2. There were no significant differences in outcome between protocols or stages. Endocrinological disturbances related to the hypothalamus-hypophysis axis were evident in 6/8 patients evaluated. Severe orbital sequelae occurred in 12 cases. CONCLUSIONS A substantial number of patients with tumor at the resection margin of the optic nerve can be cured with current therapy; however, therapy related sequelae are frequent.
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Retinoblastoma. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rodriguez-Galindo C, Wilson MW, Chantada G, Fu L, Qaddoumi I, Antonelli C, Leal-Leal C, Sharma T, Barnoya M, Epelman S, Pizzarello L, Kane JR, Barfield R, Merchant TE, Robison LL, Murphree AL, Chevez-Barrios P, Dyer MA, O′Brien J, Ribeiro RC, Hungerford J, Helveston EM, Haik BG, Wilimas J. Retinoblastoma: one world, one vision. Pediatrics 2008; 122:e763-70. [PMID: 18762512 PMCID: PMC2844325 DOI: 10.1542/peds.2008-0518] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Retinoblastoma is curable when diagnosed early and treated appropriately; however, the prognosis is dismal when the basic elements of diagnosis and treatment are lacking. In developing countries, poor education, lower socioeconomic conditions, and inefficient health care systems result in delayed diagnosis and suboptimal care. Furthermore, the complexity of multidisciplinary care required is seldom possible. Whereas ocular salvage is a priority in the Western world, death from retinoblastoma is still a major problem in developing countries. To bring the 2 ends of this spectrum together and provide a forum for discussion, the "One World, One Vision" symposium was organized, at which clinicians and researchers from various cultural, geographic, and socioeconomic backgrounds converged to discuss their experiences. Strategies for early diagnosis in developing countries were discussed. Elements of the development of retinoblastoma centers in developing countries were discussed, and examples of successful programs were highlighted. An important component in this process is twinning between centers in developing countries and mentor institutions in high-income countries. Global initiatives by nongovernmental organizations such as the International Network for Cancer Treatment and Research, Orbis International, and the International Agency for Prevention of Blindness were presented. Treatment of retinoblastoma in developing countries remains a challenge; however, it is possible to coordinate efforts at multiple levels, including public administrations and nonprofit organizations, to improve the diagnosis and treatment of retinoblastoma and to improve the outcome for these children.
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Affiliation(s)
- Carlos Rodriguez-Galindo
- Department of Oncology, St Jude Children's Research Hospital, 332 N Lauderdale, Memphis, TN 38105, USA.
| | - Mathew W. Wilson
- Department of Ophthalmology and Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee, US
| | - Guillermo Chantada
- Department of Oncology, Hospital Nacional de Pediatria J.P. Garrahan, Buenos Aires, Argentina
| | - Ligia Fu
- Department of Hematology-Oncology, Hospital de Niños, Tegucigalpa
| | - Ibrahim Qaddoumi
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Célia Antonelli
- Department of Pediatrics, Hospital do Câncer A.C. Camargo, São Paulo, Brazil
| | - Carlos Leal-Leal
- Department of Oncology, Instituto Nacional de Pediatria, Mexico City, Mexico
| | - Tarum Sharma
- The Sankara Nethralaya Foundation, Chennai, India
| | | | - Sidnei Epelman
- International Network for Cancer Treatment and Research, São Paulo, Brazil
| | - Louis Pizzarello
- International Agency for the Prevention of Blindness and Mailman School of Public Health, Columbia University, New York, US
| | - Javier R. Kane
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - Ray Barfield
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - Thomas E. Merchant
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - Leslie L. Robison
- Department of Epidemiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - A. Linn Murphree
- Department of Ophthalmology, Children’s Hospital of Los Angeles, California, US
| | | | - Michael A. Dyer
- Department of Developmental Neurobiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - Joan O′Brien
- Department of Ophthalmology, University of California at San Francisco, San Francisco, California, US
| | - Raul C. Ribeiro
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US,Department of International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
| | - John Hungerford
- Department of Ophthalmology, St. Bartholomew’s Hospital, London, UK
| | - Eugene M. Helveston
- Orbis International and Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Barrett G. Haik
- Department of Ophthalmology and Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee, US
| | - Judith Wilimas
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, US,Department of International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee, US
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Rodriguez-Galindo C, Chantada GL, Haik BG, Wilson MW. Treatment of retinoblastoma: Current status and future perspectives. Curr Treat Options Neurol 2008; 9:294-307. [PMID: 17580009 DOI: 10.1007/s11940-007-0015-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Treatment of retinoblastoma must be individualized. Most patients with unilateral, non-metastatic retinoblastoma can be cured with enucleation alone. In patients with histologic risk factors, adjuvant chemotherapy is recommended, with the addition of orbital radiation for patients with trans-scleral involvement or tumor present at the level of the cut end of the optic nerve. Patients with metastases require intensive chemotherapy and consolidation with autologous hematopoietic stem cell rescue. Patients with bilateral or multifocal disease represent a major challenge. Cure of the disease is the first priority, but the therapeutic approach also has to consider eye and vision preservation. The approach is conservative, and only eyes with very advanced disease are enucleated upfront. Patients are treated with chemotherapy and intensive focal treatments, with the aim of delaying or avoiding radiation therapy and enucleation. For patients with early intraocular stage (Reese-Ellsworth groups I-III and International Groups A-B), the two-drug combination of vincristine and carboplatin is recommended. Patients with more advanced intraocular disease (Reese-Ellsworth groups IV-V and International Groups C-D) require more intensive chemotherapy. Standard of care for these patients incorporates etoposide into the regimen. Effective agents with good intraocular penetration, such as topotecan, are being investigated. Because most failures are secondary to progression of the vitreous seeds, subconjunctival carboplatin is added in cases with poor response of the vitreous tumors. Patients must be monitored very closely, with examinations under anesthesia every 4 to 6 weeks, and focal treatments are applied during the procedure. These include cryotherapy for small anterior tumors, thermotherapy and laser photocoagulation for small posterior tumors, and brachytherapy for larger tumors. New treatment approaches under development include the refinement of periocular chemotherapy administration using slow-release devices, the use of suicide gene therapy with local delivery of the herpes simplex thyrosine kinase gene (followed by systemic administration of ganciclovir), and the development of small-molecule inhibitors of the MDMX-p53 interaction.
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Affiliation(s)
- Carlos Rodriguez-Galindo
- Carlos Rodriguez-Galindo, MD Department of Oncology, St. Jude Children’s Research Hospital, 332 N. Lauderdale, Memphis, TN 38105, USA.
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Abstract
We estimated the proportion of patients reaching a pediatric ophthalmology unit (Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital, CCBRT) or an oncology unit (ORCI) in east Africa and investigated presentation, histology, and treatment outcomes of patients with retinoblastoma. A 5-year retrospective study identified 91 patients, representing approximately 18% of the nationwide total. Mean lag time was 10 months (standard deviation (SD) = 17) and mean follow-up was 8 months (SD = 11, range 0-40, n = 91). Thirty months disease-free survival probability was 0.23 (standard error = 0.07). Outcomes for retinoblastoma in Africa remain poor. The data presented here suggest strategies for improving the outcomes, including encouraging earlier presentation and establishment of multi-disciplinary treatment centers.
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Affiliation(s)
- R J C Bowman
- Comprehensive Community Based Rehabilitation Disability Hospital, Dar es Salaam, Tanzania.
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Chantada GL, Casco F, Fandiño AC, Galli S, Manzitti J, Scopinaro M, Schvartzman E, de Dávila MTG. Outcome of Patients with Retinoblastoma and Postlaminar Optic Nerve Invasion. Ophthalmology 2007; 114:2083-9. [PMID: 17459482 DOI: 10.1016/j.ophtha.2007.01.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Revised: 01/10/2007] [Accepted: 01/11/2007] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the outcome of patients with retinoblastoma and postlaminar optic nerve invasion (PLONI). DESIGN Retrospective interventional case series. PARTICIPANTS Sixty-one consecutive patients included in 3 successive protocols were analyzed. METHODS Pathologic review was done in each case. Patients were stratified into 2 risk groups: the high-risk group included those with concomitant full choroidal and/or scleral invasion and were given adjuvant chemotherapy. Those without these features were considered low risk and chemotherapy was withheld after 1994. MAIN OUTCOME MEASURES Extraocular relapse and survival according to stratification. RESULTS The probability of event-free survival (pEFS) was 0.91 and the probability of overall survival (pOS) was 0.94 at 5 years. Patients in the high-risk group (n = 22) had pEFS of 0.86. Three had extraocular relapse (involving the central nervous system; all died of disease). Microscopic scleral invasion was associated to extraocular relapse (P = 0.05). Lower risk patients (n = 39) had a pEFS of 0.94 and pOS of 1. Eighteen received postenucleation chemotherapy and none relapsed. Twenty-one received no adjuvant therapy and 2 had a systemic relapse but were successfully retrieved. Relapsing patients had a higher ratio of affected optic nerve (>25% of it overall length; P = 0.02). CONCLUSIONS Patients with PLONI have an excellent outcome with current therapy. Risk stratification according to the presence of concomitant choroidal and/or scleral invasion may help in the decision of giving adjuvant therapy.
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Affiliation(s)
- Guillermo L Chantada
- Department of Hemato-oncology, Hospital J. P. Garrahan, Buenos Aires, Argentina.
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49
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Chantada G, Doz F, Antoneli CBG, Grundy R, Clare Stannard FF, Dunkel IJ, Grabowski E, Leal-Leal C, Rodríguez-Galindo C, Schvartzman E, Popovic MB, Kremens B, Meadows AT, Zucker JM. A proposal for an international retinoblastoma staging system. Pediatr Blood Cancer 2006; 47:801-5. [PMID: 16358310 DOI: 10.1002/pbc.20606] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although intra-retinal tumor has long been staged presurgically according to the Reese-Ellsworth (R-E) system, retinoblastoma differs from other pediatric neoplasms in never having had a widely accepted classification system that encompasses the entire spectrum of the disease. Comparisons among studies that consider disease extension, risk factors for extra-ocular relapse, and response to therapy require a universally accepted staging system for extra-ocular disease. PROCEDURE A committee of retinoblastoma experts from large centers worldwide has developed a consensus classification that can encompass all retinoblastoma cases and is presented herein. Patients are classified according to extent of disease and the presence of overt extra-ocular extension. In addition, a proposal for substaging considering histopathological features of enucleated specimens is presented to further discriminate between Stage I and II patients. RESULTS The following is a summary of the classification system developed-Stage 0: Patients treated conservatively (subject to presurgical ophthalmologic classifications); Stage I: Eye enucleated, completely resected histologically; Stage II: Eye enucleated, microscopic residual tumor; Stage III: Regional extension [(a) overt orbital disease, (b) preauricular or cervical lymph node extension]; Stage IV: Metastatic disease [(a) hematogenous metastasis: (1) single lesion, (2) multiple lesions; (b) CNS extension: (1) prechiasmatic lesion, (2) CNS mass, (3) leptomeningeal disease]. A proposal is also presented for substaging of enucleated Stages I and II eyes. CONCLUSIONS The proposed staging system is the product of an international effort to adopt a uniform staging system for patients with retinoblastoma to cover the whole spectrum of the disease.
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Affiliation(s)
- Guillermo Chantada
- Department of Hematology-Oncology, Hospital JP Garrahan, Buenos Aires, Argentina.
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Chantada GL, Fandiño AC, Raslawski EC, Manzitti J, de Dávila MTG, Casak SJ, Scopinaro MJ, Schvartzman E. Experience with chemoreduction and focal therapy for intraocular retinoblastoma in a developing country. Pediatr Blood Cancer 2005; 44:455-60. [PMID: 15558702 DOI: 10.1002/pbc.20259] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chemoreduction is used for the treatment of retinoblastoma in industrialized nations; however, there are fewer data from developing countries. Before the implementation of this program, radiotherapy was used in almost all preserved eyes. METHODS Retrospective evaluation from 1995 to 2001 at the Hospital Garrahan (Argentina). Carboplatin 18.7 mg/kg/day 1 and vincristine (0.05 mg/kg/day 1) were offered to patients with Reese-Ellsworth (RE) groups I-III and all unilateral cases. Etoposide (3.3 mg/kg/day 1 and 2) was added for groups IV and V. The number of cycles was tailored according to response. RESULTS Fifty-eight patients (78 eyes) were evaluated (39 bilateral, 19 unilateral). With a median follow-up of 47 months, 40 patients had unilateral enucleation, 14 were not enucleated, and 4 had bilateral enucleation. Nineteen patients had unilateral initial enucleation. Eye preservation at 5 years was: RE groups I-III (n = 24 eyes), 0.9 (SE: 0.095) IV-V (n = 54), 0.45 (SE 0.07). Patients received a median of four cycles of chemotherapy. Acute toxicity was mild. External beam radiotherapy was avoided in 41% of eyes with groups I-III. Etoposide was avoided in 24 patients. Two patients died of metastasis. No secondary malignancy occurred. CONCLUSIONS Compared to our previous experience, eye preservation was better and even though less radiotherapy was used, it was prescribed more often than currently recommended in eyes with less advanced disease because of limited availability of sophisticated local therapy.
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Affiliation(s)
- Guillermo L Chantada
- Department of Hematology/Oncology, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina.
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