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Nag A, Khetan V. Retinoblastoma - A comprehensive review, update and recent advances. Indian J Ophthalmol 2024; 72:778-788. [PMID: 38804799 DOI: 10.4103/ijo.ijo_2414_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/02/2023] [Indexed: 05/29/2024] Open
Abstract
Retinoblastoma is the most common pediatric ocular malignancy. It is triggered by a biallelic mutation in the RB1 gene or MYCN oncogene amplification. Retinoblastomas can be unilateral (60%-70%) or bilateral (30%-40%); bilateral tumors are always heritable and present at an earlier age as compared to unilateral ones (18-24 months vs. 36 months in India). High prevalence rates, delayed presentation, and inaccessibility to healthcare lead to worse outcomes in developing countries. The past few decades have seen a paradigm change in the treatment of retinoblastomas, shifting from enucleation and external beam radiotherapy to less aggressive modalities for eye salvage. Multimodality treatment is now the standard of care and includes intraarterial or intravenous chemotherapy along with focal consolidation therapies such as transpupillary thermotherapy, cryotherapy, and laser photocoagulation. Intravitreal and intracameral chemotherapy can help in controlling intraocular seeds. Advanced extraocular or metastatic tumors still have a poor prognosis. Genetic testing, counseling, and screening of at-risk family members must be incorporated as essential parts of management. A better understanding of the genetics and molecular basis of retinoblastoma has opened up the path for potential targeted therapy in the future. Novel recent advances such as liquid biopsy, prenatal diagnosis, prognostic biomarkers, tylectomy, and chemoplaque point to promising future directions.
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Affiliation(s)
- Adwaita Nag
- Ocular Oncology Service, Department of Ophthalmology and Vision Sciences, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Vikas Khetan
- Formerly at Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
- Professor, Department of Ophthalmology, Flaum Eye Institute, Rochester, NY, USA
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He M, Yang L, Jia S, Yang J, Wen X, Fan J, Jia R, Fan X. Does vitreous haemorrhage and calcification lead to increased risk of enucleation in advanced retinoblastoma? Acta Ophthalmol 2024; 102:e296-e301. [PMID: 37431955 DOI: 10.1111/aos.15735] [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: 03/06/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE To explore whether varying degrees of vitreous haemorrhage (VH) and calcification act as risk factors for enucleation in patients with advanced retinoblastoma (RB). METHODS Advanced RB was defined by the international classification of RB (Philadelphia version). Basic information for retinoblastoma patients diagnosed as groups D and E in our hospital between January 2017 and June 2022 was reviewed by logistics regression models. Additionally, a correlation analysis was performed, excluding variables with a VIF (variance inflation factor) >10 from the multivariate analysis. RESULTS A total of 223 eyes diagnosed with RB were included in assessing VH and calcification; of these, 101 (45.3%) eyes experienced VH, and 182 (76.2%) eyes were found to have calcification within the tumour through computed tomography (CT) or B-scan ultrasonography. Ninety-two eyes (41.3%) were enucleated, of which 67 (72.8%) had VH and 68 (73.9%) calcification, both of which were significantly relevant to enucleation (p < 0.001*). Other clinical risk factors, such as corneal edema, anterior chamber haemorrhage, high intraocular pressure during treatment and iris neovascularization, correlated significantly with enucleation (p < 0.001*). Multivariate analysis included IIRC (intraocular international retinoblastoma classification), VH, calcification and high intraocular pressure during treatment as independent risk factors for enucleation. CONCLUSIONS Despite identifying different potential risk factors for RB, there remains significant controversy concerning which patients require enucleation, and the degree of VH varies. Such eyes need to be evaluated carefully, and management with appropriate adjuvant therapy may improve the outcome of these patients.
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Affiliation(s)
- Mengjia He
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ludi Yang
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shichong Jia
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Tianjin Eye Institute, Tianjin, China
| | - Jie Yang
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xuyang Wen
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jiayan Fan
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Pai V, Muthusami P, Ertl-Wagner B, Shroff MM, Parra-Fariñas C, Sainani K, Kletke S, Brundler MA, Mallipatna A. Diagnostic Imaging for Retinoblastoma Cancer Staging: Guide for Providing Essential Insights for Ophthalmologists and Oncologists. Radiographics 2024; 44:e230125. [PMID: 38451848 DOI: 10.1148/rg.230125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Retinoblastoma is the most common cause of all intraocular pediatric malignancies. It is caused by the loss of RB1 tumor suppressor gene function, although some tumors occur due to MYCN oncogene amplification with normal RB1 genes. Nearly half of all retinoblastomas occur due to a hereditary germline RB1 pathogenic variant, most of which manifest with bilateral tumors. This germline RB1 mutation also predisposes to intracranial midline embryonal tumors. Accurate staging of retinoblastoma is crucial in providing optimal vision-, eye-, and life-saving treatment. The AJCC Cancer Staging Manual has undergone significant changes, resulting in a universally accepted system with a multidisciplinary approach for managing retinoblastoma. The authors discuss the role of MRI and other diagnostic imaging techniques in the pretreatment assessment and staging of retinoblastoma. A thorough overview of the prevailing imaging standards and evidence-based perspectives on the benefits and drawbacks of these techniques is provided. Published under a CC BY 4.0 license. Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Vivek Pai
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Prakash Muthusami
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Birgit Ertl-Wagner
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Manohar M Shroff
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Carmen Parra-Fariñas
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Kanchan Sainani
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Stephanie Kletke
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Marie-Anne Brundler
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
| | - Ashwin Mallipatna
- From the Divisions of Neuroradiology (V.P., P.M., B.E.W., M.M.S., C.P.F.) and Image Guided Therapy (P.M., M.M.S., C.P.F.), Department of Diagnostic Imaging, and Retinoblastoma Program, Department of Ophthalmology and Vision Sciences (K.S., S.K., A.M.), The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Pathology and Department of Laboratory Medicine and Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada (M.A.B.)
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Ding J, Sun J, Ma RQ, Zheng K, Han YN. Low expression of NR1D1 and NR2E3 is associated with advanced features of retinoblastoma. Int Ophthalmol 2024; 44:133. [PMID: 38480634 PMCID: PMC10937757 DOI: 10.1007/s10792-024-03055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE To investigate the expression of nuclear receptor subfamily 1 group D member 1 (NR1D1) and nuclear receptor subfamily 2 group E Member 3 (NR2E3) in retinoblastoma (RB) and their correlation with the clinical and pathological features of RB. METHODS Immunohistochemical (IHC) assays were performed to detect and evaluate the expression levels of NR1D1 and NR2E3 in paraffin-embedded tissue samples. The relationship between the expression levels and clinicopathological characteristics of RB patients was analyzed using the χ2 test or Fisher exact test. RESULTS A total of 51 RB patients were involved in this research. The expression levels of NR1D1 (P = 0.004) and NR2E3 (P = 0.024) were significantly lower in RB tumor tissues than in normal retina. The expression levels of NR1D1 and NR2E3 were less positive in RB patients with advanced stages (P = 0.007, P = 0.015), choroidal infiltration (P = 0.003, P = 0.029), and optic nerve infiltration (P = 0.036, P = 0.003). In addition, a low expression level of NR2E3 was associated with high-risk pathology (P = 0.025) and necrosis (P = 0.035) of RB tissues. CONCLUSION The expression levels of NR1D1 and NR2E3 were decreased in RB and closely associated with the clinical stage and high invasion of the disease. These findings provide new insights into the mechanism of RB progression and suggest that NR1D1 and NR2E3 could be potential targets for treatment strategies.
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Affiliation(s)
- Jie Ding
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China
| | - Jie Sun
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China
| | - Rui-Qi Ma
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China
| | - Ke Zheng
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China
| | - Yi-Nan Han
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China.
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