1
|
Yin F, Guo Z, Sun W, Hou C, Wang S, Ji F, Liu Y, Fu S, Liu C, Li R, Wang Y, Sun D. Comparing overall survival between pediatric and adult retinoblastoma with the construction of nomogram for adult retinoblastoma: A SEER population-based analysis. Asian J Surg 2024; 47:2178-2187. [PMID: 38395709 DOI: 10.1016/j.asjsur.2024.02.046] [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: 10/28/2023] [Revised: 12/19/2023] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Retinoblastoma (RB) is a rare primary malignant tumor primarily affecting children. Our study aims to compare the overall survival (OS) between pediatric and adult RB patients and establish a predictive model for adult RB patients' OS to assist clinical decision-making. METHODS This study retrospectively analyzed data from 1938 RB patients in the Surveillance, Epidemiology, and End Results (SEER) database, covering the period from 2000 to 2015. Propensity score matching (PSM) ensured balanced characteristics between pediatric and adult groups. A Cox proportional hazards regression model was used to assess prognostic factors, and selected variables were utilized to construct a predictive survival model. The Nomogram model's performance was evaluated through the C-index, time-dependent ROC curves, calibration curves, and decision curve analysis (DCA). RESULTS Following PSM, adult RB patients had lower OS compared to pediatric RB patients. Independent prognostic factors for adult RB OS included age, gender, disease stage, radiation therapy, income, and diagnosis confirmation. In the training cohort, the Nomogram achieved a C-index for OS of 0.686 and accurately predicted 2-year, 3-year, and 5-year OS with AUC values of 0.672, 0.680, and 0.660, respectively. The C-index, time-dependent ROC curves, calibration curves, and DCA in both training and validation cohorts confirmed the Nomogram's excellent performance. CONCLUSION In this study, adult RB patients have worse OS than pediatric RB patients. Consequently, we constructed a Nomogram to predict the risk for adult RB patients. The Nomogram demonstrated good accuracy and reliability, making it suitable for widespread application in clinical practice to assist healthcare professionals in assessing patients' prognoses.
Collapse
Affiliation(s)
- Fangxu Yin
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zheng Guo
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chong Hou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, China
| | - Song Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Fulong Ji
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yong Liu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Siqi Fu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunxiang Liu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Li
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuchao Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Daqing Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China.
| |
Collapse
|
2
|
Kumar SV, Kumar V, Sati A, Mishra SK, Khera S, Mishra A, Mathur A, Gopinath M, Mohimen A, Malik V, Kumar NV. Clinicodemographic profile, management, and treatment outcomes in advanced retinoblastoma at a tertiary care center in North India. Indian J Ophthalmol 2024; 72:653-658. [PMID: 38099390 DOI: 10.4103/ijo.ijo_1849_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/28/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE The study was undertaken to look into the clinicodemographic profile, management, and clinical outcomes of advanced retinoblastoma at a tertiary care center. METHODS A prospective cohort study was conducted from Jan 2019 to Dec 2022. Forty-two patients of intraocular advanced retinoblastoma were assessed. The treatment protocol was formulated based on size, extension of tumor, and laterality. Primary outcome measure was response to the treatment in terms of regression of tumor and seeds and no evidence of recurrence after 12 month in enucleated eyes. Secondary outcome measures were complications like implant exposure, metastasis, and death associated with each treatment modality. RESULTS The mean age of the study group was 13 months. The most common presentation was leukocoria with diminished vision. Most of the patients had group E retinoblastoma ( n = 40, 95%) as per the International Classification of Retinoblastoma. In 12 patients with group E retinoblastoma, primary enucleation was performed and in six patients, secondary enucleation was done, in which initially, globe salvage treatment was tried. In 30 patients, globe salvage treatment was attempted and we could manage to save 23 eyes. The most common treatment modality was intra-arterial chemotherapy using a triple-drug regimen. One patient developed intracranial spread and died due to systemic metastasis during the follow-up period. CONCLUSION The current study showed that globe salvage is possible in advanced retinoblastoma if appropriate therapy is instituted depending upon the extent of the tumor and availability of latest treatment modalities. Intra-arterial chemotherapy using triple drugs can be offered as a first-line therapy in advanced unilateral retinoblastoma as it has been found to be very effective in the present study.
Collapse
Affiliation(s)
- Sonali Vinay Kumar
- Department of Ophthalmology, Army Hospital Research and Referral, Delhi, India
| | - Vinay Kumar
- Department of Anatomy, Venkateshwara Institute of Medical Sciences, Gajraula, Uttar Pradesh, India
| | - Alok Sati
- Department of Ophthalmology, Army Hospital Research and Referral, Delhi, India
| | - Sanjay Kumar Mishra
- Department of Ophthalmology, Army Hospital Research and Referral, Delhi, India
| | - Sanjeev Khera
- Department of Paediatrics, Army Hospital Research and Referral, Delhi, India
| | - Atul Mishra
- Department of Radiology, Command Hospital Eastern Command, Kolkata, West Bengal, India
| | - Ankit Mathur
- Department of Radiology, Command Hospital Northern Command, Udhampur, Jammu and Kashmir, India
| | - Manoj Gopinath
- Department of Radiology, Army Hospital Research and Referral, Delhi, India
| | - Aneesh Mohimen
- Department of Radiology, Army Hospital Research and Referral, Delhi, India
| | - Virender Malik
- Department of Radiology, Army Hospital Research and Referral, Delhi, India
| | - Natasha V Kumar
- Department of Ophthalmology, Sri Devaraj Urs Medical College, Kolar, India
| |
Collapse
|
3
|
Kurzawa-Akanbi M, Tzoumas N, Corral-Serrano JC, Guarascio R, Steel DH, Cheetham ME, Armstrong L, Lako M. Pluripotent stem cell-derived models of retinal disease: Elucidating pathogenesis, evaluating novel treatments, and estimating toxicity. Prog Retin Eye Res 2024; 100:101248. [PMID: 38369182 DOI: 10.1016/j.preteyeres.2024.101248] [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: 12/07/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/20/2024]
Abstract
Blindness poses a growing global challenge, with approximately 26% of cases attributed to degenerative retinal diseases. While gene therapy, optogenetic tools, photosensitive switches, and retinal prostheses offer hope for vision restoration, these high-cost therapies will benefit few patients. Understanding retinal diseases is therefore key to advance effective treatments, requiring in vitro models replicating pathology and allowing quantitative assessments for drug discovery. Pluripotent stem cells (PSCs) provide a unique solution given their limitless supply and ability to differentiate into light-responsive retinal tissues encompassing all cell types. This review focuses on the history and current state of photoreceptor and retinal pigment epithelium (RPE) cell generation from PSCs. We explore the applications of this technology in disease modelling, experimental therapy testing, biomarker identification, and toxicity studies. We consider challenges in scalability, standardisation, and reproducibility, and stress the importance of incorporating vasculature and immune cells into retinal organoids. We advocate for high-throughput automation in data acquisition and analyses and underscore the value of advanced micro-physiological systems that fully capture the interactions between the neural retina, RPE, and choriocapillaris.
Collapse
|
4
|
Abdelhafeez A, Abib S, Lakhoo K. Surgically Amenable Childhood Cancers: An Overview of the Burden and Challenges of Management in Low- and Middle-Income Countries. World J Surg 2023; 47:3402-3407. [PMID: 37162509 DOI: 10.1007/s00268-023-07010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 05/11/2023]
Abstract
The World Health Organization's Global Initiative for Childhood Cancer was launched to decrease the disparities in childhood cancer outcomes and improve treatments for childhood cancer in resource-limited settings. Low-grade glioma, retinoblastoma, and Wilms tumors are among the index cancers included in this global initiative, as these cancers represent a large percentage of childhood tumors and are curable with cost-effective, evidence-based interventions. Herein, we discuss the global childhood tumor burden, the status of pediatric cancer surgery capacity and services around the world, and the strategic considerations for building pediatric surgical oncology capacity.
Collapse
Affiliation(s)
- Abdelhafeez Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
| | - Simone Abib
- Department of Pediatric Surgery, Pediatric Oncology Institute - GRAACC - Federal University of São Paulo, São Paulo, Brazil
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, Oxford University, Oxford, UK
| |
Collapse
|
5
|
Khraisat OMA, Al-Bashaireh AM, Alnazly E. Telenursing implications for future education and practice: Nursing students' perspectives and knowledge from a course on child health. PLoS One 2023; 18:e0294711. [PMID: 38011137 PMCID: PMC10681229 DOI: 10.1371/journal.pone.0294711] [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: 12/25/2022] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Technology advancements have altered the standard of nursing care, and education. This suggests the necessity to equip prospective nurses to provide competent care in a highly technical and digital environment via telenursing. AIMS The aim of this study was to assess the perceptions and knowledge of nursing students about telenursing. METHODS Using a descriptive cross-sectional design. A self-reported questionnaire was used. The distribution of 110 questionnaires to nursing students attending two private colleges in Jordan resulted in an 83.6% (n = 92) response rate. Descriptive and inferential statistics were applied. RESULTS The results showed a positive perception toward telenursing practice, as well as the difficulty in precisely defining telenursing. Age, internet usage patterns, and knowledge were all factors considered telenursing predictors. 32% of the variance was explained by the model. Telenursing would be beneficial for future nursing professionals by incorporating telenursing into the curriculum. CONCLUSIONS The learning environment is extends somewhat beyond the classroom, making it is necessary to integrate telenursing into education in order to redefine the future of the nursing practice.
Collapse
Affiliation(s)
| | - Ahmad M. Al-Bashaireh
- Faculty of Health Science, Higher Colleges of Technology, Fujairah, United Arab Emirates
| | - Eman Alnazly
- Nursing Faculty, Al-Ahliyya Amman University, Amman, Jordan
| |
Collapse
|
6
|
Nishath T, Li X, Chandramohan A, Othus M, Ji X, Zou Y, Sultana S, Rashid R, Sherief ST, Cassoux N, Garcia Leon JL, Díaz Coronado R, López AMZ, Ushakova TL, Polyakov VG, Roy SR, Ahmad A, Reddy A, Sagoo MS, Al Harby L, Kim JW, Berry JL, Polski A, Astbury N, Bascaran C, Blum S, Bowman R, Burton MJ, Foster A, Gomel N, Keren-Froim N, Madgar S, Zondervan M, Kaliki S, Fabian ID, Stacey A. Risk factors associated with abandonment of care in retinoblastoma: analysis of 692 patients from 10 countries. Br J Ophthalmol 2023; 107:1818-1822. [PMID: 36113955 PMCID: PMC10017370 DOI: 10.1136/bjo-2022-321159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Rates of care abandonment for retinoblastoma (RB) demonstrate significant geographical variation; however, other variables that place a patient at risk of abandoning care remain unclear. This study aims to identify the risk factors for care abandonment across a multinational set of patients. METHODS A prospective, observational study of 692 patients from 11 RB centres in 10 countries was conducted from 1 January 2019 to 31 December 2019. Multivariate logistic regression was used to identify risk factors associated with higher rates of care abandonment. RESULTS Logistic regression showed a higher risk of abandoning care based on country (high-risk countries include Bangladesh (OR=18.1), Pakistan (OR=45.5) and Peru (OR=9.23), p<0.001), female sex (OR=2.39, p=0.013) and advanced clinical stage (OR=4.22, p<0.001). Enucleation as primary treatment was not associated with a higher risk of care abandonment (OR=0.59, p=0.206). CONCLUSION Country, advanced disease and female sex were all associated with higher rates of abandonment. In this analysis, enucleation as the primary treatment was not associated with abandonment. Further research investigating cultural barriers can enable the building of targeted retention strategies unique to each country.
Collapse
Affiliation(s)
- Thamanna Nishath
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Xiudi Li
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Arthika Chandramohan
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Megan Othus
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yang Pu Qu, Shanghai, China
| | - Yihua Zou
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yang Pu Qu, Shanghai, China
| | - Sadia Sultana
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Riffat Rashid
- Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
| | - Sadik Taju Sherief
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nathalie Cassoux
- Department of Ophthalmology, Institut Curie, Universite de Paris UFR de Medecine de Paris Centre, Paris, France
| | | | | | | | - Tatiana L Ushakova
- Head and Neck Tumors, SRI of Pediatric Oncology and Hematology of NN Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation
- Pediatric Oncology, Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Vladimir G Polyakov
- Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of NN Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation
- Russian Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Soma Rani Roy
- Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh
| | - Alia Ahmad
- The Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | - Ashwin Reddy
- Ophthalmology, Barts Health NHS Trust, London, UK
- Paediatric Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mandeep S Sagoo
- Ophthalmology, Barts Health NHS Trust, London, UK
- NIHR Biomedical Research Centre for Ophthalmology, Joint Library of Ophthalmology Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Lamis Al Harby
- Ocular Oncology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Jonathan W Kim
- USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- The Vision Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jesse L Berry
- USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- The Vision Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ashley Polski
- USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- The Vision Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Nick Astbury
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Cova Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sharon Blum
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Matthew J Burton
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Allen Foster
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, and International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nir Gomel
- Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
- Division of Ophthalmology, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Naama Keren-Froim
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Shiran Madgar
- Ophthalmology, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Marcia Zondervan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ido Didi Fabian
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Stacey
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington, USA
| |
Collapse
|
7
|
Kakarala CL, Raval VR, Mallu A, Rao R, Gavara S, Reddy VAP, Mishra DK, Jakati S, Kaliki S. Metastatic retinoblastoma at presentation: Clinical presentation, treatment, and outcomes. Oman J Ophthalmol 2023; 16:524-528. [PMID: 38059077 PMCID: PMC10697251 DOI: 10.4103/ojo.ojo_176_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/08/2023] [Accepted: 07/22/2023] [Indexed: 12/08/2023] Open
Abstract
The aim of this study was to retrospectively determine clinical features, treatment outcomes, and overall survival in four patients with metastatic retinoblastoma at presentation. The mean age at diagnosis was 63 months (range: 24-108 months). Three patients had overt orbital disease of at least one eye and one patient had microscopic orbital disease with scleral infiltration on histopathology. Metastatic sites included regional lymph nodes (RLN) (n = 4), bone marrow (BM) (n = 2), and cerebrospinal fluid (CSF) (n = 1). The most common sites of RLN were ipsilateral preauricular nodes (two patients) and contralateral parotid gland involvement (one patient). The treatment administered included primary enucleation (n = 1), high-dose intravenous chemotherapy (n = 4), secondary enucleation (n = 2), orbital external beam radiotherapy (n = 3), and intrathecal chemotherapy (n = 1). High-risk features included massive choroidal and microscopic scleral infiltration in the eye that underwent primary enucleation. At a mean follow-up of 33 months (range, 4-68 months), one patient with CSF involvement deceased in 4 months. The remaining three patients were alive and disease-free at the last mean follow-up period of 43 months (range, 18-68 months). The results of our study showed that RLN and BM metastasis respond well to treatment while CSF metastasis is associated with poor prognosis.
Collapse
Affiliation(s)
- Chandra L. Kakarala
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vishal Rameshkumar Raval
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Akhila Mallu
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Suneetha Gavara
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vijay Anand P. Reddy
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Dilip K. Mishra
- Department of Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Saumya Jakati
- Department of Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
8
|
Elder AJ, Alazawi H, Shafaq F, Ayyad A, Hazin R. Teleoncology: Novel Approaches for Improving Cancer Care in North America. Cureus 2023; 15:e43562. [PMID: 37719501 PMCID: PMC10502915 DOI: 10.7759/cureus.43562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Due to widespread healthcare workforce shortages, many patients living in remote and rural North America currently have reduced access to various medical specialists. These shortages, coupled with the aging North American population, highlight the need to transform contemporary healthcare delivery systems. The exchange of medical information via telecommunication technology, known as telemedicine, offers promising solutions to address the medical needs of an aging population and the increased demand for specialty medical services. This progressive movement has also improved access to quality health care by mitigating the current shortage of trained subspecialists. Minimizing the effects of these shortages is particularly urgent in the care of cancer patients, many of whom require regular follow-up and close monitoring. Cancer patients living in remote areas of North America have reduced access to specialized care and, thus, have unacceptably high mortality and morbidity rates. Teleoncology, or the use of telemedicine to provide oncology services remotely, has the ability to improve access to high-quality care and assist in alleviating the burden of some of the severe adverse events associated with cancer. In this review, the authors describe how recent advances in teleoncology can reduce healthcare disparities and improve future cancer care in North America.
Collapse
Affiliation(s)
- Adam J Elder
- Department of Medical Education, Wayne State University School of Medicine, Detroit, USA
| | - Hussein Alazawi
- Department of Medical Education, Michigan State University College of Osteopathic Medicine, East Lansing, USA
| | - Fareshta Shafaq
- Department of Medical Education, American University of the Caribbean, Cupecoy, SXM
| | - Adam Ayyad
- Department of Medical Education, Ross University School of Medicine, Bridgetown, BRB
| | - Ribhi Hazin
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| |
Collapse
|
9
|
Abdelazeem B, Abbas KS, Shehata J, El-Shahat NA, Eltaras MM, Qaddoumi I, Alfaar AS. Survival trends for patients with retinoblastoma between 2000 and 2018: What has changed? Cancer Med 2023; 12:6318-6324. [PMID: 36479934 PMCID: PMC10028055 DOI: 10.1002/cam4.5406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Retinoblastoma (RB) is the most common primary intraocular cancer of childhood. Over the last few decades, a variety of techniques and treatment modalities emerged that improved the survival and ocular salvage rate of patients with RB. We investigated the relative survival trends of patients with RB from 2000 to 2018 by using the Surveillance, Epidemiology, and End Results (SEER) database. DESIGN Retrospective database review. METHODS We extracted data from SEER 18 from 2000 to 2018. All patients with clinically diagnosed RB during the study period were included. We utilized SEER*Stat 8.3.9 and JPSurv software to estimate relative 5- and 10-year survival rates and trends and generated descriptive analyses with IBM SPSS. MAIN OUTCOME MEASURES Patient survival rates at 5- and 10-year after RB diagnosis. RESULTS RB was diagnosed in 1479 patients within the SEER 18 Program during our study period. The cohort comprised 776 (52.5%) males, 615 (41.6%) non-Hispanic whites, 487(32.9%) Hispanics, 1030 (69.6%) patients with unilateral disease, and 1087 (73.5%) patients with localized disease. Relative survival trends at 5- and 10-year significantly declined over the study periods (-0.42%, and -0.50% annually, respectively) but the decline was not significant in unilateral and bilateral RB cases separately. CONCLUSIONS Five- and ten-year relative survival trends declined from 2000 to 2018 and were significantly decreasing. Further studies that include more patients are needed to identify the factors contributing to reduced survival of patients with RB over time.
Collapse
Affiliation(s)
- Basel Abdelazeem
- McLaren Health Care, Flint/Michigan State University, Flint, Michigan, USA
| | | | | | | | | | | | - Ahmad Samir Alfaar
- Ophthalmology Department, University of Um, Ulm, Germany
- Experimental Ophthalmology, Campus Virchow-Klinikum, Charite Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
10
|
Naseripour M, Sedaghat A, Mirshahi R, Abdolalizadeh P, Koushki A, Faranoush M, Ghorbani M, Kashkouli MB, Sadeghipour A, Chaibakhsh S, Mehrvar A. Targeted chemotherapy in retinoblastoma: A step forward from patient survival to globe survival. Eur J Ophthalmol 2023; 33:574-586. [PMID: 35414292 DOI: 10.1177/11206721221093018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/ OBJECTIVES Despite being the most common intraocular malignancy in childhood, there is a substantial disparity between developing and developed countries in terms of patient and globe survival in retinoblastoma (Rb). The current study intends to determine patient and globe survival before and after the introduction of the new targeted treatment modalities in a developing country. METHODS Medical records of 350 patients (516 eyes) with retinoblastoma referred to a tertiary referral center for Rb in Tehran, Iran, were reviewed. In order to compare patient and globe survival before and after the availability of the new treatment modalities, including intra-arterial and intravitreal chemotherapy, the patients were divided into group 1 (2001-2007) and group 2 (2008-2018) based on the calendar period of diagnosis. RESULTS Two-hundred-twenty-three eyes of 149 patients and 293 eyes of 201 patients were categorized into groups 1 and 2, respectively. The 5-year patient survival was 97% across the current survey, and the overall survival rate was 96% in group 1 and 99% in group 2 (P = 0.08). Overall, 50% of eyes with retinoblastoma underwent enucleation, which was the primary in 63% (116/184) of the unilateral and 30% (99/322) of the bilateral cases. Primary enucleation was significantly lower in group 2 (35%) in contrast to group 1 (50%) (P < 0.001). In addition, globe survival improved significantly in the International Classification of Retinoblastoma Groups D (17% in group 1 vs. 66% in group 2, P < 0.001) and E (1% in group 1 vs. 23% in group 2 P < 0.001) during the two timelines. In enucleated eyes, despite the increased rate of prelaminar involvement in group 2 (13% vs. 2% in group 1, P = 0.003), the rate of high-risk histopathologic findings was similar between the two groups. CONCLUSION Similar to developed countries, the application of new targeted treatment modalities, including intra-arterial and intravitreal chemotherapy, has been associated with significantly improved globe survival in Rb patients. However, it should be noted that even with the availability of these novel treatment options, the decision for on-time enucleation should not be deferred.
Collapse
Affiliation(s)
- Masood Naseripour
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Ahad Sedaghat
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Parya Abdolalizadeh
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Amin Koushki
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Mohammad Faranoush
- Pediatric growth and development research center, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghorbani
- Division of vascular and endovascular neurosurgery, Firoozgar Hospital, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bahmani Kashkouli
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Alireza Sadeghipour
- Department of Pathology, Oncopathology Research Center, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Azim Mehrvar
- MAHAK Hematology Oncology Research Center (MAHAK-HORC), MAHAK Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Chandra K, Raval V, Reddy P VA, Kaliki S. Primary Macular Retinoblastoma: Clinical Presentation and Treatment Outcomes. JOURNAL OF VITREORETINAL DISEASES 2022; 6:367-373. [PMID: 37006899 PMCID: PMC9954921 DOI: 10.1177/24741264221107757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To describe the clinical features and treatment outcomes in eyes with primary macular retinoblastoma (RB). Methods: Patients with primary macular RB were analyzed. Results: Of 41 patients (47 eyes), 20 (49%) were boys and 21 (51%) were girls. The mean age at diagnosis was 16 months (range, 1-60 months). The RB was bilateral in 6 patients (15%). At presentation, the macula was completely covered with the tumor in 22 eyes (47%) and partially covered with the fovea spared in 13 eyes (28%) and the fovea involved 12 eyes (25%). Based on the International Classification of Intraocular Retinoblastoma, 25 (53%), 15 (32%), and 7 (15%) of tumors were in Group B, Group C, and Group D, respectively. The tumor had exophytic features in 36 eyes (77%). The mean tumor basal diameter was 10.0 mm and the mean thickness, 5.6 mm. Associated features included subretinal seeds (10 eyes; 21%) and surrounding subretinal fluid (16 eyes; 34%). Forty-three eyes (92%) were treated with intravenous chemotherapy, 2 (4%) with intra-arterial chemotherapy, and 2 (4%) with transpupillary thermotherapy. Local tumor control was achieved in 45 eyes (96%), with 33 eyes (70%) showing a type III regression pattern. Over a mean follow-up of 23 months (range, 3-48 months), the macular tumor recurred in 5 eyes (11%), the globe was salvaged in all eyes with associated foveal atrophy (36 eyes; 77%), and 1 patient (2%) died. Conclusions: Macular RB has a good prognosis for globe salvage while vision salvage might be compromised as a result of associated foveal atrophy.
Collapse
Affiliation(s)
- Kiran Chandra
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Vishal Raval
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Vijay Anand Reddy P
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
12
|
Retinoblastoma as a lens for correctable disparities worldwide. THE LANCET GLOBAL HEALTH 2022; 10:e1074-e1075. [DOI: 10.1016/s2214-109x(22)00290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
|
13
|
Wong ES, Choy RW, Zhang Y, Chu WK, Chen LJ, Pang CP, Yam JC. Global retinoblastoma survival and globe preservation: a systematic review and meta-analysis of associations with socioeconomic and health-care factors. THE LANCET GLOBAL HEALTH 2022; 10:e380-e389. [DOI: 10.1016/s2214-109x(21)00555-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/17/2022] Open
|
14
|
Hussain Z. Impact of Laterality on Cumulative Survival in Patients Diagnosed with Retinoblastoma: A Retrospective Cohort Analysis of 1925 Cases in the Surveillance, Epidemiology, and End Results (SEER) Program. Clin Ophthalmol 2021; 15:991-1001. [PMID: 33707938 PMCID: PMC7943541 DOI: 10.2147/opth.s298209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Retinoblastoma is an intraocular cancer with potentially severe clinical consequences if left untreated. Diagnostic and clinical management guidelines are strictly dependent on nature of laterality. This analysis aims to characterize the influence of laterality on survival in patients diagnosed with retinoblastoma. Methods This retrospective cohort analysis utilized the Surveillance, Epidemiology, and End Results (SEER) program for population-based clinical data from 1975 to 2016, a period of 41 years. Univariable and multivariable Cox regression assessed survival with laterality as the primary independent predictor of mortality. Adjustment for demographical and clinical variables was performed. Results N = 1925 patients with a valid cause of death classification. Mean±SD age was 2.35±2.020 years (range 0–74). At the time of diagnosis, 819 (42.1%) patients were between 0 and 1 year of age, 469 (24.1%) patients were between 1 and 2 years, 350 (18.0%) patients were between 2 and 3 years, 147 (7.6%) patients were between 3 and 4 years, and 68 (3.5%) patients were between 4 and 5 years of age. The hazard of univariable cause-specific death is 55.6% and 52.9% lower for retinoblastoma patients with left-sided origin and right-sided origin as compared to patients with bilateral origin, respectively (HR = 0.444, CI 0.247–0.800, p = 0.007; HR = 0.471, CI 0.267–0.832, p = 0.009). After adjusting for confounding variables, the hazard of other-cause death for retinoblastoma patients is significantly less for left-sided origin (HR = 0.364, CI 0.140–0.946, p = 0.038) and right-sided origin (HR = 0.190, CI 0.066–0.549, p = 0.002) as compared to patients with retinoblastomas of bilateral origin. Conclusion Prognostication of survival is significantly influenced by the nature of laterality in retinoblastoma. Unilateral retinoblastomas showcase increased promise for long-term cause-specific and other-cause survival compared to cases of retinoblastoma arising from bilateral origin.
Collapse
Affiliation(s)
- Zain Hussain
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| |
Collapse
|
15
|
Global Retinoblastoma Treatment Outcomes: Association with National Income Level. Ophthalmology 2020; 128:740-753. [PMID: 33007338 DOI: 10.1016/j.ophtha.2020.09.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare metastasis-related mortality, local treatment failure, and globe salvage after retinoblastoma in countries with different national income levels. DESIGN International, multicenter, registry-based retrospective case series. PARTICIPANTS Two thousand one hundred ninety patients, 18 ophthalmic oncology centers, and 13 countries on 6 continents. METHODS Multicenter registry-based data were pooled from retinoblastoma patients enrolled between January 2001 and December 2013. Adequate data to allow American Joint Committee on Cancer staging, eighth edition, and analysis for the main outcome measures were available for 2085 patients. Each country was classified by national income level, as defined by the 2017 United Nations World Population Prospects, and included high-income countries (HICs), upper middle-income countries (UMICs), and lower middle-income countries (LMICs). Patient survival was estimated with the Kaplan-Meier method. Logistic and Cox proportional hazards regression models were used to determine associations between national income and treatment outcomes. MAIN OUTCOME MEASURES Metastasis-related mortality and local treatment failure (defined as use of secondary enucleation or external beam radiation therapy). RESULTS Most (60%) study patients resided in UMICs and LMICs. The global median age at diagnosis was 17.0 months and higher in UMICs (20.0 months) and LMICs (20.0 months) than HICs (14.0 months; P < 0.001). Patients in UMICs and LMICs reported higher rates of disease-specific metastasis-related mortality and local treatment failure. As compared with HICs, metastasis-related mortality was 10.3-fold higher for UMICs and 9.3-fold higher for LMICs, and the risk for local treatment failure was 2.2-fold and 1.6-fold higher, respectively (all P < 0.001). CONCLUSIONS This international, multicenter, registry-based analysis of retinoblastoma management revealed that lower national income levels were associated with significantly higher rates of metastasis-related mortality, local treatment failure, and lower globe salvage.
Collapse
|
16
|
Fabian ID, Stacey AW, Foster A, Kivelä TT, Munier FL, Keren-Froim N, Gomel N, Cassoux N, Sagoo MS, Reddy MA, Harby LA, Zondervan M, Bascaran C, Abdallah E, Abdullahi SU, Boubacar SA, Ademola-Popoola DS, Adio A, Aghaji AE, Portabella SA, Alfa Bio AI, Ali AM, Alia DB, All-Eriksson C, Almeida AA, Alsawidi KM, Antonino R, Astbury NJ, Atsiaya R, Balaguer J, Balwierz W, Barranco H, Popovic MB, Benmiloud S, Guebessi NB, Berete RC, Biddulph SJ, Biewald EM, Blum S, Bobrova N, Boehme M, Bornfeld N, Bouda GC, Bouguila H, Boumedane A, Brichard BG, L MC, Castela G, Català-Mora J, Chantada GL, Chernodrinska VS, Chiwanga FS, Cieslik K, Comsa C, Correa Llano MG, Csóka M, Da Gama IV, Davidson A, Potter PD, Desjardins L, Dragomir MD, Bruyn MD, Kettani AE, Elbahi AM, Elgalaly D, Elhaddad AM, Ali Elhassan MM, Elzembely MM, Essuman VA, Evina TGA, Fasina O, Fernández-Teijeiro A, Gandiwa M, Aldana DG, Geel JA, Gizachew Z, Gregersen PA, Guedenon KM, Hadjistilianou T, Hassan S, Hederova S, Hessissen L, Hordofa DF, Hummlen M, Husakova K, Ida R, Ilic VR, Jenkinson H, Amani Kabesha TB, Kabore RL, Kalinaki A, Kapelushnik N, Kardava T, Kemilev PK, Kepak T, Khotenashvili Z, Klett A, Kosh Komba Palet JE, Krivaitiene D, Kruger M, Kyara A, Lachmann ES, Latinović S, Lecuona K, Lukamba RM, Lumbroso L, Lysytsia L, Maka E, Makan M, Manda C, Begue NM, Matende IO, Matua M, Mayet I, Mbumba FB, Mengesha AA, Midena E, Mndeme FG, Mohamedani AA, Moll AC, Moreira C, Msina MS, Msukwa G, Muma KI, Murgoi G, Musa KO, Mustak H, Muyen OM, Naidu G, Naumenko L, Ndoye Roth PA, Neroev V, Nikitovic M, Nkanga ED, Nkumbe H, Nyaywa M, Obono-Obiang G, Oguego NC, Olechowski A, Oscar AH, Osei-Bonsu P, Painter SL, Paintsil V, Paiva L, Papyan R, Parrozzani R, Parulekar M, Pawinska-Wasikowska K, Perić S, Philbert R, Pochop P, Polyakov VG, Pompe MT, Pons JJ, Raobela L, Renner LA, Reynders D, Ribadu D, Riheia MM, Ritter-Sovinz P, Saakyan S, Said AM, Román Pacheco SS, Scanlan TA, Schoeman J, Seregard S, Sherief ST, Cheikh SS, Silva S, Sorochynska T, Ssali G, Stathopoulos C, Kranjc BS, Stones DK, Svojgr K, Sylla F, Tamamyan G, Tandili A, Tateshi B, Theophile T, Traoré F, Tyau-Tyau H, Umar AB, Urbak SF, Ushakova TL, Valeina S, Hoefen Wijsard MV, Veleva-Krasteva NV, Viksnins M, Wackernagel W, Waddell K, Wade PD, Wali Nigeria AH, Wime AD, Dod CW, Yanga JM, Yarovaya VA, Yarovoy AA, Zein E, Sharabi S, Zhilyaeva K, Ziko OA, Bowman R. Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries. Br J Ophthalmol 2020; 105:1435-1443. [PMID: 32933936 DOI: 10.1136/bjophthalmol-2020-316613] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/28/2020] [Accepted: 08/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.
Collapse
Affiliation(s)
- Ido Didi Fabian
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK .,The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Andrew W Stacey
- Department of Ophthalmology, University of Washington, Seattle, WA, US
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tero T Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile de Aveugles, University of Lausanne, Lausanne, Switzerland
| | | | - Nir Gomel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nathalie Cassoux
- Institut curie, université de Paris medicine Paris V Descartes, Paris, France
| | - Mandeep S Sagoo
- NIHR Biomedical Research Center for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology and London Retinoblastoma Service, Royal London Hospital, London, UK
| | - M Ashwin Reddy
- The Royal London Hospital, Barts Health NHS Trust, and Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Lamis Al Harby
- The Royal London Hospital, Barts Health NHS Trust, and Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Marcia Zondervan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elhassan Abdallah
- Ophthalmology Department of Rabat, Mohammed V university, Rabat, Morocco
| | | | | | - Dupe S Ademola-Popoola
- University of Ilorin and University of IlorinTeaching Hospital, Ilorin, Kwara State, Nigeria
| | - Adedayo Adio
- Department of Ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Ada E Aghaji
- Department of Ophthalmology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | | | | | - Amany M Ali
- Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Donjeta B Alia
- University Hospital Center 'Mother Theresa', Tirana, Albania
| | | | | | | | | | - Nicholas J Astbury
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rose Atsiaya
- Light House For Christ Eye Center, Mombasa, Kenya
| | - Julia Balaguer
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Walentyna Balwierz
- Institute of Pediatrics, Jagiellonian University Medical College, Childrens University Hospital of Krakow, Krakow, Poland
| | - Honorio Barranco
- Pediatric Oncology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Maja Beck Popovic
- Unit of Pediatric Hematology-Oncology, University Hospital CHUV, Lausanne, Switzerland
| | - Sarra Benmiloud
- Department of Pediatric Oncology, University Hassan II Fès, Fez, Morocco
| | | | - Rokia C Berete
- Ophthalmologic Department of the Teaching Hospital of Treichville, Abidjan, Côte d'ivoire
| | | | - Eva M Biewald
- University Hospital Essen, Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Sharon Blum
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Nadia Bobrova
- The Filatov Institute of Eye diseases and Tissue Therapy, Odessa, Ukraine
| | - Marianna Boehme
- University Hospital Essen, Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Norbert Bornfeld
- University Hospital Essen, Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Gabrielle C Bouda
- Center Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou, Ouagadougou, Burkina Faso
| | - Hédi Bouguila
- Institut Hédi-Raïs d'Ophtalmologie de Tunis, Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Amaria Boumedane
- Etablissement Hospitalière Spécialise Emir Abdelkader CEA Service d'Oncologie Pédiatrique, Oran, Algeria
| | | | | | - Guilherme Castela
- Centro Hospital Universitário de Coimbra, University of Coimbra, Coimbra, Portugal
| | | | | | - Violeta S Chernodrinska
- Eye Clinic, University Hospital 'Alexandrovska', Department of Ophthalmology, Medical University, Sofia, Bulgaria
| | | | - Krzysztof Cieslik
- Department of Ophthalmology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Codruta Comsa
- Oncology Institute 'Prof. Dr. Al. Trestioreanu' Bucharest, Romania
| | | | - Monika Csóka
- Semmelweis University Budapest, Budapest, Hungary
| | | | - Alan Davidson
- Red Cross Children's War Memorial Hospital and the University of Cape Town, Cape Town, South Africa
| | | | | | | | | | - Asmaa El Kettani
- Center Hospitalier et Universitaire Ibn Rochd, Casablanca, Morocco
| | - Amal M Elbahi
- Tripoli Eye Hospital, Tripoli University, Tripoli, Libya
| | - Dina Elgalaly
- Children's Cancer Hospital Egypt 57357, Cairo, Egypt
| | | | - Moawia M Ali Elhassan
- Oncology Department, National Cancer Institute, University of Gezira, Wadi Madani, Sudan
| | - Mahmoud M Elzembely
- Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Vera A Essuman
- Ophthalmology Unit, Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | | | - Oluyemi Fasina
- Department of Ophthalmology, University College Hospital/University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - Moira Gandiwa
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Jennifer A Geel
- University of the Witwatersrand, Johannesburg, South Africa.,Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Zelalem Gizachew
- Addis Ababa University, School of Medicine, Department of Ophthalmology, Addis Ababa, Ethiopia
| | - Pernille A Gregersen
- Department of Clinical Genetics, and Center for Rare Disorders, Aarhus University Hopspital, Aarhus, Denmark
| | - Koffi M Guedenon
- Département de Pédiatrie, CHU Sylvanus Olympio, Université de Lomé, Lomé, Togo
| | | | - Sadiq Hassan
- Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Laila Hessissen
- Pediatric Hematology and Oncology Department of Rabat - Mohammed V University, Rabat, Morocco
| | - Diriba F Hordofa
- Department of Pediatrics and Child Health, Jimma University Medical Center, Jimma, Ethiopia
| | - Marlies Hummlen
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | | | - Russo Ida
- Bambino Gesù IRCCS Children's Hospital, Rome, Italy
| | - Vesna R Ilic
- Institute for Oncology and Radiology, Belgrade, Serbia
| | - Helen Jenkinson
- Birmingham Children's Hospital Eye Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Rolande L Kabore
- Center Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou, Ouagadougou, Burkina Faso
| | - Abubakar Kalinaki
- Makerere University College of Health Sciences, Department of Ophthalmology, Kamplala, Uganda
| | - Noa Kapelushnik
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar Kardava
- Ophthalmology Department, Central Children's Hospital of Georgia, Tbilisi, Georgia
| | - Pavlin Kroumov Kemilev
- Eye Clinic, University Hospital 'Alexandrovska', Department of Ophthalmology, Medical University, Sofia, Bulgaria
| | - Tomas Kepak
- University Hospital Brno, Masaryk University and ICRC/St. Anna University Hospital, Brno, Czech Republic
| | - Zaza Khotenashvili
- Ophthalmology Department, Central Children's Hospital of Georgia, Tbilisi, Georgia
| | - Artur Klett
- East Tallinn Central Hospital, Tallinn, Estonia
| | | | - Dalia Krivaitiene
- Chidren's Ophthalmology Department, Chidren's Hospital of Vilnius, University Hospital Santaros Clinic, Vilnius, Lithuania
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Alice Kyara
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Slobodanka Latinović
- Clinical Center Of Vojvodina - University Eye Clinic, Eye Research Foundation Vidar - Latinović, Novi Sad, Serbia
| | - Karin Lecuona
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Robert M Lukamba
- University Clinics of Lubumbashi, University of Lubumbashi, Lubumbashi, DRC
| | | | - Lesia Lysytsia
- The Okhmatdyt National Children's Hospital, Kiev, Ukraine
| | - Erika Maka
- Semmelweis University Budapest, Budapest, Hungary
| | - Mayuri Makan
- Sekuru Kaguvi Eye Unit, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Chatonda Manda
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Nieves Martín Begue
- Department of Pediatric Ophthalmology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Ismail Mayet
- University of the Witwatersrand, Johannesburg, South Africa
| | - Freddy B Mbumba
- Botswana Government - Scottish Livingstone Hospital, Molepolole, Botswana
| | | | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | - Ahmed A Mohamedani
- Pathology Department, Faculty of Medicine, University of Gezira, Wadi Madani, Sudan
| | - Annette C Moll
- Department of Ophthalmology, Amsterdam UMC, Amsterdam, Netherlands
| | - Claude Moreira
- Service d'oncologie pédiatrique de l'hôpital Aristide le Dantec, Dakar, Senegal
| | | | - Gerald Msukwa
- Lions Sight First Eye Hospital, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Gabriela Murgoi
- Oncology Institute 'Prof. Dr. Al. Trestioreanu' Bucharest, Romania
| | - Kareem O Musa
- Department of Ophthalmology, Lagos University Teaching Hospital/College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Hamzah Mustak
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | | | - Gita Naidu
- University of the Witwatersrand, Johannesburg, South Africa
| | - Larisa Naumenko
- N.N. Alexandrov National Cancer Center of Belarus, Minsk, Belarus
| | | | - Vladimir Neroev
- Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | | | - Elizabeth D Nkanga
- Calabar Children's Eye Center, Department of Ophthalmology University of Calabar Teaching Hospital Calabar Cross River State, Nigeria
| | - Henry Nkumbe
- Magrabi ICO Cameroon Eye Institute, Yaounde, Cameroon
| | | | | | - Ngozi C Oguego
- Department of Ophthalmology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Andrzej Olechowski
- Department of Ophthalmology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Alexander Hugo Oscar
- Eye Clinic, University Hospital 'Alexandrovska', Department of Ophthalmology, Medical University, Sofia, Bulgaria
| | | | - Sally L Painter
- Birmingham Children's Hospital Eye Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Luisa Paiva
- National Ophthalmological Institute of Angola, Luanda, Angola
| | - Ruzanna Papyan
- Yerevan State Medical University, Department of Oncology and Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after R.H. Yeolyan, Yerevan, Armenia
| | | | - Manoj Parulekar
- Birmingham Children's Hospital Eye Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Katarzyna Pawinska-Wasikowska
- Institute of Pediatrics, Jagiellonian University Medical College, Childrens University Hospital of Krakow, Krakow, Poland
| | - Sanja Perić
- University Hospital Center Zagreb, Zagreb, Croatia
| | - Remezo Philbert
- Center Hospitaliere Universitaire de Kamenge, Bujumbura, Burundi
| | - Pavel Pochop
- Department of Ophthalmology for Children and Adults, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Vladimir G Polyakov
- Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Center of Oncology of Russian Federation, Moscow, Russian Federation.,Medical Academy of Postgraduate Education, Moscow, Russia
| | - Manca T Pompe
- Univ. Medical Center Ljubljana, Univ.Eye Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Léa Raobela
- Center Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar
| | - Lorna A Renner
- University of Ghana School of Medicine and Dentistry, Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | | | - Petra Ritter-Sovinz
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria
| | - Svetlana Saakyan
- Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Azza Ma Said
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | | | | | - Sadik T Sherief
- Addis Ababa University, School of Medicine, Department of Ophthalmology, Addis Ababa, Ethiopia
| | - Sidi Sidi Cheikh
- Ophthalmology department, Nouakchott Medical University, Nouakchott, Mauritania
| | - Sónia Silva
- Centro Hospital Universitário de Coimbra, University of Coimbra, Coimbra, Portugal
| | | | - Grace Ssali
- Mulago National Referral and Teaching Hospital, Kamplala, Uganda
| | - Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile de Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Branka Stirn Kranjc
- Univ. Medical Center Ljubljana, Univ.Eye Hospital Ljubljana, Ljubljana, Slovenia
| | - David K Stones
- Department of Paediatrics and Child Health, University of the Free Sate, Bloemfontein, South Africa
| | - Karel Svojgr
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | - Gevorg Tamamyan
- Yerevan State Medical University, Department of Oncology and Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after R.H. Yeolyan, Yerevan, Armenia
| | - Alketa Tandili
- University Hospital Center 'Mother Theresa', Tirana, Albania
| | | | | | - Fousseyni Traoré
- Pediatric Oncology Service, Gabriel Toure Hospital, Bamako, Mali
| | | | - Ali B Umar
- Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Steen F Urbak
- Department of ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Tatiana L Ushakova
- Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Center of Oncology of Russian Federation, Moscow, Russian Federation.,Medical Academy of Postgraduate Education, Moscow, Russia
| | | | | | - Nevyana V Veleva-Krasteva
- Eye Clinic, University Hospital 'Alexandrovska', Department of Ophthalmology, Medical University, Sofia, Bulgaria
| | | | | | | | | | | | - Amelia Dc Wime
- National Ophthalmological Institute of Angola, Luanda, Angola
| | | | - Jenny M Yanga
- Service d'Ophtalmologie, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, DRC
| | - Vera A Yarovaya
- S.Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - Andrey A Yarovoy
- S.Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - Ekhtelbenina Zein
- Assistante Hospitalo - Universitaire, Faculte de Medecine de Nouakchott Medecin Oncopediatre, Center National d'Oncologie, Nouakchott, Mauritania
| | - Shirley Sharabi
- Radiology Department, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Othman Ao Ziko
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Richard Bowman
- Ophthalmology Department, Great Ormond Street Children's Hospital, London, UK
| |
Collapse
|
17
|
Gualy S, Herrera C, Warden C, Valle T, Barnum J, Colman B, Siu A, Swanson JW. Enabling Community Health Worker Recognition and Referral of Surgical Diseases: Pilot Study Results of a Pictorial Guide. World J Surg 2020; 43:2949-2958. [PMID: 31511941 DOI: 10.1007/s00268-019-05173-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Access to surgical care is a pressing challenge, particularly for vulnerable populations. Informal and formal community health workers (CHWs), including lay people, increasingly function in pivotal roles in primary care, however, remain disconnected from surgical care in most environments. This study examined the degree to which CHW understanding of surgical conditions could be improved through the use of a pictorially based manual. METHODS A manual and associated situational problem-solving questionnaire instrument were developed and contextualized through focus groups in Central America. A baseline assessment was obtained. In the program implementation, cohorts of formal and informal CHWs were introduced and trained to use the manual through a short curriculum. Assessment was repeated in program implementation, first with access to relevant manual content only, and then after the teaching session. Participants were also surveyed about manual scheme, usability, and utility. RESULTS A total of 100 subjects (67% female) participated in baseline assessment, and 403 subjects (68% female) were assessed through the program implementation. Baseline problem-solving averaged 11.8 (SD 2.46) out of a possible 20 points. Mean score increased to 15.4 (SD 3.10) when participants had access to relevant surgical manual content and again to 15.9 (SD 3.09, p < 0.0001) following participation with an instructive curriculum. Participant score while utilizing the manual correlated with amount of education completed (r = 0.26), but baseline score did not. High readability 389 (96%) and high self-reported willingness for use 398 (96%) were noted. CONCLUSION Baseline familiarity with surgically treatable conditions appears modest among rural Central American populations, and improves with access to a contextualized, pictorial manual focused on recognizing and appropriately referring surgical conditions.
Collapse
Affiliation(s)
- Sebastian Gualy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Operation Smile, Tegucigalpa, Honduras
- Operation Smile, Managua, Nicaragua
| | - Christopher Herrera
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Operation Smile, Tegucigalpa, Honduras
- Operation Smile, Managua, Nicaragua
| | - Clara Warden
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tyron Valle
- General Surgery, Hospital Carlos Centeno, Siuna, Nicaragua
| | - Jeanie Barnum
- Operation Smile, Tegucigalpa, Honduras
- Operation Smile, Managua, Nicaragua
| | - Bessy Colman
- Operation Smile, Tegucigalpa, Honduras
- Operation Smile, Managua, Nicaragua
| | - Armando Siu
- Operation Smile, Tegucigalpa, Honduras
- Operation Smile, Managua, Nicaragua
| | - Jordan W Swanson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Operation Smile, Tegucigalpa, Honduras.
- Operation Smile, Managua, Nicaragua.
| |
Collapse
|
18
|
Gupta N, Pandey A, Dimri K, Prinja S. Epidemiological profile of retinoblastoma in North India: Implications for primary care and family physicians. J Family Med Prim Care 2020; 9:2843-2848. [PMID: 32984136 PMCID: PMC7491789 DOI: 10.4103/jfmpc.jfmpc_265_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/13/2020] [Accepted: 04/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Retinoblastoma is the most common primary intraocular malignancy among children. Despite being curable in early stages, majority of the cases in India present in late stages, when outcomes are very poor. Objectives: The aim of this study was to assess the epidemiological profile, clinical characteristics, and treatment practices among retinoblastoma patients in north India. Materials and Methods: Data on all patients with retinoblastoma, over a 10-year-time period from 2009 to 2018, who were treated in a tertiary care hospital in north India, were assessed. Data were analyzed to describe the demographic characteristics, clinical features in terms of stage at presentation, and management practices in terms of diagnostic investigations and treatment. The statistical significance for difference in percentages was assessed using Fischer's exact test at a 5% significance level. Results: A total of 25 retinoblastoma patients were enlisted, of whom one was excluded as it was adult onset retinoblastoma. The median age at presentation was 3 years, with a male to female ratio of 1:1.4. Bilateral presentation was seen in 16.6% cases. Majority (66.6%) of the patients underwent magnetic resonance imaging of brain and orbit as a part of the diagnostic workup. Intraocular disease was seen in 58.3% patients, whereas 41.6% patients had extraocular disease. Local therapy with vision preservation could be used only in 8.3% patients, whereas 87.5% patients were referred for enucleation. Chemotherapy with combination of vincristine, etoposide, and carboplatin was used extensively both, in neoadjuvant setting (83.3%) and in the adjuvant setting. Conclusion: Despite availability of treatment for eye preservation, its utility is limited due to the advanced stage at presentation. Awareness about the disease and its symptoms for early diagnosis, especially with the Mid-Level Health Provider at Health and Wellness Centers, is likely to improve early reporting and treatment and meeting the Vision 2020 goals.
Collapse
Affiliation(s)
- Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Awadhesh Pandey
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Kislay Dimri
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
19
|
Superselective intra-arterial chemotherapy treatment for retinoblastoma: clinical experience from a tertiary referral centre. Can J Ophthalmol 2020; 55:406-412. [PMID: 32527493 DOI: 10.1016/j.jcjo.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 03/18/2020] [Accepted: 04/13/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the treatment outcomes of an alternative retrograde superselective ophthalmic artery catheterization (intra-arterial chemotherapy [IAC]), while treating retinoblastoma patients. METHODS A retrospective review of IAC for 21 treatment-naïve eyes (21 patients, primary group) and 10 eyes of previously treated 9 patients (secondary group). Statistical analysis was performed using Number Cruncher Statistical System 2007, Kaplan-Meier survival analysis, and Fisher's exact test. RESULTS Total fluoroscopy time ranged from 3 to 12 minutes. Globe salvage was 71.4% (15/21 eyes) and 80% (8/10 eyes) in the primary and secondary groups, respectively. Globe salvage rates were recorded as 100%, 100%, 70%, and 0% for group B, C, D, and E patients, respectively. CONCLUSIONS Retrograde IAC is effective in tumour control with shorter fluoroscopy time and acceptable complication rates both for naïve and treated patients. Furthermore, controlling retinoblastoma in advanced group D eyes was efficacious.
Collapse
|
20
|
Reed HD, Mehta P, Slone JS. Opportunities for improving retinoblastoma screening practices among physicians in Botswana. Pediatr Hematol Oncol 2020; 37:269-271. [PMID: 31858896 DOI: 10.1080/08880018.2019.1704952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Helen D Reed
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Parth Mehta
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jeremy S Slone
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
21
|
Garza-Garza LA, Ruiz-Lozano RE, Rebolledo-Méndez G, Ibarra-Nava I, Morales-Garza HJ, Ancona-Lezama D. Challenge of Retinoblastoma in Mexico in 2020: Perspectives and Solutions. J Ophthalmol 2020; 2020:1953602. [PMID: 32850140 PMCID: PMC7439193 DOI: 10.1155/2020/1953602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/28/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022] Open
Abstract
Early diagnosis and positive outcomes of retinoblastoma in childhood have been positively correlated with the economic wealth of high-income countries (HICs) worldwide. Adequate curability and survival rates, adherence to treatment, presence of poor prognostic initial clinical signs, and metastatic disease at diagnosis appear to have a less favorable picture in low-income countries (LICs). However, this is not always the case. An example is Argentina, where disease-free survival rates of retinoblastoma are notably higher than expected when taking into consideration its economic situation. Unfortunately, as in other Latin American LICs, retinoblastoma outcomes in Mexico are worrisome. Interestingly, the Human Development Index (HDI) in Mexico varies widely between its different geographical regions. While in some states, the HDI resembles those of high-income countries, and in others, the opposite is observed. A unifying picture of Mexico's developmental status, health resources, indicators, and other factors possibly influencing outcomes in retinoblastoma is currently unavailable. The present review explores the previously mentioned factors in Mexico and compares them to other countries. Additionally, it recommends solutions or enhancements where possible.
Collapse
Affiliation(s)
- Lucas A. Garza-Garza
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Raúl E. Ruiz-Lozano
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Genaro Rebolledo-Méndez
- 2Writing Lab, TecLabs, Vicerrectoria de Investigación y Transferencia de Tecnología, Tecnologico de Monterrey, Monterrey, Mexico
| | - Ismael Ibarra-Nava
- 3Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Héctor J. Morales-Garza
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
| | - David Ancona-Lezama
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
| |
Collapse
|
22
|
Chen R, Ye H, Liu S, Lin Y, Xiao W, Bi S, Chen G, Zhang T, Chen J, Yang H. Head and Eye Trauma Before Retinoblastoma Diagnosis. Cancer Manag Res 2019; 11:10269-10274. [PMID: 31827335 PMCID: PMC6902857 DOI: 10.2147/cmar.s217920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/18/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose To improve public and medical awareness of the possibility of retinoblastoma (RB) in children who experienced inadvertent trauma with or without trauma-related symptoms and signs. Patients and methods Retrospective study of the clinical characteristics of children with a trauma history preceding a diagnosis of RB at the Zhongshan Ophthalmic Center, Sun Yat-sen University, between January 2013 and August 2018, and the number of children hospitalized with eye trauma during the same period. Results Among 793 consecutive patients with RB, 10 (1.3%) had a history of trauma. Two of these 10 patients (20%, accounting for nearly 0.2% of the 1103 eye trauma patients who were treated at our center) had undergone vitrectomy in an eye with unsuspected tumors. Of the 10 cases (12 eyes), only 5 (7 eyes) were initially diagnosed with RB or an intraocular space-occupying mass before referral to the oncology clinic, and 8 patients (80%) with 8 eyes that were ultimately staged as cT2b or higher underwent enucleation on referral to the oncology clinic. Although additional treatment was performed, two of these patients experienced intracranial metastasis and death during a mean follow-up time of 25.9 months from treatment. Conclusion More attention should be paid to the possibility of underlying RB in children of preschool age who have experienced trauma with or without eye signs.
Collapse
Affiliation(s)
- Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Huijing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Shu Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Yueyan Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Shaowei Bi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Guo Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Te Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Jingqiao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| |
Collapse
|
23
|
Luna-Fineman S, Chantada G, Alejos A, Amador G, Barnoya M, Castellanos ME, Fu L, Fuentes-Alabi S, Girón V, Goenz MA, Maldonado C, Méndez G, Morales RA, Ortiz R, Sanchez G, Wilson M, Rodríguez-Galindo C. Delayed Enucleation With Neoadjuvant Chemotherapy in Advanced Intraocular Unilateral Retinoblastoma: AHOPCA II, a Prospective, Multi-Institutional Protocol in Central America. J Clin Oncol 2019; 37:2875-2882. [PMID: 31536438 PMCID: PMC6823891 DOI: 10.1200/jco.18.00141] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Treatment abandonment because of enucleation refusal is a limitation of improving outcomes for children with retinoblastoma in countries with limited resources. Furthermore, many children present with buphthalmos and a high risk of globe rupture during enucleation. To address these unique circumstances, the AHOPCA II protocol introduced neoadjuvant chemotherapy with delayed enucleation. PATIENTS AND METHODS Patients with advanced unilateral intraocular disease (International Retinoblastoma Staging System [IRSS] stage I) were considered for upfront enucleation. Those with diffuse invasion of the choroid, postlaminar optic nerve, and/or anterior chamber invasion received six cycles of adjuvant chemotherapy (vincristine, carboplatin, and etoposide). Patients with buphthalmos and those with a perceived risk for enucleation refusal and/or abandonment were given two to three cycles of chemotherapy before scheduled enucleation followed by adjuvant chemotherapy to complete six cycles, regardless of pathology. RESULTS A total of 161 patients had unilateral IRSS stage I disease; 102 underwent upfront enucleation, and 59 had delayed enucleation. The estimated 5-year abandonment-sensitive event-free and overall survival rates for the group were 0.81 ± 0.03 and 0.86 ± 0.03, respectively. The 5-year estimated abandonment-sensitive event-free survival rates for patients undergoing upfront and delayed enucleation were 0.89 ± 0.03 and 0.68 ± 0.06, respectively (P = .001). Compared with AHOPCA I, abandonment for patients with IRSS stage I retinoblastoma decreased from 16% to 4%. CONCLUSION AHOPCA describes the results of advanced intraocular retinoblastoma treated with neoadjuvant chemotherapy. In eyes with buphthalmos and patients with risk of abandonment, neoadjuvant chemotherapy can be effective when followed by enucleation and adjuvant chemotherapy. Our study suggests that this approach can save patients with buphthalmos from ocular rupture and might reduce refusal of enucleation and abandonment.
Collapse
Affiliation(s)
- Sandra Luna-Fineman
- Children's Hospital Colorado, University of Colorado, Denver, CO.,Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | - Amanda Alejos
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | - Margarita Barnoya
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala.,Hospital Herrera Llerandi, Guatemala City, Guatemala
| | | | - Ligia Fu
- Hospital Universitario, Tegucigalpa, Honduras
| | | | - Verónica Girón
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | - Gustavo Méndez
- Hospital Infantil Manuel de Jesús Rivera-La Mascota, Managua, Nicaragua
| | - Rosa Amelia Morales
- Hospital Infantil Manuel de Jesús Rivera-La Mascota, Managua, Nicaragua.,Centro Nacional de Oftalmología, Managua, Nicaragua
| | - Roberta Ortiz
- Hospital Infantil Manuel de Jesús Rivera-La Mascota, Managua, Nicaragua
| | | | - Matthew Wilson
- University of Tennessee Health Sciences Center, Memphis, TN.,St Jude Children's Research Hospital, Memphis, TN
| | | |
Collapse
|
24
|
Rishi P, Agarwal A, Chatterjee P, Sharma T, Sharma M, Saravanan M, Ravikumar R. Intra-Arterial Chemotherapy for Retinoblastoma: Four-Year Results from Tertiary Center in India. Ocul Oncol Pathol 2019; 6:66-73. [PMID: 32002408 DOI: 10.1159/000500010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/27/2019] [Indexed: 02/01/2023] Open
Abstract
Background There are limited reports of intra-arterial chemotherapy (IAC) for retinoblastoma (RB) from developing world. Objectives In this study, we report our 4-year experience of IAC for RB from India. Methods Retrospective, interventional case series. Primary outcome measures included tumor regression, vitreous seeds and subretinal seeds control, and globe salvage. Secondary outcome measures were best-corrected visual acuity and treatment complications. Results Fifteen eyes underwent 53 IAC procedures over mean 28.6 ± 13.8 months (range 10-51 months). IAC was employed as primary (n = 6) or secondary (n = 9) chemotherapy. Following IAC, complete regression of main tumor was seen in 7 eyes (47%) and partial regression in 3 (20%) eyes. Enucleation was done in 5(33%) eyes. Globe salvage rates were achieved in 1 eye (100%) in group B, 2 eyes (67%) in group C (n = 3), 6 eyes (67%) in group D (n = 9), and 1 eye (50%) in group E (n = 2). Following IAC, Kaplan-Meier survival curve showed 93% globe survival rate at 1 year, 76% at 2 years, and 66% at 3, and 4 years. Conclusion IAC has enhanced globe salvage rates in eyes with RB. Multicenter studies with longer follow-up are necessary to better understand outcomes in the long term.
Collapse
Affiliation(s)
- Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India
| | - Ashutosh Agarwal
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India
| | - Pritam Chatterjee
- Apollo Institute of Interventional Radiology, Apollo Hospital, Chennai, India
| | - Tarun Sharma
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India
| | - Minal Sharma
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India
| | - Munusamy Saravanan
- Apollo Institute of Interventional Radiology, Apollo Hospital, Chennai, India
| | - R Ravikumar
- Apollo Institute of Interventional Radiology, Apollo Hospital, Chennai, India
| |
Collapse
|
25
|
Mattosinho CCDS, Moura ATMS, Oigman G, Ferman SE, Grigorovski N. Time to diagnosis of retinoblastoma in Latin America: A systematic review. Pediatr Hematol Oncol 2019; 36:55-72. [PMID: 31014139 DOI: 10.1080/08880018.2019.1605432] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Retinoblastoma (RB) is the most common intraocular tumor of childhood. In low income countries, Time to diagnosis (TTD: interval between first symptom and diagnosis) has been associated with extraocular disease, metastasis and mortality. However, the relationship between TTD and prognosis is complex and not simply a linear correlation, particularly if TTD is <6 months. This systematic review aims to identify studies reporting TTD of retinoblastoma in Latin America, highlighting factors affecting TTD, alongside proposals and initiatives to obtain shorter intervals. The review also aims to discuss the methodology linked to cancer pathways studies. The study respected PRISMA recommendations, was registered on Prospero, an international database for systematic review registries under number CRD42017076777. MEDLINE/PUBMED, LILACS and SCIELO databases were searched. Studies from Latin America and the Caribbean, published between 1997 and 2017, reporting TTD and age at diagnosis of patients with retinoblastoma were selected. Nine studies were selected, concerning 1560 patients from Argentina, Brazil, Chile, Honduras, Mexico and Peru. The median TTD ranged from 3 to 5 months and the median age at diagnosis ranged from 16.5 to 22.2 months. A prolonged TTD was observed and was associated to damaging results on retinoblastoma outcomes, particularly increasing extraocular disease, and mortality rates. Methodological heterogeneity was observed and reiterates the importance of standardization of TTD studies, allowing more reliable comparisons and greater knowledge about retinoblastoma pathways before diagnosis. Reports on successful initiatives against delayed diagnosis were scarce, emphasizing a need for further studies.
Collapse
Affiliation(s)
| | | | - Gabriela Oigman
- b Instituto Nacional de Câncer José Gomes de Alencar - Pediatric Oncology
| | - Sima E Ferman
- b Instituto Nacional de Câncer José Gomes de Alencar - Pediatric Oncology
| | | |
Collapse
|
26
|
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.
Collapse
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.
| |
Collapse
|
27
|
Lukamba RM, Yao JJA, Kabesha TA, Budiongo AN, Monga BB, Mwembo AT, Bey P, Chenge GB, Desjardins L, Luboya ON, Doz F, Stefan CD. Retinoblastoma in Sub-Saharan Africa: Case Studies of the Republic of Côte d'Ivoire and the Democratic Republic of the Congo. J Glob Oncol 2018; 4:1-8. [PMID: 30241234 PMCID: PMC6223407 DOI: 10.1200/jgo.17.00056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In most low-income countries, the diagnosis of retinoblastoma is delayed, resulting in a severe prognosis. The objectives of this study were to describe the access to diagnosis and care of children diagnosed with retinoblastoma and the challenges in two sub-Saharan African countries: the Republic of Côte d'Ivoire and the Democratic Republic of the Congo. PATIENTS AND METHODS A descriptive cross-sectional study was conducted. Data were collected from the medical records of patients admitted during the period of January 1, 2013 to December 31, 2014. Data were entered and analyzed using Epi Info7.1 software and SAS 9.3. RESULTS One hundred sixteen cases of retinoblastoma were collected, including 60 boys and 56 girls. The median diagnosis age was 3 years for both countries. Ninety-eight patients (84%) had unilateral retinoblastoma. Most of the patients presented with advanced disease (76% had extraocular retinoblastoma). Median time between initial symptoms and diagnosis was 8.5 months (range, 0.4 to 116.7 months). Median time between diagnosis and treatment initiation was 31 days (range, 0 to 751 days). The median cost for the treatment of the disease was estimated at $1,954 per patient. CONCLUSION Late diagnosis of retinoblastoma, with extraocular disease, occurs frequently in both African countries. It is associated with delay in initiating treatment, and the cost of the treatment remains unaffordable for most of the families. Support groups for parents of affected children and the support of the Franco-African Pediatric Oncology Group remain important in improving early diagnosis and providing treatment in sub-Saharan African countries.
Collapse
Affiliation(s)
- Robert M. Lukamba
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - Jean-Jacques A. Yao
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - Theophile A. Kabesha
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - Aleine N. Budiongo
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - Ben B. Monga
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - Albert T. Mwembo
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - Pierre Bey
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - Gabrielle B. Chenge
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - Laurence Desjardins
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - Oscar N. Luboya
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - François Doz
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| | - Cristina D. Stefan
- Robert M. Lukamba and Oscar N. Luboya, University Clinics of Lubumbashi; Robert M. Lukamba, Ben B. Monga, Albert T. Mwembo, Gabrielle B. Chenge, Oscar N. Luboya, University of Lubumbashi, Lubumbashi; Theophile A. Kabesha, Official University of Bukavu, Bukavu; Aleine N. Budiongo, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo; Robert M. Lukamba, Pierre Bey, Gabrielle B. Chenge, and Laurence Desjardins, Alliance Mondale Contre le Cancer; Pierre Bey, Laurence Desjardins, and François Doz, Institut Curie; François Doz, University Paris Descartes, Paris; Pierre Bey, University of Lorraine, Lorraine; Cristina D. Stefan, International Prevention Research Institute, Lyon, France; and Jean-Jacques A. Yao, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
| |
Collapse
|
28
|
Traoré F, Sylla F, Togo B, Kamaté B, Diabaté K, Diakité AA, Diall H, Dicko F, Sylla M, Bey P, Desjardins L, Gagnepain-Lacheteau A, Coze C, Harif M, Doz F. Treatment of retinoblastoma in Sub-Saharan Africa: Experience of the paediatric oncology unit at Gabriel Toure Teaching Hospital and the Institute of African Tropical Ophthalmology, Bamako, Mali. Pediatr Blood Cancer 2018; 65:e27101. [PMID: 29697190 DOI: 10.1002/pbc.27101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Retinoblastoma (Rb) is the most common intraocular primary malignancy in children. In industrialised countries, the cure rate is about 95%. We present the results of a prospective study on the management of Rb in the paediatric oncology unit of Gabriel Touré Teaching Hospital and African Institute of Tropical Ophthalmology, from November 1, 2011 to December 31, 2015. PROCEDURE The aims of this prospective study were to evaluate the treatment of localised Rb, ocular prosthesis after enucleation, conservative management for bilateral Rb as well as survival rates in all patients. Patients with early stage Rb at diagnosis were included. The treatment was performed according to the retinoblastoma treatment guidelines of the French-African Paediatric Oncology Group. RESULTS Eighty-eight patients were included in the study. Sex ratio was 1:1 (M = 44, F = 44). Median age at diagnosis was 3 years (range: 2 months-5 years). Unilateral intraocular Rb was predominant (n = 50; 56.8%). Conservative treatments were performed on nine eyes in nine patients. Overall survival and event-free survival of the entire cohort at the end of 4 years were 73% (95% CI 60.8-81.2%) and 59% (95% CI 47.9-69.5%), respectively, with a median follow-up of 3.7 years (0.1-5.6 years). In conclusion, early enucleation in early stage of Rb can improve outcomes in resource-limited countries. Delayed enucleation and refusal of adherence to treatment are still major concerns and remain a barrier to improving overall patient survival.
Collapse
Affiliation(s)
- Fousseyni Traoré
- Pediatric Department, Pediatric Oncology Unit, CHU Gabriel Touré, Bamako, Mali
| | - Fatou Sylla
- Pediatric Ophtalmology Department, Institute of African Tropical Ophthalmology, Bamako, Mali
| | - Boubacar Togo
- Pediatric Department, Pediatric Oncology Unit, CHU Gabriel Touré, Bamako, Mali
| | | | | | - Abdoul Aziz Diakité
- Pediatric Department, Pediatric Oncology Unit, CHU Gabriel Touré, Bamako, Mali
| | - Hawa Diall
- Pediatric Department, Pediatric Oncology Unit, CHU Gabriel Touré, Bamako, Mali
| | - Fatoumata Dicko
- Pediatric Department, Pediatric Oncology Unit, CHU Gabriel Touré, Bamako, Mali
| | - Mariam Sylla
- Pediatric Department, Pediatric Oncology Unit, CHU Gabriel Touré, Bamako, Mali
| | - Pierre Bey
- Pediatric Oncology Department, Institut Curie, Paris, France
| | | | | | - Carole Coze
- Pediatric Unit, Assistance Publique Hopitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Mhamed Harif
- Pediatric Oncology Department, CHU Mohammed VI, Marrakech, Morrocco
| | - François Doz
- Pediatric Oncology Department, Centre SIREDO (Soins, Innovation, Recherche en oncologie de l'enfant, l'adolescent et l'adulte jeune), Institut Curie et Université Paris-Descartes, Paris, France
| |
Collapse
|
29
|
Xing L, Zhang L, Feng Y, Cui Z, Ding L. Downregulation of circular RNA hsa_circ_0001649 indicates poor prognosis for retinoblastoma and regulates cell proliferation and apoptosis via AKT/mTOR signaling pathway. Biomed Pharmacother 2018; 105:326-333. [PMID: 29864621 DOI: 10.1016/j.biopha.2018.05.141] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 12/17/2022] Open
Abstract
Retinoblastoma (RB) is the most common intraocular malignancy in infants and children with high mortality rate in developing countries. Emerging evidence demonstrated that abnormally expressed circular RNAs (circRNAs) are involved in tumorigenesis and progression in several malignancies. However, their clinical values, biological functions and mechanisms in RB has not been reported before. Recently, hsa_circ_0001649 was found to play imperative roles in cholangiocarcinoma, gastric cancer, and hepatocellular carcinoma. In the current study, qRT-PCR was performed to detect the expression of hsa_circ_0001649 in RB samples and cells. The correlations between hsa_circ_0001649 expression and clinicopathologic characteristics were further analyzed. In addition, we up-regulated hsa_circ_0001649 in Y79 cells and knocked down hsa_circ_0001649 in WERI-Rb1 cells to explore its effect on cell proliferation and apoptosis. The animal study was performed to confirm the in vitro results. Furthermore, AKT/mTOR signaling pathway was detected to clarify the molecular mechanisms of hsa_circ_0001649 exerts in RB cell growth. The results indicated that hsa_circ_0001649 was decreased in RB tissues and cells, and this downregulation was associated with larger tumor size and advanced intraocular international retinoblastoma classify (IIRC) stage in RB patients. Additionally, hsa_circ_0001649 could act as an independent prognostic predictor for overall survival in patients with RB. Moreover, hsa_circ_0001649 inhibits cell growth and promotes cell apoptosis in RB cells. AKT/mTOR signaling pathway is involved in the cell growth alteration affected by hsa_circ_0001649. Overall, hsa_circ_0001649 might be a potentially useful prognostic biomarker and therapeutic target for RB.
Collapse
Affiliation(s)
- Lichen Xing
- Department of Ophthalmology, Third Affiliated Hospital of Qiqihar Medical University, Heilongjiang Province, 161000, China
| | - Leiming Zhang
- Department of Ophthalmology, Third Affiliated Hospital of Qiqihar Medical University, Heilongjiang Province, 161000, China
| | - Yali Feng
- Department of Ophthalmology, Third Affiliated Hospital of Qiqihar Medical University, Heilongjiang Province, 161000, China
| | - Zhe Cui
- Department of Ophthalmology, Third Affiliated Hospital of Qiqihar Medical University, Heilongjiang Province, 161000, China
| | - Lin Ding
- Department of Clinical Skills Experimental Teaching Center, Qiqihar Medical University, Heilongjiang Province, 161000, China.
| |
Collapse
|
30
|
Yi QY, Bai ZS, Cai B, Chen N, Chen LS, Yuan T, Mao JH. HSV‑TK/GCV can induce cytotoxicity of retinoblastoma cells through autophagy inhibition by activating MAPK/ERK. Oncol Rep 2018; 40:682-692. [PMID: 29845211 PMCID: PMC6072295 DOI: 10.3892/or.2018.6454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/09/2018] [Indexed: 12/17/2022] Open
Abstract
Retinoblastoma is an severe ophthalmic disease and the most common type intraocular malignant tumor, particularly in infants. Currently, few drugs and therapies are available. Gene therapy has been considered to be a potential treatment to cure cancer effectively and Herpes simplex virus type 1 thymidine kinase/ganciclovir (HSV-TK/GCV) is one type of suicide gene therapy that has been extensively studied. Numerous in vitro and in vivo studied have shown that this system can kill tumor cells, including liver and lung cancer cells. GCV is used as an antiviral drug, and the thymidine kinase, HSV-TK can phosphorylate GCV to GCV-TP, a competitive inhibitor of DNA synthesis, instead of guanine-5′-triphosphate in the process of DNA synthesis. This process prevents DNA chain elongation causing cell death via apoptosis. However, the toxic effects of HSV-TK/GCV on retinoblastoma cells remain unknown, and the molecular mechanisms of its therapeutic effects have not been fully elucidated. Our results suggest that HSV-TK/GCV can significantly cause the death of retinoblastoma cell lines, HXO-RB44 and Y79. Further studies have reported that this cell death is induced by the inhibition of autophagy by activating the MAPK/ERK (mitogen-activated protein kinase/ERK) signaling pathway. The mTOR inhibitor Torin1 can partially block the toxic effects of HSV-TK/GCV on HXO-RB44 cells. The above results demonstrate that the mechanism undertaken by HSV-TK/GCV to exhibit therapeutic effects mechanism may inhibit autophagy by activating MAPK/ERK. The findings of the present study may provide novel insight for the exploration of HSV-TK/GCV in the treatment of retinoblastoma.
Collapse
Affiliation(s)
- Quan-Yong Yi
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Zhi-Sha Bai
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Bin Cai
- Ningbo Central Blood Center, Ningbo, Zhejiang 315040, P.R. China
| | - Nan Chen
- Department of Ophthalmology, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Li-Shuang Chen
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Tao Yuan
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang 315040, P.R. China
| | - Jing-Hai Mao
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang 315040, P.R. China
| |
Collapse
|
31
|
Correa-Acosta A, González-Alviar ME, Gaviria-Bravo ML. Retinoblastoma and optic nerve enhancement in a brain magnetic resonance scan: is it always a metastasis? ACTA ACUST UNITED AC 2017; 93:251-254. [PMID: 29277434 DOI: 10.1016/j.oftal.2017.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 12/31/2022]
Abstract
CASE REPORT The case is presented on a girl with a unilateral retinoblastoma that required treatment with intra-arterial chemotherapy. In the nuclear magnetic resonance imaging of the brain performed 1 month after intra-arterial chemotherapy treatment, post-laminar optic nerve (ON) enhancement was observed, leading to the suspicion of an ON tumour infiltration. Additional examinations were requested by which a probable optic neuropathy was diagnosed. DISCUSSION The ON enhancement in magnetic resonance imaging of the brain in retinoblastoma generally corresponds to tumour invasion of the ON. However, other diagnostic alternatives associated with the use of new treatments, such as intra-arterial chemotherapy, should be considered.
Collapse
Affiliation(s)
- A Correa-Acosta
- Servicio de Oftalmología, Hospital Universitario San Vicente Fundación, Universidad de Antioquia, Medellín, Colombia.
| | - M E González-Alviar
- Servicio de Oftalmología, Hospital Universitario San Vicente Fundación, Universidad de Antioquia, Medellín, Colombia
| | - M L Gaviria-Bravo
- Servicio de Oftalmología, Hospital Universitario San Vicente Fundación, Universidad de Antioquia, Medellín, Colombia
| |
Collapse
|
32
|
Qu W, Meng B, Yu Y, Wang S. EpCAM antibody-conjugated mesoporous silica nanoparticles to enhance the anticancer efficacy of carboplatin in retinoblastoma. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 76:646-651. [DOI: 10.1016/j.msec.2017.03.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/12/2017] [Accepted: 03/04/2017] [Indexed: 11/26/2022]
|
33
|
|
34
|
Trilaksana N, Riwanto I, Tjandrawinata RR, Winarto R. Inhibition of Mahkota Dewa ( Phaleria macrocarpa ) bioactive fraction on proliferation of human retinoblastoma tumor cells Y-79 through suppression of mRNA level of cyclin E. Asian Pac J Trop Biomed 2017. [DOI: 10.1016/j.apjtb.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
35
|
Soliman SE, Eldomiaty W, Goweida MB, Dowidar A. Clinical presentation of retinoblastoma in Alexandria: A step toward earlier diagnosis. Saudi J Ophthalmol 2017; 31:80-85. [PMID: 28559718 PMCID: PMC5436382 DOI: 10.1016/j.sjopt.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 02/09/2017] [Accepted: 03/11/2017] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the clinical presentation of retinoblastoma in Alexandria, Egypt, correlate the timing of accurate diagnosis with the presence of advanced disease and identify causes of delayed presentation. Methods Retrospective noncomparative single institution study reviews demographic and clinical data of all new children with retinoblastoma presenting to Alexandria Main University ocular oncology clinic (OOC) from January 2012 to June 2014. Diagnosis time was from initial parental complaint to retinoblastoma diagnosis and referral time was from retinoblastoma diagnosis to presentation to the Alexandria OCC. Delayed Diagnosis and referral were counted if >2 weeks. Advanced presentation is defined as clinical TNMH (8th edition) staging of cT2 or cT3 (international intraocular retinoblastoma classification group D or E) in at least one eye or the presence of extra-ocular disease (cT4). Results Seventy eyes of 47 children were eligible: 52% unilateral, 7% with family history and 96% presented with leukocorea. Sixty-four percent of children had advanced intraocular disease and none had extra-ocular disease. Delayed presentation occurred in 58% of children and was significantly associated with advanced disease in both unilaterally and bilaterally affected children (p = 0.003, 0.002 respectively). The delay in diagnosis was more in unilateral cases while the delay in referral was more in bilateral cases. The main cause of delayed presentation in unilateral retinoblastoma was misdiagnosis (30%) while parental shopping for second medical opinion (30%) was the main cause in bilateral children. Conclusions Delayed diagnosis is a problem affecting retinoblastoma management. Better medical education and training, health education and earlier screening are recommended to achieve earlier diagnosis.
Collapse
Affiliation(s)
- Sameh E Soliman
- The Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.,The Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Wesam Eldomiaty
- The Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Mohamed B Goweida
- The Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Amgad Dowidar
- The Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| |
Collapse
|
36
|
Long non-coding RNA HOTAIR regulates proliferation and invasion via activating Notch signalling pathway in retinoblastoma. J Biosci 2017; 41:677-687. [PMID: 27966488 DOI: 10.1007/s12038-016-9636-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Retinoblastoma is the most frequently occurring tumour in the eyes in early childhood. Novel targets that are important for the diagnosis or treatment of retinoblastoma could be valuable in increasing the survival rate of patients affected by this disease. Long non-coding RNAs (lncRNAs) are a recently discovered type of RNAs with no proteincoding function; yet it has become increasingly clear that lncRNAs are responsible for important gene regulatory functions in various diseases. In this study, the expression of lncRNA HOTAIR was measured by qRT-PCR, and HOTAIR expression was found to be significantly upregulated in human retinoblastomas tissues as compared with that in paracancerous tissues. Knockdown of HOTAIR restricted the proliferation and invasion of the more invasive retinoblastoma Y79 cells, and led to G0/G1 arrest, possibly through inhibiting phospho-RB1, RB1 and CCNE. Furthermore, we found that the Notch signalling pathway was activated abnormally in retinoblastoma cell lines, while knockdown of HOTAIR attenuated the endogenous Notch signalling pathway in vitro and in vivo. In addition, knockdown of HOTAIR could inhibit the tumour progression in a xenograft model of retinoblastoma. In summary, our findings indicate that HOTAIR may play important roles in retinoblastoma progression via Notch pathway. HOTAIR has the potential to enhance the development of novel targeted diagnostic and therapeutic approaches for retinoblastoma.
Collapse
|
37
|
Mattosinho CCDS, Grigorovski N, Lucena E, Ferman S, Soares de Moura ATM, Portes AF. Prediagnostic Intervals in Retinoblastoma: Experience at an Oncology Center in Brazil. J Glob Oncol 2016; 3:323-330. [PMID: 28831440 PMCID: PMC5560453 DOI: 10.1200/jgo.2016.005595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose Retinoblastoma is the most common intraocular malignancy of childhood. In most cases, parents are the first to notice leukocoria and other symptoms before undergoing a prolonged period of stress before diagnosis. The purpose of this study was to determine prediagnostic intervals of patients with retinoblastoma at an oncology tertiary center (Instituto Nacional de Cancer) in Rio de Janeiro, Brazil, and relate them to stage at diagnosis, eye salvage, and survival. Methods Parents or caregivers of children with retinoblastoma registered between January 2006 and September 2013 were interviewed using a semistructured individually applied questionnaire, concerning their trajectory before registration. Results Out of 76 patients, 39 (51%) were girls, 52 (68%) had unilateral retinoblastoma, and 24 (32%) had bilateral retinoblastoma, totaling 100 affected eyes. The most common stage of diagnosis was the intraocular group, with 63 (83%) patients; nine (12%) were extraocular, and four (5%) had metastatic disease. During the follow-up time of 37 ± 24.5 months, 10 (13%) patients died and 70 (70%) eyes were enucleated. Mean family interval was 1.6 ± 2.6 months, mean medical interval was 5.0 ± 6.2 months, mean referral interval was 0.2 ± 1.4 months, and mean overall interval was 7.1 ± 6.9 months. In univariate analysis, age at diagnosis, maternal education, medical interval, and overall interval were significantly related to advanced stage at diagnosis and survival. In multivariate analysis, maternal education and medical interval were significantly related to advanced stage at diagnosis and survival. No variables affected eye salvage. Conclusion Medical interval was responsible for 70% of the overall interval; therefore, programs or campaigns targeting retinoblastoma early diagnosis should focus emphasize in medical awareness.
Collapse
Affiliation(s)
| | - Nathalia Grigorovski
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Evandro Lucena
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sima Ferman
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Arlindo Freire Portes
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
38
|
Dyer MA. Lessons from Retinoblastoma: Implications for Cancer, Development, Evolution, and Regenerative Medicine. Trends Mol Med 2016; 22:863-876. [PMID: 27567287 DOI: 10.1016/j.molmed.2016.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/31/2016] [Accepted: 07/31/2016] [Indexed: 12/14/2022]
Abstract
Retinoblastoma is a rare childhood cancer of the developing retina, and studies on this orphan disease have led to fundamental discoveries in cancer biology. Retinoblastoma has also emerged as a model for translational research for pediatric solid tumors, which is particularly important as personalized medicine expands in oncology. Research on retinoblastomas has been combined with the exploration of retinal development and retinal degeneration to advance a new model of cell type-specific disease susceptibility termed 'cellular pliancy'. The concept can even be extended to species-specific regeneration. This review discusses the remarkable path of retinoblastoma research and how it has shaped the most current efforts in basic, translational, and clinical research in oncology and beyond.
Collapse
Affiliation(s)
- Michael A Dyer
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA.
| |
Collapse
|
39
|
Hill JA, Kimani K, White A, Barasa F, Livingstone M, Gallie BL, Dimaras H. Achieving optimal cancer outcomes in East Africa through multidisciplinary partnership: a case study of the Kenyan National Retinoblastoma Strategy group. Global Health 2016; 12:23. [PMID: 27229322 PMCID: PMC4882853 DOI: 10.1186/s12992-016-0160-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/07/2016] [Indexed: 11/23/2022] Open
Abstract
Background Strategic, interdisciplinary partnerships are essential to addressing the complex drivers of health inequities that result in survival disparities worldwide. Take for example the aggressive early childhood eye cancer retinoblastoma, where survival reaches 97 % in resource-rich countries, but is as low 30 % in some resource-limited nations, where 92 % of the burden lies. This suggests a need for a multifaceted approach to achieve a tangible and sustainable increase in survival. Methods We assembled the history the Kenyan National Retinoblastoma Strategy (KNRbS), using information documented in NGO reports, grant applications, news articles, meeting agendas and summaries. We evaluated the KNRbS using the principles found in the guide for transboundary research partnerships developed by the Swiss Commission for Research Partnerships with Developing Countries. Results A nationally co-ordinated approach drawing input and expertise from multiple disciplines and sectors presented opportunities to optimise cure of children with retinoblastoma. Annual meetings were key to achieving the over 40 major outputs of the group’s efforts, related to Awareness, Medical Care, Family Support and Resource Mobilization. Three features were found to be critical to the KNRbS success: multidisciplinarity, consistency and flexibility. Conclusion The KNRbS has achieved a number of key outputs with limited financial investment. As a partnership, the KNRbS meets most of the criteria identified for success. Challenges remain in securing the long-term sustainability of its achievements. Elements of the Kenyan National Retinoblastoma Strategy may be useful to other developing countries struggling with limited survival of retinoblastoma and other cancers or rare diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12992-016-0160-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jessica A Hill
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Ave., Room 7265, Toronto, ON, M5G 1X8, Canada
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Abby White
- World Eye Cancer Hope (formerly Daisy's Eye Cancer Fund - International)
| | | | - Morgan Livingstone
- World Eye Cancer Hope (formerly Daisy's Eye Cancer Fund - International)
| | - Brenda L Gallie
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Ave., Room 7265, Toronto, ON, M5G 1X8, Canada.,Department of Ophthalmology & Vision Sciences, Faculty of Medicine & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Ave., Room 7265, Toronto, ON, M5G 1X8, Canada. .,Department of Ophthalmology & Vision Sciences, Faculty of Medicine & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Department of Human Pathology, University of Nairobi, Nairobi, Kenya.
| | | |
Collapse
|
40
|
A change roadmap towards research paradigm in low-resource countries: retinoblastoma model in Egypt. Int Ophthalmol 2016; 37:111-118. [DOI: 10.1007/s10792-016-0233-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
|
41
|
Chantada GL, Dunkel IJ, Schaiquevich PS, Grynszpancholc EL, Francis J, Ceciliano A, Zubizarreta PA, Fandiño AC, Abramson DH. Twenty-Year Collaboration Between North American and South American Retinoblastoma Programs. J Glob Oncol 2016; 2:347-352. [PMID: 28717719 PMCID: PMC5493246 DOI: 10.1200/jgo.2015.002782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Guillermo L Chantada
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ira J Dunkel
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paula S Schaiquevich
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edith L Grynszpancholc
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jasmine Francis
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alejandro Ceciliano
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pedro A Zubizarreta
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adriana C Fandiño
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - David H Abramson
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
42
|
Lentivirus-Mediated Knockdown of Astrocyte Elevated Gene-1 Inhibits Growth and Induces Apoptosis through MAPK Pathways in Human Retinoblastoma Cells. PLoS One 2016; 11:e0148763. [PMID: 26894431 PMCID: PMC4760765 DOI: 10.1371/journal.pone.0148763] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/06/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose To explore expression and function of astrocyte elevated gene-1 (AEG-1) in human retinoblastoma (RB). Methods The expression of AEG-1 in histological sections of human RBs and in RB cell lines was examined using immunohistochemical staining and RT-PCR and Western blotting respectively. We knocked down AEG-1 gene levels by AEG-1-siRNA lentivirus transfection of human RB cell lines SO-RB50 and Y79, and using an MTT assay, we assessed the role of AEG-1 on RB cell proliferation. The biological significance of lentivirus transfection induced AEG-1 down-regulation was examined by assessing the apoptosis rate in the transfected RB cells by Annexin V-APC staining and flow cytometry. We additionally measured the expression of Bcl-2, Bax, cleaved-caspase-3 and caspase-3, and the phosphorylation and non-phosphorylation alternation of MAPKs. Results AEG-1 expression was detected to be strongly positive in the histological slides of 35 out of 54 (65%) patients with RB. AEG-1 expression increased significantly (P<0.05) with tumor stage. In the RB cell lines SO-RB50, Y79 and WERI-RB1 as compared with retinal pigment epithelium cells, expression of AEG-1 mRNA and AEG-1 protein was significantly higher. In AEG-1-siRNA lentivirus transfected cell cultures as compared with negative control lentivirus transfected cell cultures, levels of AEG-1 mRNA and of AEG-1 protein (P<0.05) and cell growth rates (P<0.01) were significantly lower, and apoptosis rate (P<0.001), Bax/Bcl-2 ratio and cleaved-caspase-3 protein level were significantly increased. The P-ERK/ERK ratio was significantly decreased in the AEG-1-siRNA lentivirus transfected cell lines. Conclusions Expression of AEG-1 was associated with RB, in histological slides of patients and in cell culture experiments. Lentivirus transfection induced knockdown of AEG-1 had a tumor suppressive effect, potentially by tumor cell apoptosis induction through inhibition of ERK.
Collapse
|
43
|
Hahn SM, Kim HS, Kim DJ, Lee SC, Lyu CJ, Han JW. Favorable outcome of alternate systemic and intra-arterial chemotherapy for retinoblastoma. Pediatr Hematol Oncol 2016; 33:74-82. [PMID: 26901285 DOI: 10.3109/08880018.2015.1135363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The recent trend of treatment for retinoblastoma is to salvage the eye globes as well as achieving patients' survival. Intra-arterial chemotherapy (IAC) is one of the current standard treatment; however, it cannot exclude the risk of occult micrometastases in the central nervous system in advanced-stage retinoblastoma. Alternate fashion of intravenous chemotherapy (IVC) and IAC strategy was developed to increase the eye salvage rate and to reduce the metastatic risk. Between January 2012 and December 2014, 13 eyes of 12 patients with newly diagnosed retinoblastoma received alternate chemotherapy using IVC and IAC in Yonsei Cancer Center. Eye salvage rate was assessed by the eye preservation time, which was defined as the duration from the diagnosis to the time of enucleation. Total 13 eyes were classified according to the International Classification of Retinoblastoma (ICRB) as group B (n = 1, 7.7%), group C (n = 2, 15.4%), group D (n = 5, 38.5%), or group E (n = 5, 38.5%). IAC was performed, 3 to 5 times (median: 4 times) for each eye, total 54 times. Five to 15 courses (median: 8 courses) of systemic chemotherapy were performed in the patients. During the median follow-up period of 30.4 months, overall eye salvage rate was 63.9 ± 14.7%. All patients survived. The treatment was tolerable without significant complications. These results showed that primary alternate IVC-IAC was tolerable and effective for retinoblastoma.
Collapse
Affiliation(s)
- Seung Min Hahn
- a Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System , Seoul , Korea.,b Department of Pediatric Hemato-Oncology , Yonsei Cancer Center, Yonsei University Health System , Seoul , Korea
| | - Hyo Sun Kim
- a Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System , Seoul , Korea.,b Department of Pediatric Hemato-Oncology , Yonsei Cancer Center, Yonsei University Health System , Seoul , Korea
| | - Dong Joon Kim
- c Department of Radiology , Yonsei University College of Medicine , Seoul , Korea
| | - Sung Chul Lee
- d Department of Ophthalmology , The Institute of Vision Research, Yonsei University College of Medicine , Seoul , Korea
| | - Chuhl Joo Lyu
- a Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System , Seoul , Korea.,b Department of Pediatric Hemato-Oncology , Yonsei Cancer Center, Yonsei University Health System , Seoul , Korea
| | - Jung Woo Han
- a Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System , Seoul , Korea.,b Department of Pediatric Hemato-Oncology , Yonsei Cancer Center, Yonsei University Health System , Seoul , Korea
| |
Collapse
|
44
|
Chiu HH, Dimaras H, Downie R, Gallie B. Breaking down barriers to communicating complex retinoblastoma information: can graphics be the solution? Can J Ophthalmol 2016; 50:230-5. [PMID: 26040224 DOI: 10.1016/j.jcjo.2015.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 12/08/2014] [Accepted: 02/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the impact of a graphical timeline summarizing bilateral retinoblastoma disease and treatment outcomes on parents' understanding of complex medical information. DESIGN Cross-sectional survey. PARTICIPANTS Parents of children with retinoblastoma who were being actively managed at The Hospital for Sick Children were recruited. Forty-five parents from 42 families participated. METHODS After a standardized presentation on retinoblastoma and visual tool named Disease-Specific electronic Patient Illustrated Clinical Timeline (DePICT), parents completed a 19-item questionnaire designed to assess their understanding of treatment choices for 2 eyes in bilateral retinoblastoma as communicated using DePICT. SPSS was used to perform statistical analysis. RESULTS Forty-five parents from 42 families participated (65% female). Median age of participants was 34 years. Median level of participant education was completion of college/trade school. The median level of annual income was $40,000 to $70,000 CDN. Median time since diagnosis of retinoblastoma in their child was 13.5 months. Twenty-three (51%) participants were parents of children with unilateral retinoblastoma, and 22 (49%) were parents of children with bilateral retinoblastoma. Median number of correct answers was 15 of 19, and mean score was 77%. Normal distribution of scores was noted. English as a first language was significantly associated with score (p = 0.01). No significant association was observed between other variables and score in all analyses. CONCLUSIONS This study builds on the validation of DePICT by demonstrating that parents can achieve good comprehension even when considering choices for treatment for 2 eyes with bilateral retinoblastoma. Clinical application of this tool can enhance the consent process.
Collapse
Affiliation(s)
- Hannah H Chiu
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto
| | - Rob Downie
- Research, Policy and Planning, Fanshawe College, London
| | - Brenda Gallie
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children; Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ont..
| |
Collapse
|
45
|
Clinical presentation of intraocular retinoblastoma; 5-year hospital-based registry in Egypt. J Egypt Natl Canc Inst 2015; 27:195-203. [DOI: 10.1016/j.jnci.2015.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 08/31/2015] [Accepted: 09/10/2015] [Indexed: 01/26/2023] Open
|
46
|
Tapela NM, Mpunga T, Karema N, Nzayisenga I, Fadelu T, Uwizeye FR, Hirschhorn LR, Muhimpundu MA, Balinda JP, Amoroso C, Wagner CM, Binagwaho A, Shulman LN. Implementation Science for Global Oncology: The Imperative to Evaluate the Safety and Efficacy of Cancer Care Delivery. J Clin Oncol 2015; 34:43-52. [PMID: 26578617 DOI: 10.1200/jco.2015.61.7738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science-the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed-is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. METHODS The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. RESULTS Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. CONCLUSION Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.
Collapse
Affiliation(s)
- Neo M Tapela
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA.
| | - Tharcisse Mpunga
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Nadine Karema
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Ignace Nzayisenga
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Temidayo Fadelu
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Frank R Uwizeye
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Lisa R Hirschhorn
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Marie Aimee Muhimpundu
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Jean Paul Balinda
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Cheryl Amoroso
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Claire M Wagner
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Agnes Binagwaho
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Lawrence N Shulman
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| |
Collapse
|
47
|
Li SY, Chen SCC, Tsai CF, Sheu SM, Yeh JJ, Tsai CB. Incidence and survival of retinoblastoma in Taiwan: a nationwide population-based study 1998-2011. Br J Ophthalmol 2015; 100:839-42. [PMID: 26370121 PMCID: PMC4893080 DOI: 10.1136/bjophthalmol-2015-307211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/23/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the epidemiology of retinoblastoma in Taiwan from 1998 to 2011. DESIGN This was a retrospective population-based cohort study using the Taiwan National Health Insurance Research Database. RESULTS The present study included 154 patients (92 males, 62 females) with retinoblastoma and the documented overall retinoblastoma incidence was 1 in 17 373 live births without a notable trend over the study period. The incidence per million live births examined by gender was 65.8 for males and 48.5 for females. The age-specific sex ratio increased from 1.4 at age younger than 1 year to 3.0 above age 4 years. Enucleation was performed in 109 (70.8%) children with retinoblastoma, and it was more prevalent in males than in females (77.2% vs 61.3%, p=0.0335). Multivariate Cox regression analyses with adjustment for diagnostic age, sex, and birth year elucidated that enucleation was a significant factor associated with survival (OR 0.27, 95% CI 0.10 to 0.61). CONCLUSIONS The incidence of retinoblastoma in Taiwan exhibited no marked trend over time. There were more cases of males than females and the male-to-female rate ratio increased with age. Survival outcome was significantly associated with the intervention of enucleation.
Collapse
Affiliation(s)
- Su-Yin Li
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan Chia Nan University of Pharmacy and Science, Taiwan
| | - Solomon Chih-Cheng Chen
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan Department of Pediatrics, School of Medicine, Medical College, Taipei Medical University, Taipei City, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Shew-Meei Sheu
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Jun-Jun Yeh
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan Chia Nan University of Pharmacy and Science, Taiwan Meiho University, Pingtung, Taiwan
| | - Chong-Bin Tsai
- Department of Ophthalmology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| |
Collapse
|
48
|
Bhavsar D, Subramanian K, Sethuraman S, Krishnan UM. Management of retinoblastoma: opportunities and challenges. Drug Deliv 2015; 23:2488-2496. [PMID: 25758593 DOI: 10.3109/10717544.2015.1016193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Nano-delivery systems have significantly evolved over the last decade for the treatment of cancer by enabling site-specific delivery and improved bioavailability. The widely investigated nanoparticle systems are biodegradable polyesters, dendrimers, liposomes, mesoporous silica and gold nanoparticles. These particles when conjugated with different targeting motifs enhance the therapeutic efficiency of the drug molecules and biocompatibility. However, the application of such systems towards the treatment of retinoblastoma (RB), a rapidly spreading childhood eye cancer, still remains in its infancy. Nanoparticle-based systems that have been investigated for RB therapy have displayed improved drug delivery to the most restricted posterior segment of the eyes and have increased intra-vitreal half-life of the chemotherapy agents highlighting its potential in treatment of this form of cancer. This review focuses on the challenges involved in the treatment of RB and highlights the attempts made to develop nano-dimensional systems for the treatment of RB.
Collapse
Affiliation(s)
- Dhiraj Bhavsar
- a School of Chemical & Biotechnology, Centre for Nanotechnology & Advanced Biomaterials, Sastra University , Thanjavur , Tamil Nadu , India and
| | - Krishnakumar Subramanian
- b L&T Ophthalmic Pathology Department , Vision Research Foundation , Sankara Nethralaya , Chennai , Tamil Nadu , India
| | - Swaminathan Sethuraman
- a School of Chemical & Biotechnology, Centre for Nanotechnology & Advanced Biomaterials, Sastra University , Thanjavur , Tamil Nadu , India and
| | - Uma Maheswari Krishnan
- a School of Chemical & Biotechnology, Centre for Nanotechnology & Advanced Biomaterials, Sastra University , Thanjavur , Tamil Nadu , India and
| |
Collapse
|
49
|
Grossniklaus HE. Retinoblastoma. Fifty years of progress. The LXXI Edward Jackson Memorial Lecture. Am J Ophthalmol 2014; 158:875-91. [PMID: 25065496 PMCID: PMC4250440 DOI: 10.1016/j.ajo.2014.07.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/14/2014] [Accepted: 07/14/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE To review the progress made in understanding the genetic basis, molecular pathology, and treatment of retinoblastoma since the previous Jackson lecture on the topic was published 50 years ago. DESIGN Perspective based on personal experience and the literature. METHODS The literature regarding retinoblastoma was reviewed since 1963. Advances in understanding the biology and treatment of retinoblastoma provided context through the author's clinical, pathologic, and research experiences. RESULTS Retinoblastoma was first identified in the 1500s and defined as a unique clinicopathologic entity in 1809. Until the mid-1900s, knowledge advanced sporadically, with technological developments of ophthalmoscopy and light microscopy, and with the introduction of surgical enucleation, chemotherapy, and radiation therapy. During the last 50 years, research and treatment have progressed at an unprecedented rate owing to innovations in molecular biology and the development of targeted therapies. During this time period, the retinoblastoma gene was discovered; techniques for genetic testing for retinoblastoma were developed; and plaque brachytherapy, chemoreduction, intra-arterial chemotherapy, and intraocular injections of chemotherapeutic agents were successfully introduced. CONCLUSIONS Nearly all patients with retinoblastoma in developed countries can now be cured of their primary cancer--a remarkable achievement for a childhood cancer that once was uniformly fatal. Much of this success is owed to deciphering the role of the Rb gene, and the benefits of targeted therapies, such as chemoreduction with consolidation as well as intra-arterial and intravitreal chemotherapies. Going forward, the main challenge will be ensuring that access to care is available for all children, particularly those in developing countries.
Collapse
Affiliation(s)
- Hans E Grossniklaus
- Departments of Ophthalmology and Pathology, Emory University School of Medicine, Atlanta, Georgia.
| |
Collapse
|
50
|
Baroni LV, Sampor C, Fandiño A, Solernou V, Demirdjian G, de Davila MTG, Chantada GL. Anterior segment invasion in retinoblastoma: is it a risk factor for extraocular relapse? J Pediatr Hematol Oncol 2014; 36:e509-12. [PMID: 24732059 DOI: 10.1097/mph.0000000000000167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a retrospective review of patients with retinoblastoma and anterior segment invasion (ASI) as risk factors for extraocular relapse. Only those with ASI combined with postlaminar optic nerve invasion and/or scleral invasion received adjuvant chemotherapy and those with tumor at the resection margin received orbital radiotherapy. Those with only uveal invasion did not receive adjuvant therapy. Of 479 evaluable patients, 67 patients had pathologically confirmed ASI, including 52 with anterior chamber invasion and 47 with iris or ciliary body invasion. ASI occurred with other pathology risk factors (25 had concomitant posterior uveal invasion, 36 had postlaminar optic nerve invasion, 11 with cut-end invasion, and 25 with scleral invasion). The 5-year disease-free survival (pDFS) was 0.9 (95% CI, 0.8-0.95) for children with ASI with no significant differences among children with other pathology risk factors with and without ASI. ASI was not significantly associated with extraocular relapse in multivariate analysis. There were no significant differences in pDFS for patients with anterior chamber invasion and those with iris-ciliary body invasion (pDFS 0.89 [95% CI, 0.65-0.96] vs. 0.93 [95% CI, 0.61-0.98]). To conclude, ASI was seen with other pathology risk factors and it did not add a significant risk for extraocular relapse.
Collapse
Affiliation(s)
- Lorena V Baroni
- Services of *Hemato-oncology †Ophthalmology ‡Pathology §Technological Coordination, Hospital JP Garrahan, Buenos Aires, Argentina
| | | | | | | | | | | | | |
Collapse
|