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Madan R, Radhakrishnan V, Meel R, Chinnaswamy G, Singh L, Kulkarni S, Sasi A, Kaur T, Sharma J, Dhaliwal RS, Haldorai M, Rath GK, Bakhshi S. Management of Extraocular Retinoblastoma: ICMR Consensus Guidelines. Indian J Pediatr 2024:10.1007/s12098-024-05104-2. [PMID: 38639859 DOI: 10.1007/s12098-024-05104-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/13/2024] [Indexed: 04/20/2024]
Abstract
Retinoblastoma (RB) is the most common intraocular malignancy of childhood. Advanced stage presentation of RB is common in low middle-income countries (LMICs) due to lack of awareness, social taboos associated with enucleation, seeking alternative conservative treatment options, and poor accessibility to health care. Over the last few decades, there have been significant advancements in the management of extraocular RB (EORB) which have improved outcomes and helped in minimizing treatment-related toxicities. The incorporation of multimodality approaches including chemotherapy, surgery, and radiotherapy (RT) has shown promising results; however, prognosis remains poor especially in LMICs. In this article, authors have discussed the ICMR consensus guidelines on the management of EORB, including metastatic RB.
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Affiliation(s)
- Renu Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Venkatraman Radhakrishnan
- Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India.
| | - Rachna Meel
- Department of Oculoplasty and Oncology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Lata Singh
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Suyash Kulkarni
- Department of Interventional Radiology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Tanvir Kaur
- Division of Non-Communicable Diseases (NCD Division), Indian Council of Medical Research (ICMR), New Delhi, India
| | - Jyoti Sharma
- Division of Non-Communicable Diseases (NCD Division), Indian Council of Medical Research (ICMR), New Delhi, India
| | - R S Dhaliwal
- Division of Non-Communicable Diseases (NCD Division), Indian Council of Medical Research (ICMR), New Delhi, India
| | - Meena Haldorai
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Gaura Kishore Rath
- Former Head NCI and Chief, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Lavasidis G, Papaioannou K, Anagnostou N, Ketteler P, Bechrakis NE, Ntzani E. Evidence in Focus: The Sparse Landscape of Randomized Trials on Retinoblastoma Treatment. Ocul Oncol Pathol 2024; 10:53-62. [PMID: 38751498 PMCID: PMC11095627 DOI: 10.1159/000536410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/15/2024] [Indexed: 05/18/2024] Open
Abstract
Background Retinoblastoma, although rare, is one of the most common intraocular malignancies worldwide. Its prognosis has improved significantly in the past few decades, thanks to modern treatments, like systemic, intra-arterial, and intravitreal chemotherapy. However, regarding survival, there are significant differences between high- and low-income countries, eye salvage is still a challenge worldwide, and treatment-related toxicity needs to be carefully and sufficiently managed. Summary To appraise the strength of supporting evidence, we performed a systematic review of randomized controlled trials investigating any therapeutic protocol for retinoblastoma. Four trials with 174 participants (188 eyes) were eligible, all pertaining to different intravenous chemotherapy regimens. Vincristine, etoposide, and carboplatin (VEC) appear superior to a 5-drug combination for stage III retinoblastoma. Moreover, etoposide and carboplatin as neoadjuvant chemotherapy followed by thermochemotherapy seem to offer better local control than vincristine and carboplatin. However, increasing carboplatin dose in the VEC protocol failed to improve treatment efficacy. Key Messages Retinoblastoma is a success story of modern medicine. However, only intravenous chemotherapy has been studied through randomized trials, while evidence for the most novel retinoblastoma treatments has mainly stemmed from observational studies. International collaborations for multicenter randomized trials could overcome difficulties and increase certainty and precision in the field.
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Affiliation(s)
- Georgios Lavasidis
- Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Ophthalmology, Elpis General Hospital of Athens, Athens, Greece
| | - Kyriaki Papaioannou
- Department of Pediatric Hematology and Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nikolaos Anagnostou
- Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Petra Ketteler
- Department of Pediatric Hematology and Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nikolaos E. Bechrakis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Evangelia Ntzani
- Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Li N, Wang YZ, Zhang Y, Zhang WL, Huang DS. Characteristics of patients with recurrent retinoblastoma: a survival analysis. BMC Cancer 2024; 24:287. [PMID: 38438837 PMCID: PMC10910724 DOI: 10.1186/s12885-024-12058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Management guidelines and corresponding survival data for patients with recurrent retinoblastoma (RB) are lacking. This study aimed to summarize the clinical characteristics of patients with recurrent RB and analyze their survival outcomes. METHODS We retrospectively analyzed 68 patients with recurrent RB who underwent treatment in our institution from January 2016 to December 2020. Patients were grouped according to location of recurrence: intraocular, orbital, and distant metastasis. RESULTS The male:female ratio was 1.3:1 and the median age at recurrence was 37.5 months (range, 30.3-62.8). The number of patients in the intraocular recurrence, orbital recurrence, and metastasis groups was 13 (19.1%), 23 (33.8%), and 32 (47.1%), respectively. Thirty patients died, 36 were alive at last follow-up, and two were lost to follow-up. Eye enucleation was performed in 94.1% of patients. Five-year overall survival in patients with intraocular recurrence, orbital recurrence, and metastasis was 84.6%, 69.6%, and 31.3%, respectively (P = 0.001). Most deaths occurred within 2 years of recurrence. Presence of high-risk pathological factors, central nervous system invasion, and absence of combination therapy were independent predictors of worse 5-year overall survival. CONCLUSION The rate of eye preservation in survivors of recurrent RB was very low. Although 5-year overall survival in patients who underwent treatment for intraocular and orbital recurrence was high, it was low in those with metastasis. RB patients may need lifelong follow-up for recurrence and secondary malignancy.
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Affiliation(s)
- Nan Li
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Yizhuang Economic and Technological Development Zone, No. 2, Xihuan South Road, Beijing, 100176, China
| | - Yi-Zhuo Wang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Yizhuang Economic and Technological Development Zone, No. 2, Xihuan South Road, Beijing, 100176, China
| | - Yi Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Yizhuang Economic and Technological Development Zone, No. 2, Xihuan South Road, Beijing, 100176, China
| | - Wei-Ling Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Yizhuang Economic and Technological Development Zone, No. 2, Xihuan South Road, Beijing, 100176, China
| | - Dong-Sheng Huang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Yizhuang Economic and Technological Development Zone, No. 2, Xihuan South Road, Beijing, 100176, China.
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Kritfuangfoo T, Rojanaporn D. Update on chemotherapy modalities for retinoblastoma: Progress and challenges. Asia Pac J Ophthalmol (Phila) 2024; 13:100061. [PMID: 38641204 DOI: 10.1016/j.apjo.2024.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
Retinoblastoma stands as a paradigm of success in treating malignancies among pediatric patients. Over recent decades, the approach to managing retinoblastoma has evolved significantly, transitioning from the preservation of patients' lives to the preservation of eyes and vision while minimizing treatment-related complications. Chemotherapy, administered through diverse routes, has solidified its role as the cornerstone of retinoblastoma treatment. In addition to intravenous chemotherapy (IVC), alternative administration routes, including intraarterial (IAC), intravitreal, intracameral, and periocular delivery, have emerged as promising modalities for retinoblastoma management. Numerous studies have demonstrated outstanding outcomes, achieving nearly 100% salvage rates for eyes classified under groups A-C. However, for advanced intraocular retinoblastoma (groups D and E eyes), IAC appears to offer superior local control rates compared to IVC. Intravitreal injection of chemotherapeutic agents, when administered in a controlled and secure manner, holds promise in averting the need for enucleation and radiotherapy in advanced retinoblastoma cases presenting with vitreous seeds. The optimal chemotherapy strategy remains meticulously tailored based on numerous factors. This review provides a comprehensive update on chemotherapy across various routes, encompassing key considerations, dosages, administration methods, treatment outcomes, and potential complications. Furthermore, it explores emerging potential treatments and outlines future directions aimed at enhancing treatment outcomes.
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Affiliation(s)
- Thanaporn Kritfuangfoo
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand; Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Duangnate Rojanaporn
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
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Requejo F, Opezzo J, Vater A, Asprea M, Lagomarsino E, Sampor C, Fandiño A, Chantada G, Francis JH, Abramson DH, Schaiquevich P. Pharmacokinetics of Orbital Topotecan After Ophthalmic Artery Chemosurgery and Intravenous Infusion in the Swine Model. Invest Ophthalmol Vis Sci 2023; 64:3. [PMID: 37656475 PMCID: PMC10479255 DOI: 10.1167/iovs.64.12.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023] Open
Abstract
Purpose Surgery, multiagent systemic chemotherapy, and radiation are used for patients with orbital retinoblastoma but are associated with unacceptable short- and long-term toxicity (including death). We studied orbital and systemic exposure of topotecan in the swine model after ophthalmic artery chemosurgery (OAC) and intravenous (IV) delivery. Methods Landrace pigs (n = 3) underwent 30-minute OAC of topotecan (4 mg), and samples were serially obtained from the femoral artery and from a microdialysis probe inserted into the lateral rectus muscle sheath of the infused eye as a surrogate of the orbital irrigation. Animals were recovered, and, after a wash-out period, plasma and microdialysate samples from the contralateral eye were collected after a 30-minute IV infusion of topotecan (4 mg). Samples were quantified by high-performance liquid chromatography, and population pharmacokinetic analysis was conducted using MonolixSuite. Results After OAC, median topotecan exposure in the orbit was 5624 ng × h/mL (range 3922-12531) compared to 23 ng × h/mL (range 18-75) after IV infusion. Thus, topotecan exposure in the orbit was 218-fold (range 75-540) higher after OAC than after IV infusion despite comparable systemic exposure (AUCpl) between routes (AUCpl, OAC: 141 ng × h/mL [127-191] versus AUCpl, IV: 139 ng × h/mL [126-186]). OAC was more selective to target the orbit because the median (range) orbital-to-plasma exposure ratio was 44 (28-65) after OAC compared to 0.18 (0.13-0.40) after IV infusion. Conclusions OAC of topotecan resulted in higher orbital exposure than after IV infusion and was a more selective route for local drug delivery. Patients with orbital retinoblastoma may benefit from a multimodal treatment strategy including OAC therapy.
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Affiliation(s)
- Flavio Requejo
- Neuroradiology Service, Hospital de Pediatría Prof. Dr. JP Garrahan, Buenos Aires, Argentina
| | - Javier Opezzo
- Pharmacology Department, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Alan Vater
- Unit of Innovative Treatments, Hospital de Pediatría Prof. Dr. JP Garrahan, Buenos Aires, Argentina
| | - Marcelo Asprea
- Animal facility, Hospital de Pediatría Prof. Dr. JP Garrahan, Buenos Aires, Argentina
| | - Eduardo Lagomarsino
- Pharmacy Service, Hospital de Pediatría Prof. Dr. JP Garrahan, Buenos Aires, Argentina
| | - Claudia Sampor
- Hematology-Oncology Service, Hospital de Pediatría Prof. Dr. JP Garrahan, Buenos Aires, Argentina
| | - Adriana Fandiño
- Ophthalmology Service, Hospital de Pediatría Prof. Dr. JP Garrahan, Buenos Aires, Argentina
| | - Guillermo Chantada
- Pediatric Cancer Center, Hospital Sant Joan de Deu, Barcelona, Spain
- Research Department, Fundacion Perez-Scremini, Montevideo, Uruguay
| | - Jasmine H. Francis
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Department of Ophthalmology, Weill/Cornell Medical School, New York, New York, United States
| | - David H. Abramson
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Department of Ophthalmology, Weill/Cornell Medical School, New York, New York, United States
| | - Paula Schaiquevich
- Unit of Innovative Treatments, Hospital de Pediatría Prof. Dr. JP Garrahan, Buenos Aires, Argentina
- National Scientific and Technological Research Council (CONICET), Buenos Aires, Argentina
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Sait SF, Bernot MR, Klein E, Abramson DH, Francis JH, Gilheeney S, Karajannis MA, Spitzer B, Wolden S, Dunkel IJ, Kernan NA. Lack of complete response pretransplant is not associated with inferior overall survival for stage 4a metastatic retinoblastoma. Pediatr Blood Cancer 2023; 70:e29921. [PMID: 35934994 PMCID: PMC9701149 DOI: 10.1002/pbc.29921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stage 4a metastatic retinoblastoma (RB) is curable with intensive multimodality therapy including myeloablative chemotherapy with autologous stem cell transplant (HDC-ASCT) and involved field radiation therapy (IFRT). To our knowledge, no data exist on the impact of (a) pre-ASCT disease status, and (b) IFRT to sites of metastatic disease post ASCT on survival. PROCEDURE We retrospectively reviewed patients with stage 4a metastatic RB who underwent induction chemotherapy followed by HDC-ASCT, with or without IFRT, to residual tumor sites at Memorial Sloan Kettering Cancer Center (MSKCC) (n = 24). RESULTS The degree of postinduction response prior to ASCT did not affect outcome, with 5-year overall survival (OS) of 68% and 86% in patients who achieved complete response (CR) and very good partial response (VGPR)/partial response (PR) prior to ASCT, respectively. IFRT administered post ASCT in patients with possible residual bony metastatic disease increases the likelihood of developing osteosarcoma in the radiation field. CONCLUSION OS for patients with stage 4a metastatic RB treated with ASCT with VGPR or PR to pretransplant chemotherapy was not significantly different from patients with CR. In addition, IFRT does not seem to be required for bony disease control and increased the likelihood of developing osteosarcoma.
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Affiliation(s)
- Sameer Farouk Sait
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mauricio Rendon Bernot
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elizabeth Klein
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - David H. Abramson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Jasmine H. Francis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Stephen Gilheeney
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Matthias A. Karajannis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Barbara Spitzer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ira J. Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Nancy A. Kernan
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Dunkel IJ, Piao J, Chantada GL, Banerjee A, Abouelnaga S, Buchsbaum JC, Merchant TE, Granger MM, Jubran RF, Weinstein JL, Saguilig L, Abramson DH, Krailo MD, Rodriguez-Galindo C, Chintagumpala MM. Intensive Multimodality Therapy for Extraocular Retinoblastoma: A Children's Oncology Group Trial (ARET0321). J Clin Oncol 2022; 40:3839-3847. [PMID: 35820112 PMCID: PMC9671757 DOI: 10.1200/jco.21.02337] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/21/2022] [Accepted: 06/08/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Metastatic retinoblastoma has a poor prognosis when treated with conventional chemotherapy and radiation therapy (RT). Intensified therapy may improve the outcome. METHODS A prospective, international trial enrolled patients with extraocular retinoblastoma. Patients with stage II or III (locoregional) retinoblastoma received four cycles of chemotherapy, followed by involved field RT (45 Gy). Patients with stage IVa or IVb (metastatic or trilateral) retinoblastoma also received four cycles of chemotherapy and those with ≥ partial response then received one cycle of high-dose carboplatin, thiotepa, and etoposide with autologous hematopoietic stem-cell support. Patients with stage IVa or IVb with residual tumor postchemotherapy received RT. The proportion of patients who achieved event-free survival would be reported and compared with historical controls separately for each of the three groups of patients. RESULTS Fifty-seven eligible patients were included in the analyses. Event-free survival at 1 year was 88.1% (90% CI, 66.6 to 96.2) for stage II-III, 82.6% (90% CI, 61.0 to 92.9) for stage IVa, and 28.3% (90% CI, 12.7 to 46.2) for stage IVb/trilateral. Toxicity was significant as expected and included two therapy-related deaths. CONCLUSION Intensive multimodality therapy is highly effective for patients with regional extraocular retinoblastoma and stage IVa metastatic retinoblastoma. Although the study met its aim for stage IVb, more effective therapy is still required for patients with CNS involvement (ClinicalTrials.gov identifier: NCT00554788).
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Affiliation(s)
- Ira J. Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jin Piao
- University of Southern California, Los Angeles, CA
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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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Gu H, Wang Y, Huang D, Zhang Y, Zhang W, Hu H, Zhang P, Zhou Y, Yi Y, Chen L, Han S. Case report: Delayed retinoblastoma relapse in a lymph node after 9 years of complete remission. Curr Probl Cancer 2021; 45:100703. [PMID: 33618927 DOI: 10.1016/j.currproblcancer.2020.100703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Retinoblastoma (RB) is the most common primary intraocular malignancy of childhood. Recurrence of RB often occurs within 6 months to 1 year after the end of treatment. Orbital tissue is the most common site of recurrence in children who have undergone enucleation; other sites include the central nervous system, bone, bone marrow, lymph nodes, and other organs. Here, we describe an adolescent girl who presented with RB recurrence and metastasis in a distant lymph node after 9 years of complete remission. The tumor was an incidental finding during a routine examination and was misdiagnosed as lymphadenitis. After histopathologic examination of an aspiration biopsy sample, the correct diagnosis of recurrent metastatic RB was made. Systemic chemotherapy and surgical excision were provided; the patient remained tumor-free during the 6-month follow-up period. RB often relapses within 1 year after treatment; orbital tissue is the most common site of recurrence. However, our patient's case was unique in terms of delayed relapse and the presence of a single metastatic site; these findings may provide new insights into the behavior of RB. Furthermore, this case report indicates the need for lifelong follow-up of children with RB. Oncologists should be vigilant when treating patients with a history of RB, because complete remission does not mean complete safety; long-term recurrence and metastasis may occur. Lifelong follow-up is necessary for children with RB. Complete remission might be achieved after active and standardized treatment.
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Affiliation(s)
- Huali Gu
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yizhuo Wang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dongsheng Huang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Yi Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Weiling Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Huimin Hu
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Pinwei Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yan Zhou
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - You Yi
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lin Chen
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Siyu Han
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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10
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Choucair ML, Brisse HJ, Fréneaux P, Desjardins L, Dorfmüller G, Puget S, Dendale R, Chevrier M, Doz F, Lumbroso-Le Rouic L, Aerts I. Management of advanced uni- or bilateral retinoblastoma with macroscopic optic nerve invasion. Pediatr Blood Cancer 2020; 67:e27998. [PMID: 31571399 DOI: 10.1002/pbc.27998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/05/2019] [Accepted: 09/04/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Retinoblastoma with macroscopic optic nerve (ON) invasion depicted by imaging at diagnosis remains a major problem and carries a poor prognosis. We sought to describe the treatment and outcome of these high-risk patients. METHODS Retrospective mono-institutional clinical, radiological, and histological review of patients with uni- or bilateral retinoblastoma with obvious ON invasion, defined by radiological optic nerve enlargement (RONE) depicted by computed tomography scan or magnetic resonance imaging (MRI), was performed. RESULTS Between 1997 and 2014, among the 936 patients with retinoblastoma treated at Institut Curie, 11 had detectable RONE. Retinoblastoma was unilateral in 10 and bilateral in one. Median age at diagnosis was 28 months (range, 11-96). ON enlargement extended to the orbital portion in three patients, to the optic canal in five, to the prechiasmatic portion in two, and to the optic chiasm in one. Nine patients received neoadjuvant chemotherapy and partial response was obtained in all. Enucleation was performed in 10/11 patients-by an anterior approach in three and by anterior and subfrontal approaches in seven. Three patients had a positive ON resection margin (2/3 after primary enucleation). All enucleated patients received adjuvant treatment (conventional chemotherapy: 10, high-dose chemotherapy: seven, radiotherapy: five). Leptomeningeal progression occurred in four patients. Seven are in first complete remission (median follow up: 8 years [3.5-19.4]). CONCLUSION Neoadjuvant chemotherapy and microscopic complete resection have a pivotal role in the management of retinoblastoma with RONE. MRI is recommended for initial and pre-operative accurate staging. Surgery should be performed by neurosurgeons in case of posterior nerve invasion. Radiotherapy is required in case of incomplete resection.
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Affiliation(s)
- Marie-Louise Choucair
- Oncology Center SIREDO: Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France
| | - Hervé J Brisse
- Radiology Department, Institut Curie, Paris, France.,Paris Sciences et Lettres Research University, Paris, France
| | - Paul Fréneaux
- Paris Sciences et Lettres Research University, Paris, France.,Tumor Biology Department, Institut Curie, Paris, France
| | - Laurence Desjardins
- Paris Sciences et Lettres Research University, Paris, France.,Ocular Oncology, Institut Curie, Paris, France
| | - Georg Dorfmüller
- Pediatric Neurosurgery Department, Fondation Rothschild, Paris, France
| | - Stéphanie Puget
- Department of Pediatric Neurosurgery, Necker Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Rémi Dendale
- Paris Sciences et Lettres Research University, Paris, France.,Radiation Oncology Department, Institut Curie, Paris, France
| | - Marion Chevrier
- Paris Sciences et Lettres Research University, Paris, France.,Biostatistics Department, Institut Curie, Paris, France
| | - François Doz
- Oncology Center SIREDO: Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France.,Université Paris Descartes, Paris, France
| | - Livia Lumbroso-Le Rouic
- Paris Sciences et Lettres Research University, Paris, France.,Ocular Oncology, Institut Curie, Paris, France
| | - Isabelle Aerts
- Oncology Center SIREDO: Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France.,Paris Sciences et Lettres Research University, Paris, France
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11
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Aschero R, Torbidoni A, Sampor C, Laurent V, Zugbi S, Winter U, Lubieniecki F, Alonso D, Schaiquevich P, Chantada GL. Minimally disseminated disease and outcome in overt orbital retinoblastoma. Pediatr Blood Cancer 2019; 66:e27662. [PMID: 30803140 DOI: 10.1002/pbc.27662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/17/2019] [Accepted: 01/26/2019] [Indexed: 11/09/2022]
Abstract
In this retrospective study of patients with overt orbital retinoblastoma, we evaluated minimally disseminated disease (MDD) in bone marrow and cerebrospinal fluid (CSF) using CRX and/or GD2 synthase as markers. Ten patients were evaluated-five (50%) at diagnosis and five upon relapse. MDD was detected in four cases (one in the bone marrow, two in the CSF, and in one case in both sites). All patients received chemotherapy and four received orbital radiotherapy. Seven patients relapsed or progressed and all of them died. Three patients remain in complete remission. There was no apparent correlation between MDD and the outcome.
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Affiliation(s)
- Rosario Aschero
- Pathology Service, Pediatric Hospital S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Ana Torbidoni
- Laboratory of Molecular and Cellular Therapy, Fundación Instituto Leloir, IIBBA-CONICET, Buenos Aires, Argentina.,Scientific and Technical Research Council, CONICET, Buenos Aires, Argentina
| | - Claudia Sampor
- Hematology-Oncology Service, Pediatric Hospital S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Viviana Laurent
- Hematology-Oncology Service, Pediatric Hospital S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Santiago Zugbi
- Clinical Pharmacokinetics Unit, Pediatric Hospital S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Ursula Winter
- Scientific and Technical Research Council, CONICET, Buenos Aires, Argentina.,Clinical Pharmacokinetics Unit, Pediatric Hospital S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Fabiana Lubieniecki
- Pathology Service, Pediatric Hospital S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Daniel Alonso
- Scientific and Technical Research Council, CONICET, Buenos Aires, Argentina.,Molecular Oncology Laboratory, Quilmes National University, Bernal, Argentina
| | - Paula Schaiquevich
- Scientific and Technical Research Council, CONICET, Buenos Aires, Argentina.,Clinical Pharmacokinetics Unit, Pediatric Hospital S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Guillermo L Chantada
- Scientific and Technical Research Council, CONICET, Buenos Aires, Argentina.,Hematology-Oncology Service, Pediatric Hospital S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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12
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Jain M, Rojanaporn D, Chawla B, Sundar G, Gopal L, Khetan V. Retinoblastoma in Asia. Eye (Lond) 2018; 33:87-96. [PMID: 30385881 DOI: 10.1038/s41433-018-0244-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 09/23/2018] [Accepted: 10/04/2018] [Indexed: 01/22/2023] Open
Abstract
Asia-Pacific region bears a significant global burden of retinoblastoma (RB), therefore understanding RB in Asia-Pacific region is important. Based on the year 2013 population estimates, 43% (3452 of 8099 children) of the global burden of RB lives in 6 countries of Asia-Pacific region: 1486 children in India, 1103 children in China, 277 children in Indonesia, 260 children in Pakistan, 184 children in Bangladesh, 142 children in Philippines. There exists a wide disparity, technological and socio-economical, within countries in this region resulting in a varied pattern of clinical presentation and survival varies. Challenges in developing nations are not just technological, but also social. Opportunities emerge for research to study and understand the socio-economical aspects of the disease to develop interventions that are relevant culturally and feasible economically. Possible steps include disease education and counselling, universal screening, highly subsidized/free of cost treatment for low socioeconomic strata, raising funds through the government and non-governmental organizations, sensitization and training of man-power in screening, diagnosis and treatment, and developing new specialized centers with tele-ophthalmology services.
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Affiliation(s)
- Mukesh Jain
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, 600006, Tamil Nadu, India
| | - Duangnate Rojanaporn
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
| | - Bhavna Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Gangadhar Sundar
- Retinoblastoma Service, Department of Ophthalmology, National University Hospital, National University of, Singapore, 119074, Singapore
| | - Lingam Gopal
- Retinoblastoma Service, Department of Ophthalmology, National University Hospital, National University of, Singapore, 119074, Singapore
| | - Vikas Khetan
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, 600006, Tamil Nadu, India.
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13
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Chawla B, Chaurasia S, Sharma S, Pattebahadur R, Hasan F, Seth R, Kashyap S, Sen S. Magnetic resonance imaging for tumor restaging after chemotherapy in retinoblastoma with optic nerve invasion. Ophthalmic Genet 2018; 39:584-588. [PMID: 30089224 DOI: 10.1080/13816810.2018.1502790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Extraocular retinoblastoma with optic nerve invasion is treated by a multimodal protocol consisting of neoadjuvant chemotherapy, enucleation, and adjuvant therapy. This study was conducted to evaluate the performance of magnetic resonance imaging (MRI) used for tumor restaging in these children after systemic chemotherapy administration. METHODS Contrast-enhanced MRI scan of orbits and brain was performed at diagnosis and patients were treated with neoadjuvant chemotherapy. After chemotherapy, MRI scan was repeated for tumor restaging and residual post-laminar thickening and/or enhancement of the affected optic nerve, if any, was recorded. MRI findings were correlated with histopathology in enucleated specimens. The main outcome measures were specificity, sensitivity, and accuracy of MRI in predicting post-laminar invasion after neoadjuvant chemotherapy. RESULTS A total of 46 eyes (46 patients) were studied. Optic nerve thickening on MRI had a sensitivity, specificity, and accuracy of 100% (95% Confidence Interval (CI): 64.6-100%), 76.9% (95% CI: 61.7-87.4%), and 80.4% (95% CI: 66.8-89.4%), respectively. Optic nerve enhancement had a sensitivity, specificity, and accuracy of 85.7% (95% CI: 48.7-97.4%), 79.5 % (95% CI: 64.5-89.2%), and 80.4% (95% CI: 66.8-89.4%), respectively. Combined thickening and enhancement of the optic nerve had a sensitivity, specificity, and accuracy of 100% (95% CI: 60.9-100%), 82.4% (95% CI: 66.5-91.7%), and 85% (95% CI: 70.9-92.9%), respectively. CONCLUSION MRI is a valuable tool for restaging of retinoblastoma and predicting residual optic nerve disease after neoadjuvant chemotherapy. Combined thickening and enhancement on MRI appeared to be a more reliable indicator of post-laminar invasion as compared to thickening or enhancement alone.
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Affiliation(s)
- Bhavna Chawla
- a Ocular Oncology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Shweta Chaurasia
- a Ocular Oncology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Sanjay Sharma
- b Ocular Radiology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rajesh Pattebahadur
- a Ocular Oncology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Fahmi Hasan
- a Ocular Oncology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rachna Seth
- c Pediatric Oncology Division, Department of Paediatrics , All India Institute of Medical Sciences , New Delhi , India
| | - Seema Kashyap
- d Ocular Pathology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Seema Sen
- d Ocular Pathology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
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Pant G, Verma N, Kumar A, Pooniya V, Gupta SK. Outcome of extraocular retinoblastoma in a resource limited center from low middle income country. Pediatr Hematol Oncol 2017; 34:419-424. [PMID: 29337595 DOI: 10.1080/08880018.2017.1422060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Retinoblastoma (RB) is the most common ocular malignancy in children, and is managed by multimodal treatment. There is a paucity of data regarding the clinical profile and outcome of children with extraocular retinoblastoma from Low Middle Income Countries (LMIC) including India. Case records of children with newly diagnosed extraocular RB from January 2013 to August 2016 treated at our unit were analysed for clinical profile, treatment, and outcome. Over the 44 month study period, 91 children were diagnosed with RB, out of which 41 had extraocular disease. While 26 children had extraocular spread limited to orbit (IRSS stage III), 15 had a distant spread to brain (IRSS stage IV). Median lag period for diagnosis was eight months. Treatment abandonment rates were 38.5% and 46.6% in International Retinoblastoma Staging System (IRSS) stage III and IV respectively. With a median follow up of 31.5 months, the projected overall survival for IRSS III at one, two, and three years was 87.5%, 55.6%, and 39.7%. All patients with stage IV disease died after a median follow up duration of three months. High treatment abandonment rates and limited availability of resources lead to suboptimal survival in children with extraocular RB from LMIC. Initiatives aimed at improving early diagnosis, so that the disease is detected in the intraocular stage, are critical to improve the survival in children with RB.
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Affiliation(s)
- Gitika Pant
- a Pediatric Hematology-Oncology Unit, Department of Pediatrics , King George's Medical University , Lucknow , Uttar Pradesh , India
| | - Nishant Verma
- a Pediatric Hematology-Oncology Unit, Department of Pediatrics , King George's Medical University , Lucknow , Uttar Pradesh , India
| | - Archana Kumar
- a Pediatric Hematology-Oncology Unit, Department of Pediatrics , King George's Medical University , Lucknow , Uttar Pradesh , India
| | - Vishal Pooniya
- a Pediatric Hematology-Oncology Unit, Department of Pediatrics , King George's Medical University , Lucknow , Uttar Pradesh , India
| | - Sanjiv Kumar Gupta
- b Department of Ophthalmology , King George's Medical University , Lucknow , Uttar Pradesh , India
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15
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Chawla B, Singh R. Recent advances and challenges in the management of retinoblastoma. Indian J Ophthalmol 2017; 65:133-139. [PMID: 28345569 PMCID: PMC5381292 DOI: 10.4103/ijo.ijo_883_16] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The treatment of retinoblastoma (Rb) has improved significantly in recent times. Worldwide, there is an increasing trend to use conservative treatment modalities that aim to preserve the globe as well as vision with minimum morbidity. Recently, the use of targeted delivery of chemotherapy to the eye in the form of selective intra-arterial and intravitreal chemotherapy has shown promising results. Radiotherapy is beneficial in selected cases, either in the form of plaque brachytherapy or as external beam radiotherapy. Orbital disease carries a poor prognosis for survival. However, a multimodal treatment protocol has improved survival in children with extraocular disease. Nevertheless, challenges remain, especially for the developing world. This review aims to highlight recent advances in the management of Rb that have contributed towards improving treatment outcomes and also discuss the challenges ahead, with special reference to the Indian scenario.
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Affiliation(s)
- Bhavna Chawla
- Dr. R.P Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rashmi Singh
- Dr. R.P Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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16
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Kaliki S, Patel A, Iram S, Palkonda VAR. Clinical Presentation and Outcomes of Stage III or Stage IV Retinoblastoma in 80 Asian Indian Patients. J Pediatr Ophthalmol Strabismus 2017; 54:177-184. [PMID: 27977038 DOI: 10.3928/01913913-20161019-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 09/28/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the clinical features and outcomes of patients with stage III or IV retinoblastoma. METHODS This was a retrospective study of 80 patients. RESULTS Based on the International Retinoblastoma Staging System (IRSS), the tumors (n = 81) belonged to stage IIIa (n = 38, 47%), IIIb (n = 1, 1%), IVa2 (n = 10, 12%), IVb1 (n = 14, 17%), and IVb3 (n = 18, 22%). Of 80 patients, 42 (53%) were compliant to treatment and 38 (47%) were non-compliant. All 38 patients who were non-compliant to treatment died of the disease at a mean duration of 13 months from diagnosis. Of the 42 patients compliant to treatment, 22 (52%) died before completion of treatment. Twenty patients with stage III disease (25%) could complete the multimodal treatment and 17 (71%) were alive and well at a median follow-up duration of 77 months. CONCLUSIONS Compliant multimodality treatment is beneficial in patients with IRSS stage III disease. IRSS stage IV retinoblastoma has poor prognosis despite treatment. [J Pediatr Ophthalmol Strabismus. 2017;54(3):177-184.].
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18
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Leila S, Ibtissam H, Hafsa E, Abdeljalil M. Extra-ocular retinoblastoma: about 12 cases followed at the Mohamed VI university hospital of Marrakech. Pan Afr Med J 2016; 25:131. [PMID: 28292093 PMCID: PMC5326070 DOI: 10.11604/pamj.2016.25.131.8599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/05/2016] [Indexed: 11/26/2022] Open
Abstract
Retinoblastoma is the most frequent childhood intraocular tumor. The aim of our study is to evaluate the clinical features and management of extra-ocular retinoblastoma in the Mohamed VI university hospital of Marrakech. Retrospective case series, the patient's records were reviewed for patient and tumor features, ocular management, histopathological findings, and patient survival. Over a period of three years, 35 eyes were diagnosed with retinoblastoma; 12 children (16 eyes) (46%) had extra-ocular retinoblastoma. Mean age was 27 months, 60% were males. Six cases had unilateral tumor, five bilateral and one case of trilateral retinoblastoma. There was no positive family history, proptosis was the mean mode of presentation (41,6%) followed by staphyloma (25%) orbital cellulitis (25%) and hyphema(8,3%). The median lag period was 18 months. On imaging and histopathological analysis, there was extrascleral involvement in 41.6%, involvement of orbital part of optic nerve (75%), of orbital muscles (50%) and eyelids in 16.6%. the surgical treatment included according to the degree of extension enucleation (75%) or exenteration (25%) associated to chemotherapy in all cases and one case of external beam radiation. There were 2 cases of orbital recurrence, one death and no metastases at 30 months follow-up.Orbital retinoblastoma still stands as a tall challenge requiring multi-modal and multi-disciplinary approach. Although the survival has increased over the last few years, lack of access to medical facilities, lack of education about the need for early medical attention and cultural resistance to enucleation continue to contribute to an epidemic of extra ocular disease at diagnosis in the developing world.
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Affiliation(s)
- Soltani Leila
- Ophthalmology Department, Mohamed VI University Hospital, Marrakech, Morroco
| | - Hajji Ibtissam
- Ophthalmology Department, Mohamed VI University Hospital, Marrakech, Morroco
| | - Essafi Hafsa
- Ophthalmology Department, Mohamed VI University Hospital, Marrakech, Morroco
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Multimodal Therapy for Stage III Retinoblastoma (International Retinoblastoma Staging System): A Prospective Comparative Study. Ophthalmology 2016; 123:1933-9. [PMID: 27449712 DOI: 10.1016/j.ophtha.2016.05.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/21/2016] [Accepted: 05/23/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To compare the efficacy of 2 chemotherapeutic drug combinations as part of multimodal therapy for orbital retinoblastoma. DESIGN Prospective, comparative, study. PARTICIPANTS Patients with stage III retinoblastoma (International Retinoblastoma Staging System). METHODS Demographic and clinical features were recorded at presentation. Treatment consisted of a multimodal protocol with neoadjuvant chemotherapy, enucleation, orbital external-beam radiotherapy, and adjuvant chemotherapy. For chemotherapy, patients were randomized into 2 groups: group A patients were treated with vincristine, etoposide, and carboplatin (VEC) and group B patients were treated with carboplatin and etoposide, alternating with cyclophosphamide, idarubicin, and vincristine. Treatment outcomes and adverse effects were recorded. Efficacy parameters were compared between the groups. MAIN OUTCOME MEASURES Survival probability, cause of death, and chemotherapy-related toxicity. RESULTS A total of 54 children were recruited (27 in each group). The mean ± SD follow-up was 21.3±11.34 months. The overall Kaplan-Meier survival probability was 80% (95% confidence interval [CI], 0.67-0.89) and 42% (95% CI, 0.24-0.59) at 1 year and 4 years, respectively. There were 9 deaths in group A and 15 deaths in group B. The Kaplan-Meier survival probability at 1 year was similar between the groups: 81% (95% CI, 0.60-0.91) and 79% (95% CI, 0.58-0.9) for groups A and B, respectively. At 4 years, the survival probability for group A was higher (63% [95% CI, 0.41-0.79] vs. 25% [95% CI, 0.08-0.46] for groups A and B, respectively), with a strong trend of better survival in group A over time (P = 0.05). The major cause of death was central nervous system relapse (8 patients in group A and 7 patients in group B). Two patients in group B died of sepsis after febrile neutropenia. Grade 3 and grade 4 hematologic toxicities were more common in group B, with a significant difference in grade 4 neutropenia (P = 0.002). CONCLUSIONS This study compared the outcomes of VEC chemotherapy with a 5-drug combination of etoposide and carboplatin, alternating with cyclophosphamide, idarubicin, and vincristine, for stage III retinoblastoma. The VEC combination was found to be more effective and may be recommended as neoadjuvant and adjuvant chemotherapy.
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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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21
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Waddell KM, Kagame K, Ndamira A, Twinamasiko A, Picton SV, Simmons IG, Revill P, Johnston WT, Newton R. Improving survival of retinoblastoma in Uganda. Br J Ophthalmol 2015; 99:937-42. [PMID: 25583281 DOI: 10.1136/bjophthalmol-2014-306206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/17/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Diagnostic delay results in relatively high mortality among children with retinoblastoma in Uganda, where treatment was limited to surgery and, for some, radiotherapy. In order to improve outcomes, a simple programme of neoadjuvant and adjuvant chemotherapy was introduced. Here we report survival before and after this change to medical practice. METHODS Affordable standard off-patent chemotherapy agents were administered by trained paramedical staff to groups of patients at the same time. Survival before and after the introduction of chemotherapy was monitored. Between 2006 and 2013 a total of 270 patients with retinoblastoma were included, 181 treated prior to chemotherapy and 89 after (beginning in 2009). We had 94% follow-up and 249 had histological verification of diagnosis. RESULTS Using a proportional hazards model adjusted for age, sex and laterality, children treated after chemotherapy was introduced had a 37% lower risk of dying (HR 0.63, 95% CI 0.41 to 0.99) compared with children treated before. Prior to the introduction of chemotherapy only 15% of children who survived bilateral disease retained vision after treatment compared with 71% after chemotherapy. CONCLUSIONS The introduction of chemotherapy proved safe and cost-effective in non-specialist hands and was associated with significant improvements in survival and, among bilateral cases, in preserving vision.
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Affiliation(s)
- Keith M Waddell
- Ruharo Eye Hospital, Mbarara, Uganda Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kenneth Kagame
- Ruharo Eye Hospital, Mbarara, Uganda Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Andrew Ndamira
- Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Amos Twinamasiko
- Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Susan V Picton
- Departments of Ophthalmology and Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian G Simmons
- Departments of Ophthalmology and Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | - W Tom Johnston
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Robert Newton
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Research Unit on AIDS, Entebbe, Uganda International Agency for Research on Cancer, Lyon, France
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22
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ElZomor H, Taha H, Aleieldin A, Nour R, Zaghloul MS, Fawzi M, Kamel A, Alfaar AS. High Risk Retinoblastoma: Prevalence and Success of Treatment in Developing Countries. Ophthalmic Genet 2015; 36:287-9. [DOI: 10.3109/13816810.2015.1016241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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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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Kumar N, D G, Gupta G, Karnati R. Chebulagic acid from Terminalia chebula causes G1 arrest, inhibits NFκB and induces apoptosis in retinoblastoma cells. Altern Ther Health Med 2014; 14:319. [PMID: 25169718 PMCID: PMC4158129 DOI: 10.1186/1472-6882-14-319] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 08/20/2014] [Indexed: 12/20/2022]
Abstract
Background Plants are the valuable source of natural products with important medicinal properties. Most of the approved anti cancer drugs have a natural product origin or are natural products. Retinoblastoma is the most common ocular cancer of children. Although chemotherapy is the preferred mode of therapy, a successful treatment for retinoblastoma requires enucleation. Chebulagic acid (CA) from Terminalia chebula was shown to have anti-proliferative properties in the studies on cancerous cell lines. Due to anti cancer properties of CA and due to limitation in treatment options for retinoblastoma, the present study is undertaken to understand the role of CA on the proliferation of retinoblastoma cells. Methods Anti proliferative potential of CA was determined by MTT assay. The expression levels of various cell death mediators in retinoblastoma cells with CA treatment were assessed by Western blotting. Flowcytometer analysis was used to estimate the mitochondrial membrane potential (MMP) and to determine the percentage of cells undergoing apoptosis. Results The present study showed CA inhibited the proliferation of retinoblastoma cells in a dose dependent manner. CA modulated MMP, induced release of Cytochrome c, activated caspase 3 and shifted the ratio of BAX and Bcl2 towards cell death. G1 arrest, noticed in CA treated cells, is mediated by the increase in the expression of CDK inhibitor p27. CA treatment also decreased the levels of NFκB in the nucleus. This decrease is mediated by suppression in degradation of IκBα. Conclusion CA has shown significant anti proliferative potential on retinoblastoma cells. Our findings clearly demonstrate that CA induces G1 arrest, inhibits NFκB and induces apoptosis of retinoblastoma cells.
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MRI in retinoblastoma with orbital cellulitis. Ophthalmology 2013; 120:1308-9.e1-4. [PMID: 23732058 DOI: 10.1016/j.ophtha.2013.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/04/2013] [Indexed: 11/21/2022] Open
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ZHAO FEI, WANG HAN, KUNDA PATRICILIA, CHEN XUEMEI, LIU QIULING, LIU TAO. Artesunate exerts specific cytotoxicity in retinoblastoma cells via CD71. Oncol Rep 2013; 30:1473-82. [DOI: 10.3892/or.2013.2574] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/15/2013] [Indexed: 11/06/2022] Open
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Tandem therapy for retinoblastoma: immunotherapy and chemotherapy enhance cytotoxicity on retinoblastoma by increasing apoptosis. J Cancer Res Clin Oncol 2013; 139:1357-72. [DOI: 10.1007/s00432-013-1448-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/07/2013] [Indexed: 12/22/2022]
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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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Lee TC, Gombos DS, Harbour JW, Mansfield NC, Murphree AL. Retinoblastoma. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00128-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The presenting features of retinoblastoma in developing countries and their correlation with disease stage and patient survival are poorly known and they may be useful as background information for planning early diagnosis initiatives. Therefore, we undertook a retrospective review of 508 patients (467 evaluable, 296 unilateral) treated in Argentina from 1988 to 2008. Patients presented at an older age than reported from high-income countries [mean age 24 mo (range, 0 to 165 mo), 31 mo for unilateral (range, 0 to 165 mo), and 13.3 mo (range, 0 to 62 mo) for bilateral disease]. Leukocoria was the most common presenting sign (n=402, 86%). Strabismus was the only complaint in 25 (5.3%) patients. Forty-two patients (9%) presented with an enlarged eyeball and 37 (7.9%) with a red eye. Retinoblastoma was diagnosed in 22 (4.7%) asymptomatic children. These patients and those with strabismus alone were significantly younger and had a significantly better survival. Children presenting with enlarged eyeballs were significantly older and had significantly lower survival. In multivariable analysis older age and presentation with enlarged eyeballs were independently associated to advanced stage and mortality (P<0.001). Retinoblastoma is diagnosed in later stages in our setting and presentation with eye enlargement and increasing age at diagnosis correlate with worse outcome.
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Radhakrishnan V, Kashyap S, Pushker N, Sharma S, Pathy S, Mohanti BK, Vishnubhatla S, Ghose S, Bakhshi S. Outcome, pathologic findings, and compliance in orbital retinoblastoma (International Retinoblastoma Staging System stage III) treated with neoadjuvant chemotherapy: a prospective study. Ophthalmology 2012; 119:1470-7. [PMID: 22463820 DOI: 10.1016/j.ophtha.2012.01.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/02/2012] [Accepted: 01/13/2012] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The present study prospectively evaluated outcome, pathologic findings, and compliance in orbital retinoblastoma patients (International Retinoblastoma Staging System [IRSS] stage III). DESIGN Prospective study and case series. PARTICIPANTS Twenty-eight consecutive IRSS stage III retinoblastoma patients were enrolled prospectively in the study after ethics committee approval and written informed consent. METHODS Planned therapy for patients included treatment with a uniform protocol consisting of neoadjuvant chemotherapy followed by enucleation, adjuvant radiotherapy, and chemotherapy. Prospective computerized data entry and telephone contact were undertaken to improve compliance, a major issue in treatment of orbital retinoblastoma. MAIN OUTCOME MEASURES Event-free survival (EFS) and overall survival (OS) were calculated using Kaplan-Meier survival analysis. The difference between groups was analyzed using the log-rank test. RESULTS Median follow-up was 14.75 months (range, 2.23-26.3 months). The OS for all patients was 40.4% and the EFS was 33.33% at a follow-up of 26.3 months. The median EFS and OS were 10.37 months and 15.73 months, respectively. At baseline, bilateral retinoblastoma predicted inferior EFS (P = 0.0006) and OS (P = 0.0081). Twenty-two of 28 patients underwent enucleation, and viable tumor was present in 21 of 22 enucleated specimens (95%). Neoadjuvant chemotherapy prevented orbital exenterations. Presence of tumor in the cut end of the optic nerve significantly correlated with inferior EFS (P = 0.012) and OS (P = 0.0098). Central nervous system metastasis was the most common site of relapse and death. The overall rate of compliance with treatment was 67.8% (19/28), which was twice the compliance rate at the authors' center before initiation of the present study. CONCLUSIONS There is a paucity of information in the literature on outcomes and pathologic findings after neoadjuvant chemotherapy in IRSS stage III retinoblastoma treated with a uniform treatment protocol, and as far as the authors are aware, there has been no prospective study. Neoadjuvant chemotherapy was able to avoid exenteration in all operated patients; however, residual viable tumor was present in 95% of enucleated specimens. Bilaterality and tumor in the optic nerve cut end after neoadjuvant chemotherapy were associated with inferior outcome. Compliance could be improved with computerized data entry and regular telephone contact.
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Chantada G, Leal-Leal C, Brisse H, de Graaf P, Sitorus RS, Qaddoumi I, de Antoneli CB, Tacyildiz N, Fineman SL, Lumbroso L, Doz F. Is It Pre-Enucleation Chemotherapy or Delayed Enucleation of Severely Involved Eyes With Intraocular Retinoblastoma That Risks Extraocular Dissemination and Death? J Clin Oncol 2011; 29:3333-4; author reply 3335-6. [DOI: 10.1200/jco.2011.35.9190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Guillermo Chantada
- Grupo de America Latina de Oncología Pediátrica; Hospital Juan Pedro Garrahan, Buenos Aires, Argentina
| | - Carlos Leal-Leal
- Grupo Mexicano para el Tratamiento del Retinoblastoma; Instituto Nacional de Pediatría, Mexico Distrito Federal, Mexico
| | - Herve Brisse
- European Retinoblastoma Imaging Collaboration; Institut Curie, Paris, France
| | - Pim de Graaf
- European Retinoblastoma Imaging Collaboration; Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Rita S. Sitorus
- Indonesian Retinoblastoma Protocol; Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | | | - Nurdan Tacyildiz
- Ankara University Retinoblastoma Group; Ankara University, School of Medicine, Ankara, Turkey
| | - Sandra Luna Fineman
- Asociacion de Hemato-Oncologia Pediátrica de Centro America; Stanford University, Palo Alto, CA
| | - Livia Lumbroso
- Institut Curie Paris and University Paris Descartes, Paris, France
| | - François Doz
- Institut Curie Paris and University Paris Descartes, Paris, France
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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 MJ, Honavar SG, Reddy VAP. Orbital retinoblastoma: Present status and future challenges - A review. Saudi J Ophthalmol 2011; 25:159-67. [PMID: 23960917 PMCID: PMC3729383 DOI: 10.1016/j.sjopt.2010.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 10/06/2010] [Indexed: 10/19/2022] Open
Abstract
Orbital retinoblastoma is a catastrophic event traditionally carrying a dismal prognosis. Although its incidence is less in the developed countries it continues to be one of the major diagnosis at presentation in the developing world. Orbital retinoblastoma encompasses a wide range of distinct clinical entities with varying tumor load. There are no standard treatment protocols as of now but the current preferred management is multimodal with a combination of initial high-dose chemotherapy, surgery, external beam radiotherapy and prolonged chemotherapy for twelve cycles. In spite of progress on all fronts including surgical, medical, diagnostic, genetic and rehabilitative with improving survival rates, however, lack of access to medical facilities, lack of education about the need for early medical attention and cultural resistance to enucleation continue to contribute to an epidemic of extra ocular disease at diagnosis in the developing world. This review introduces the various terminologies used in the spectrum of orbital retinoblastoma, discusses in details the clinical aspects and management protocols, current status and the future directions.
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Affiliation(s)
- Mohammad J Ali
- Ocular Oncology Service, L.V. Prasad Eye Institute, Road No. 2, Banjara Hills, Hyderabad 500034, India
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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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Dunkel IJ, Khakoo Y, Kernan NA, Gershon T, Gilheeney S, Lyden DC, Wolden SL, Orjuela M, Gardner SL, Abramson DH. Intensive multimodality therapy for patients with stage 4a metastatic retinoblastoma. Pediatr Blood Cancer 2010; 55:55-9. [PMID: 20486171 DOI: 10.1002/pbc.22504] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND We previously reported promising pilot results treating patients with stage 4a metastatic retinoblastoma with combined intensive conventional chemotherapy, high-dose chemotherapy with autologous hematopoietic stem cell rescue, and radiation therapy and now present an expanded and updated series. PROCEDURE Fifteen patients with bone marrow (n = 14), bone (n = 10), orbit (n = 9), and/or liver (n = 4) disease were treated. Induction chemotherapy usually consisted of vincristine, cyclophosphamide, cisplatin, and etoposide. The high-dose chemotherapy regimen included carboplatin and thiotepa alone (n = 1) or with etoposide (n = 5) or topotecan (n = 7). RESULTS Bone marrow cleared at first post-initiation of chemotherapy examination in all patients and stem cells were harvested after a median of 3.5 cycles of chemotherapy (range 3-6 cycles). Two patients progressed prior to high-dose chemotherapy and died. Thirteen received high-dose chemotherapy at a median of 6 months post-diagnosis of metastases (range 4-8 months). Ten are retinoblastoma-free in first remission at a median follow-up of 103 months (range 34-202 months) while three recurred (two in the CNS, one in the mandible) 14-20 months post-diagnosis of metastases. Retinoblastoma-free and event-free survival at 5 years are 67% (95% confidence interval 38-85%) and 59% (95% confidence interval 31-79%). Six of the 10 survivors received radiation therapy. Three patients developed secondary osteosarcoma 14, 4, and 9 years after diagnosis of metastatic disease. CONCLUSIONS Intensive multimodality therapy including high-dose chemotherapy with autologous hematopoietic stem cell rescue was curative for the majority of patients with stage 4a metastatic retinoblastoma treated. The contribution of external beam radiation therapy is unclear.
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Affiliation(s)
- Ira J Dunkel
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
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Treatment and outcome of nonmetastatic extraocular retinoblastoma with a uniform chemotherapy protocol. J Pediatr Hematol Oncol 2010; 32:e42-5. [PMID: 20168241 DOI: 10.1097/mph.0b013e3181bfcd83] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nonmetastatic extraocular retinoblastoma is a common entity in South-East Asia. We did a retrospective study of patients treated for isolated extraocular retinoblastoma, that is, International retinoblastoma staging system stages II and III, using a uniform chemotherapy protocol at our oncology center, between June 2003 and June 2008. Out of the 25 patients having nonmetastatic extraocular retinoblastoma, 6 were in stage II, and 19 in stage III. The probability of event-free survival was 0.54 at 18 months of follow-up with no significant difference between the 2 stages and the presence of optic nerve involvement; 11 out of 13 relapses were systemic. This is the largest case series of nonmetastatic extraocular retinoblastoma from South-East Asia.
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Aung L, Khyne T, Yeoh AEJ, Quah TC, Ta AM. Retinoblastoma: A Recent Experience at the National University Hospital, Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n8p693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction: Retinoblastoma is a very rare disease. There were 30 cases of retinoblastoma diagnosed and treated at National University Hospital (NUH).
Materials and Methods: A retrospective chart review was performed on the medical records of 30 patients who were diagnosed with retinoblastoma between 1995 and 2008 at the Department of Paediatrics, National University Hospital, Singapore.
Results: The median age at diagnosis was 1.6 years (range, 0-5.9) with a median follow-up of 1.8 years (range, 0.1 to 11.6). The median time from presenting signs to the time of diagnosis was 5.2 months (range, 0-25.2). Common presenting signs of retinoblastoma were identified; the most common of which were leukocoria (50.0%), squinting (13.3%), poor vision (10.0%), strabismus (6.6%) and unknown (33.3%). Of the 30 patients, 10 were from Singapore whilst the other 20 patients were from the surrounding countries. Twelve patients had bilateral disease at the time of diagnosis, while 18 had unilateral disease. Staging information was available in 27 patients. Enucleation was performed in 25 of 30 patients. Radiation therapy was given in 3 patients in 1995 (bilateral disease), 2001 (bilateral disease) and 2003 (unilateral disease). At the time of analysis, 19 patients were alive with no evidence of disease. Overall 5-year survival for the cohort was 88.1% [95% confidence interval (CI), 88.0-100] and event-free survival for the whole cohort was 74.2% (95% CI, 55.8-92.6).
Conclusion: In our limited experience, the importance of collaboration and standardisation of the staging system, raising awareness and education of primary healthcare providers and parents are strongly stressed.
Key words: Asian experience, Outcome, Staging, Survival
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Affiliation(s)
- LeLe Aung
- National University of Singapore, Singapore
| | | | | | | | - Ah Moy Ta
- National University of Singapore, Singapore
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Bonanomi MTBC, Almeida MTAD, Cristofani LM, Odone Filho V. Retinoblastoma: a three-year-study at a Brazilian medical school hospital. Clinics (Sao Paulo) 2009; 64:427-34. [PMID: 19488609 PMCID: PMC2694247 DOI: 10.1590/s1807-59322009000500010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Accepted: 03/02/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To present the characteristics and treatment outcomes of patients with retinoblastoma. METHODS A retrospective case series was conducted to review the records of all new patients diagnosed with retinoblastoma between 2003 and 2005. Eyes with early disease, or advanced disease with potential vision were treated with chemotherapy (carboplatin and etoposide) in conjunction with early local therapy (laser or cryo). Radiotherapy was used in cases where the disease did not respond to the above protocols or in recurrent cases. Eyes in the late stage of disease with no potential vision in the initial examination or eyes and where conservative treatment had failed were enucleated. RESULTS In total, we reviewed 28 new cases of retinoblastoma, 15 of which were unilateral and 13 of which were bilateral (46%). These data correspond to a mean of 9.3 new cases per year (0.77 case/ month). The mean age at diagnosis was 33.8 months for unilateral cases, and 19.15 months for bilateral cases (p=0.015). Leucocoria was the major presenting symptom (75%). All but one patient with unilateral disease had the affected eye enucleated due to advanced disease (mean follow-up: 39.91 months). Among the 13 bilateral cases, 13 eyes (50%) were enucleated, 11 eyes (42.4%) were saved with chemotherapy in conjunction with local therapy and 2 eyes (7.6%) were saved using external beam radiotherapy (mean follow-up: 41.91 months). In unilateral and bilateral disease, pathology data revealed choroid involvement in 50% and 30%, respectively, and optic nerve invasion in 92% and 50%, respectively. CONCLUSION In this population, retinoblastoma was diagnosed too late and most eyes were consequently enucleated. In cases with bilateral disease, half of the eyes were preserved.
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Antczak C, Kloepping C, Radu C, Genski T, Müller-Kuhrt L, Siems K, de Stanchina E, Abramson DH, Djaballah H. Revisiting old drugs as novel agents for retinoblastoma: in vitro and in vivo antitumor activity of cardenolides. Invest Ophthalmol Vis Sci 2009; 50:3065-73. [PMID: 19151399 DOI: 10.1167/iovs.08-3158] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Intra-arterial delivery of chemotherapeutic agents offers a new and exciting opportunity for the treatment of advanced intraocular retinoblastoma. It allows local delivery of relatively high doses of chemotherapy agents while bypassing general blood circulation. For this reason, this study was undertaken to revisit some of the FDA-approved drugs for the treatment of retinoblastoma. METHODS High-throughput screening (HTS) of 2640 approved drugs and bioactive compounds resulted in the identification of cytotoxic agents with potent activity toward both the Y79 and RB355 human retinoblastoma cell lines. Subsequent profiling of the drug candidates was performed in a panel of ocular cancer cell lines. Induction of apoptosis in Y79 cells was assessed by immunofluorescence detection of activated caspase-3. Therapeutic effect was evaluated in a xenograft model of retinoblastoma. RESULTS Several FDA-approved drugs were identified that showed potent cytotoxic activity toward retinoblastoma cell lines in vitro. Among them were several cardiac glycosides, a class of cardenolides historically associated with the prevention and treatment of congestive heart failure. Caspase-3 activation studies provided an insight into the mechanism of action of cardenolides in retinoblastoma cells. When tested in a xenograft model of retinoblastoma, the cardenolide ouabain induced complete tumor regression in the treated mice. CONCLUSIONS Cardenolides were identified as a new class of antitumor agents for the treatment of retinoblastoma. Members of this class of cardiotonic drugs could be repositioned for retinoblastoma if administered locally via direct intra-arterial infusion.
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Affiliation(s)
- Christophe Antczak
- High Throughput Screening Core Facility, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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Armenian SH, Panigrahy A, Murphree AL, Jubran RF. Management of retinoblastoma with proximal optic nerve enhancement on MRI at diagnosis. Pediatr Blood Cancer 2008; 51:479-84. [PMID: 18478574 DOI: 10.1002/pbc.21604] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In North America, retinoblastoma rarely presents with gross clinical evidence of tumor involving the optic nerve. Extent of microscopic tumor infiltration into the postlaminar optic nerve is a significant risk factor for metastasis, especially if there is tumor at the cut end. Due to poor outcomes in patients with metastatic disease, historical treatment for patients with clinical evidence of extraocular optic nerve involvement has included upfront enucleation followed by aggressive adjuvant chemotherapy. Additional orbital irradiation is advocated for individuals with optic nerve involvement at the surgical margin. Little is known about the role of neoadjuvant therapy in the setting of orbital optic nerve enhancement on magnetic resonance imaging (MRI) at diagnosis. METHODS A retrospective review of consecutive retinoblastoma cases at Childrens Hospital Los Angeles over a 3-year period (2004-2006) found to have gadolinium contrast enhancement in the proximal portion of optic nerve on MRI at diagnosis. RESULTS Nine patients fit the inclusion criteria. Two had secondary glaucoma of a sufficient degree to cause an enlarged eye (buphthalmos). Median age at presentation was 17 months (2-36 months). All patients received neoadjuvant chemotherapy prior to enucleation. Only two received external beam radiation. All are disease-free with a median follow-up of 22 months (12-41 months). CONCLUSIONS Neoadjuvant chemotherapy is well tolerated prior to enucleation of retinoblastoma-containing eyes associated with contrast enhancement of the proximal optic nerve on MRI at diagnosis. Such an approach may be used to decrease intensity or duration of chemotherapy and need for external beam radiation.
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Affiliation(s)
- Saro H Armenian
- Division of Hematology/Oncology, Childrens Hospital Los Angeles, Los Angeles, California, USA.
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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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The addition of ifosfamide/etoposide to cisplatin/teniposide improves the survival of children with retinoblastoma and orbital involvement. J Pediatr Hematol Oncol 2007; 29:700-4. [PMID: 17921851 DOI: 10.1097/mph.0b013e31814fb7ea] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to determine the impact of the addition of ifosfamide/etoposide to a regimen containing cisplatin/teniposide on the survival of patients with retinoblastoma with orbital involvement. Thirty patients were treated at the A. C. Camargo Hospital, Brazil, from 1986 to 2002. From 1986 to April 1992 (period I, n=12), treatment consisted of 3 cycles of induction chemotherapy with cisplatin and teniposide, followed by maintenance with same drugs alternating with cyclophosphamide, vincristine, and doxorubicin every 21 days for 60 weeks. Since April 1992 (period II, n=18), the treatment consisted of 3 cycles of ifosfamide and etoposide followed by maintenance with same drugs, alternating with cisplatin and teniposide every 21 days for 36 weeks. In both periods, children were submitted to exenteration with eyelid preservation and orbital radiation therapy with 45 cGy, and also received intrathecal therapy with methotrexate plus dexamethasone and cytarabine. Kaplan-Meier method was used for survival analysis. The median age was 31 months. Most patients (86.7%) presented unilateral tumors. The 3-year overall survival was 34.4% and 72.2%, respectively, for patients treated during periods I and II (P=0.061). The addition of ifosfamide/etoposide to chemotherapy with cisplatin/teniposide improves survival in these patients, but further studies are still necessary.
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Ozdemir H, Tacyildiz N, Unal E, Yavuz G, Ugur H, Gunduz K. Clinical and epidemiological characteristics of retinoblastoma: correlation with prognosis in a Turkish pediatric oncology center. Pediatr Hematol Oncol 2007; 24:221-31. [PMID: 17454793 DOI: 10.1080/08880010601107623] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Advanced intraocular tumors and metastatic disease in retinoblastoma patients still occur frequently in developing countries. The aim of this retrospective study was to describe the clinical and epidemiological characteristics of patients with retinoblastoma and the effects of these features on disease prognosis in the authors' pediatric oncology unit as a developing country profile to define the problem. A retrospective chart review of 91 patients who presented to the unit between May 1996 and December 2003 was conducted in this study. Patients with unilateral disease presented at a median age of 24 months and those with bilateral disease at a median age of 9.5 months (p < .01). Most of the eyes with retinoblastoma (68.6%) had Reese-Ellsworth stage V disease. Metastatic disease was diagnosed in 19 (20.9%) patients. Cases with metastatic disease presented at a median age of 24 months and those without metastatic disease at a median age of 12.5 months (p < .05). In 31 patients (34.1%) there was a delay in diagnosis. The enucleation ratio in eyes with advanced intraocular stage was significantly higher than in eyes with early intraocular stage (57.9 vs. 3.8%) (p < .001). In patients with metastatic disease, tumor recurrence was more frequent than in the nonmetastatic patients (36.8 vs. 4.2%) (p < .01). Seven children (7.7%) died due to central nervous system (CNS) metastasis (p < .01). Advanced intraocular disease and distant metastases occur more frequently in Turkish children with retinoblastoma than in children in developed countries, causing a higher rate of enucleation and mortality. Late referral might account for the delayed diagnosis.
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Affiliation(s)
- Halil Ozdemir
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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Shah HR, Conway RM, Van Quill KR, Madigan MC, Howard SA, Qi J, Weinberg V, O'Brien JM. Beta-lapachone inhibits proliferation and induces apoptosis in retinoblastoma cell lines. Eye (Lond) 2007; 22:454-60. [PMID: 17363928 DOI: 10.1038/sj.eye.6702764] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIMS To investigate the cytotoxicity of beta-lapachone, a potent agent that may selectively target tumour cells, in retinoblastoma (RB) cell lines. METHODS Growth inhibitory effects of beta-lapachone were evaluated in Y79, WERI-RB1, and RBM human retinoblastoma cell lines. Pro-apoptotic effects of beta-lapachone were evaluated in Y79 cells by detection of caspase 3/7 activity, by enzyme-linked immunosorbent assay for nucleosome fragments, and by cellular morphological analysis. RESULTS Beta-lapachone induced significant dose-dependent growth inhibitory effects in all three retinoblastoma cell lines. The 50% growth inhibitory concentration (IC(50)) of this agent was 1.9 microM in Y79 cells, 1.3 microM in WERI-RB1 cells, and 0.9 microM in RBM cells. Beta-lapachone also induced proapoptotic effects in RB cells. Treatment of Y79 cells with 1.9 microM beta-lapachone (IC(50)) resulted in a peak, fourfold induction of caspase 3/7 activity at 72 h post-treatment; a peak, 5.6-fold increase in nucleosome fragments at 96 h post-treatment; and a peak, 1.7-fold increase in the frequency of apoptotic cells at 48 h post-treatment, relative to vehicle-treated controls. CONCLUSION Beta-lapachone induced potent cytotoxic effects in RB cell lines at low micromolar concentrations, suggesting this agent could be useful in the clinical management of RB.
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Affiliation(s)
- H R Shah
- Department of Ophthalmology, University of California at San Francisco, San Francisco, CA, USA
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Schefler AC, Jockovich ME, Toledano S, Murray TG. Historical and modern approaches to chemotherapy for retinoblastoma. EXPERT REVIEW OF OPHTHALMOLOGY 2006. [DOI: 10.1586/17469899.1.1.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Leal-Leal CA, Rivera-Luna R, Flores-Rojo M, Juárez-Echenique JC, Ordaz JC, Amador-Zarco J. Survival in extra-orbital metastatic retinoblastoma:treatment results. Clin Transl Oncol 2006; 8:39-44. [PMID: 16632438 DOI: 10.1007/s12094-006-0093-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Retinoblastoma (RB) is the most frequent malignant eye tumor in childhood. In developing countries advanced stages are common. The purpose of this paper is to present our 21-year clinical experience with metastatic extra ocular RB patients treated with 5 different chemotherapy schemas at a single Mexican Pediatric referral center. MATERIALS AND METHODS A retrospective analysis was carried out reviewing the clinical characteristics of patients with metastatic RB. The information analyzed included the delay in diagnosis after first symptoms, age, sex, ocular staging, and anatomic site of metastases, treatment scheme, initial response and status at the last contact or date of death. RESULTS Eighty-one patients were included; age range was from 3 to 80 months. The most common site of metastasis was central nervous system (83.9%). From those patients treated with chemotherapy (n = 74), 89.2% presented a complete initial response (n = 66). Early mortality occurred in 7 cases before any treatment. Fifty-six received treatment and died with progressive disease. All patients without radiotherapy died with tumor activity (n = 15). The use of cisplatin was related with longer disease free intervals; no other variable was related with survival. Four patients were alive and disease free at 33 to 144.3 months of follow up from diagnosis. The prevalent cause of death was tumor progression. CONCLUSIONS In our experience, metastatic RB has a very high mortality rate in spite of the use of different chemotherapy regimens.
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Affiliation(s)
- Carlos A Leal-Leal
- Department of Oncology, Instituto Nacional de Pediatría, Mexico DF, Mexico.
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