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Munier FL, Beck-Popovic M, Chantada GL, Cobrinik D, Kivelä TT, Lohmann D, Maeder P, Moll AC, Carcaboso AM, Moulin A, Schaiquevich P, Bergin C, Dyson PJ, Houghton S, Puccinelli F, Vial Y, Gaillard MC, Stathopoulos C. Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. "Alive, with good vision and no comorbidity". Prog Retin Eye Res 2019; 73:100764. [PMID: 31173880 DOI: 10.1016/j.preteyeres.2019.05.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.
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Affiliation(s)
- Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland.
| | - Maja Beck-Popovic
- Unit of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Guillermo L Chantada
- Hemato-Oncology Service, Hospital JP Garrahan, Buenos Aires, Argentina; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - David Cobrinik
- The Vision Center and The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA; USC Roski Eye Institute, Department of Biochemistry & Molecular Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tero T Kivelä
- Department of Ophthalmology, Ocular Oncology and Pediatric Ophthalmology Services, Helsinki University Hospital, Helsinki, Finland
| | - Dietmar Lohmann
- Eye Oncogenetics Research Group, Institute of Human Genetics, University Hospital Essen, Essen, Germany
| | - Philippe Maeder
- Unit of Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Annette C Moll
- UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Angel Montero Carcaboso
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Alexandre Moulin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paula Schaiquevich
- Unit of Clinical Pharmacokinetics, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Ciara Bergin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paul J Dyson
- Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015, Lausanne, Switzerland
| | - Susan Houghton
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Francesco Puccinelli
- Interventional Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yvan Vial
- Materno-Fetal Medicine Unit, Woman-Mother-Child Department, University Hospital of Lausanne, Switzerland
| | - Marie-Claire Gaillard
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
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Totadri S, Munikoty V, Singh U, Srinivasan R, Trehan A, Jain R, Kakkar N, Saxena AK, Rajwanshi A, Bansal D. Is a diagnostic lumbar puncture indicated in intraocular retinoblastoma? INDIAN J PATHOL MICR 2018; 61:201-203. [PMID: 29676357 DOI: 10.4103/ijpm.ijpm_475_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Lumbar puncture (LP) is frequently performed in patients with advanced intraocular retinoblastoma. However, this may not be necessary in a significant proportion of patients. Materials and Methods: A file review of patients who were diagnosed with retinoblastoma over a 13-year-period was performed. Patients who underwent LP as part of staging were included in the study. Results The study included 223 patients. One-third had bilateral retinoblastoma. The grouping was C, D, and E in 4 (2.9%), 41 (29.9%), and 92 (67.2%) patients, respectively. The stage was 0, I, II, III, and IV in 14 (6.3), 123 (55.2%), 13 (5.8%), 70 (31.4%), and 3 (1.3%) patients, respectively. Eight (3.6%) patients had a positive cerebrospinal fluid (CSF) cytology. None of the patients with intraocular disease and 7 (10%) patients with extraocular disease had a positive CSF. Conclusions A diagnostic CSF is not indicated in patients with intraocular retinoblastoma.
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Affiliation(s)
- Sidharth Totadri
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinay Munikoty
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Jain
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Kumar Saxena
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics, Advanced Pediatrics Center, Pediatric Hematology-Oncology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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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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