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Yousef YA, Sid Ahmed IM, Kanj Ahmad D, Mohammad M, Makahleh H, AlJabari R, Alkhatib F, Toro MD, Rejdak R, Mehyar M, Alnawaiseh I. Optic Disc Swelling in Cancer Patients: Etiology and Implications. J Clin Med 2023; 12:7140. [PMID: 38002752 PMCID: PMC10672066 DOI: 10.3390/jcm12227140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE To analyze the etiology and implications of optic disc swelling in cancer patients treated at a specialized tertiary cancer center in Jordan. METHODS This was a retrospective study of all cancer patients who had optic disc swelling between January 2019 and December 2020 at King Hussein Cancer Center (KHCC). Patients' data included age, sex, laterality, visual acuity, and the underlying cause and management for the optic disc swelling. RESULTS Optic disc swelling was present in 58 cancer patients (96 eyes), with 38 (65%) having bilateral involvement. Among these, 33 (57%) were female, and 43 (74%) were ≤40 years old. At diagnosis, 58 (63%) eyes had a best-corrected visual acuity (BCVA) better than 0.5, improving to 73 (76%) eyes at the last follow-up. High intracranial pressure (ICP) was the most common primary cause (30 patients/52%), followed by tumor infiltration of the optic nerve (10 patients/17%), optic nerve compression (7 patients/12%), and optic nerve inflammation (5 patients/9%). Four patients had pseudopapilledema. Among the 30 patients with high ICP, CNS tumors were predominant (21 patients/70%), with only 3 having idiopathic intracranial hypertension. Medications, including ATRA (All-Trans Retinoic Acid) and systemic steroids, contributed to increased ICP in six patients (20%). BCVA was less than 0.5 in all eyes (100%) affected by tumor infiltration, optic nerve inflammation, and ischemic optic neuropathy, while only eight eyes (14%) with optic disc swelling due to elevated ICP had a BCVA less than 0.5 (p < 0.0001). Management included steroids (53 patients/91%), acetazolamide (30 patients/52%), chemotherapy (20 patients/34%), radiation therapy (13 patients/22%), frequent lumbar punctures (12 patients/21%), and surgery (28 patients/48%). Visual acuity improved in 40 eyes (42%), with only 4 eyes (4%) experiencing deterioration. At a 12-month median follow-up period, 11 (19%) patients were dead, 10 (10%) eyes had poor vision (BCVA less than 0.1), and 21 (22%) eyes had BCVA 0.5 or better. CONCLUSIONS Various underlying pathologies can induce optic disc swelling in cancer patients, a grave condition capable of causing vision loss. Notably, tumor infiltration of the optic nerve tends to result in more profound visual impairment compared to papilledema due to elevated ICP. Timely detection is crucial, and immediate symptomatic treatment followed by addressing the underlying cause is essential to prevent irreversible optic nerve damage and vision loss in cancer patients.
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Affiliation(s)
- Yacoub A. Yousef
- Department of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (I.M.S.A.); (R.A.); (M.M.); (I.A.)
| | - Isra M. Sid Ahmed
- Department of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (I.M.S.A.); (R.A.); (M.M.); (I.A.)
- Alzarga Eye Center, Khartoum 11115, Sudan
| | - Danah Kanj Ahmad
- Department of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (I.M.S.A.); (R.A.); (M.M.); (I.A.)
| | - Mona Mohammad
- Department of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (I.M.S.A.); (R.A.); (M.M.); (I.A.)
| | - Hala Makahleh
- Department of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (I.M.S.A.); (R.A.); (M.M.); (I.A.)
| | - Reem AlJabari
- Department of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (I.M.S.A.); (R.A.); (M.M.); (I.A.)
| | - Fawzieh Alkhatib
- Department of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (I.M.S.A.); (R.A.); (M.M.); (I.A.)
| | - Mario Damiano Toro
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
- Eye Clinic, Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland
| | - Mustafa Mehyar
- Department of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (I.M.S.A.); (R.A.); (M.M.); (I.A.)
| | - Ibrahim Alnawaiseh
- Department of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (I.M.S.A.); (R.A.); (M.M.); (I.A.)
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Yousef YA, Mohammad M, Al-Nawaiseh I, Mahafza H, Halalsheh H, Mehyar M, AlJabari R, Al-Rawashdeh K, Jaradat I, Sultan I, Al-Hussaini M. Retinoblastoma and uveal melanoma in Jordan: incidence, demographics, and survival (2011-2020). Ophthalmic Genet 2023; 44:119-126. [PMID: 35848346 DOI: 10.1080/13816810.2022.2090008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE We present an epidemiologic analysis of retinoblastoma (RB) and uveal melanoma (UM) in Jordan to aid national strategies for improved ocular cancer surveillance and control. METHODS A retrospective cohort of all Jordanian patients with RB and UM diagnosed over 10 years (2011-2020). Outcome measures included incidence, demographics, and outcomes. RESULTS Retinoblastoma (n = 124) was more common than UM (n = 82); there was no sex predilection for either group. The median age at diagnosis of RB was 15 months(Six and 28 months for bilateral and unilateral cases, respectively), and the mean age-adjusted incidence was 8.2 cases per-million-children per year for children aged five years or less(one per 15,620 newborn per year). Fifty-one(41%) had bilateral disease, and 18(15%) had familial disease. Ninety-six(55%) eyes were group D or E(78% were T3/T4), and the five-year survival rate was 96%.For UM, the median age at diagnosis was 45 years with an incidence of 1.39 new cases per year per one million population. All(100%) had nonfamilial unilateral disease. Seventy-three(89%) had the tumor in the choroid, and 48(58%) had an advanced tumor that had invaded the sclera or the orbit (T3/T4) tumor. Sixty-two(76%) were treated by I-125 radioactive plaque, with globe salvage in 59(95%); the five-year survival rate was 85%. CONCLUSION In Jordan, RB is more common and has better survival than UM. RB in Jordan and Western countries is equal in terms of incidence, globe salvage, and survival. UM is less common, with lower age at diagnosis (that was associated with better survival) in Jordan than in Western countries.
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Affiliation(s)
- Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Ibrahim Al-Nawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Hala Mahafza
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Hadeel Halalsheh
- Department of Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Reem AlJabari
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Khaleel Al-Rawashdeh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Imad Jaradat
- Department of Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Iyad Sultan
- Department of Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology, and Laboratory Medicine, King Hussein Cancer Centre (KHCC), Amman, Jordan
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Yousef YA, Abu Salim QF, Mohammad M, Jaradat I, Mehyar M, AlJabari R, Al-Habahbeh O, Saboubeh K, Halalsheh H, Khzouz J, Shawagfeh M, Sultan I, AlMasri M, Al-Nawaiseh I, Al-Hussaini M, Mansour A. Presentation and management outcomes of Retinoblastoma among Syrian refugees in Jordan. Front Oncol 2023; 12:1056963. [PMID: 36713556 PMCID: PMC9880551 DOI: 10.3389/fonc.2022.1056963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose The humanitarian crisis in Syria has had a profound impact on the entire region. In this study, we report the patterns of presentation and management outcomes of Syrian patients with Retinoblastoma (Rb) treated at a single tertiary cancer center in Jordan. Methods and Materials This is a retrospective comparative study of Syrian refugees and Jordanian citizens who had Rb between 2011 and 2020. Collected data included patient demographics, presentation, tumor stage, treatment modalities, eye salvage rate, metastasis, and mortality. Results Thirty Syrian refugees (16 (53%) had bilateral disease) and 124 Jordanian citizens (51(41%) had bilateral disease) were diagnosed with Rb during this period. The median age at diagnosis for refugees was 10 and 32 months for patients with bilateral and unilateral Rb consecutively, compared to 6 and 28 months for citizens. The median lag time between signs of disease and initiation of treatment was 3 months for refugees, compared to 1 month for citizens.Refugees were more likely to present with a more advanced stage (p=0.046). Out of 46 affected eyes in refugees; 32 (70%) eyes were group D or E, while out of 175 affected eyes among citizens; 98 (56%) eyes were group D or E. Therefore, refugees with Rb were more likely to mandate primary enucleation (48%) compared to citizens (25%) (p=0.003). However, out of 24 eyes among refugees who received conservative therapy, 15 (62%) eyes were successfully salvaged, while out of 131 affected eyes among citizens who received conservative therapy, 105 (80%) eyes were successfully salvaged (p=0.06). Two (7%) of the refugees and four (3.2%) of the citizens with Rb died from metastasis. Conclusion Syrian refugees with Rb presented with more advanced disease due to delay in diagnosis and referral that increased the treatment burden by decreasing the chance for eye globe salvage. However, patients who received the timely intervention had a similar outcome to citizens with Rb; probably a reflection of the management of all patients at a single specialized center. We advocate for the timely referral of refugees with this rare life-threatening tumor to a specialized cancer center for the best possible outcome.
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Affiliation(s)
- Yacoub A. Yousef
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan,*Correspondence: Yacoub A. Yousef,
| | | | - Mona Mohammad
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Imad Jaradat
- Department Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Reem AlJabari
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Omar Al-Habahbeh
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Khalid Saboubeh
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Hadeel Halalsheh
- Department Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Jakub Khzouz
- Department Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Munir Shawagfeh
- Department Anesthesia, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Iyad Sultan
- Department Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mahmoud AlMasri
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | | | - Maysa Al-Hussaini
- Department Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Asem Mansour
- Department Diagnostic Radiology, King Hussein Cancer Centre (KHCC), Amman, Jordan
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Yousef YA, Mohammad M, AlNawaiseh I, AlJabari R, Toro MD, Gharaibeh A, Rejdak R, Nowomiejska K, Zweifel S, Avitabile T, Rejdak M, Nazzal R. Ultrasound Biomicroscopy Measurements of the Normal Thickness for the Ciliary Body and the Iris in a Middle East Population. Clin Ophthalmol 2022; 16:101-109. [PMID: 35046635 PMCID: PMC8760099 DOI: 10.2147/opth.s297977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Ciliary body (CB) and iris thicknesses may change with certain eye diseases as well as between different populations. Here, we report Ultrasound Biomicroscopy Measurements (UBM) of the normal thickness for the CB and the iris from a homogenous population in the Middle East. Patients and Methods Sonomed 35-MHz (SONOMED, INC. New York, USA) images were obtained at 4 radial meridians, and the thickness was measured at 3 locations along the radial length of the iris and at the thickest part of the CB. Parameters included mean thickness, median thickness, range, and standard deviation. Results Of 46 adult patients, 83 normal eyes were included in this analysis. The overall mean, median iris thicknesses at the iris root, midway along the radial length of the iris, and at the juxtapupillary margin in mm were 0.42, 0.41 ± 0.08, 0.52, 0.51± 0.08, and 0.72, 0.71± 0.1, respectively. The overall mean, median thicknesses of the CB and CB + ciliary processes in mm were 0.72, 0.71 ± 0.1, and 1.42, 1.37 ± 0.2 respectively. Gender, age, side, and height had no impact on iris and/or CB thickness (p>0.05). However, the iris thickness was significantly thicker in the superior quadrant than inferiorly, and in the nasal quadrant than the temporal quadrant (p=0.04), and the CB thickness and the CB + ciliary processes thickness were significantly thicker in the superior quadrant than inferiorly (P = 0.04 and 0.02 consecutively). Conclusion We measured in this study the normal thickness of the CB and the iris in normal eyes from homogenous population in the Middle East using ultrasound biomicroscopy. Our findings are essential for the ophthalmic community worldwide and in the Middle East region and can be used as a normative thickness data for the iris and CB in healthy eyes.
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Affiliation(s)
- Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Ibrahim AlNawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Reem AlJabari
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Mario Damiano Toro
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland.,Department of Ophthalmology, University of Zürich, Zürich, Switzerland
| | | | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | | | - Sandrine Zweifel
- Department of Ophthalmology, University of Zürich, Zürich, Switzerland
| | | | - Magdalena Rejdak
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Rashed Nazzal
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
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Amin S, AlJboor M, Toro MD, Rejdak R, Nowomiejska K, Nazzal R, Mohammad M, Al-Hussaini M, Khzouz J, Banat S, AlJabari R, Jaradat I, Mehyar M, Sultan I, AlNawaiseh I, Yousef YA. Management and Outcomes of Unilateral Group D Tumors in Retinoblastoma. Clin Ophthalmol 2021; 15:65-72. [PMID: 33447011 PMCID: PMC7802086 DOI: 10.2147/opth.s282741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose Retinoblastoma presents most commonly as advanced unilateral disease, particularly in developing countries for which primary enucleation has been the preferred method of treatment. However, with the evolution of newer treatment modalities including intravitreal chemotherapy, intra-arterial chemotherapy and newer chemotherapeutic combinations, a trend towards more conservative approaches is being observed. Our aim is to evaluate outcomes of group D eyes following conservative and non-conservative treatment options. Patients and Methods The ocular oncology database was used to identify eyes with unilateral retinoblastoma that fulfilled the International Intraocular Retinoblastoma Classification (IIRC) group D criteria from August 2010 to August 2018 and these were retrospectively reviewed. Overall, 39 eyes were identified. Results Nineteen (49%) eyes underwent primary enucleation and 20 (51%) received eye-conserving treatment. Eye salvage was possible in 15 (75%) eyes in the attempted salvage group. None of the patient revealed signs of metastasis. All eyes received conventional chemotherapy (carboplatin, vincristine, etoposide) and focal laser therapy. Additional treatment modalities offered included intravitreal chemotherapy, intra-arterial chemotherapy and topotecan. Three (11%) eyes in the primary enucleation group showed high-risk features on histopathology and none developed metastasis. Conclusion The results of the study seem promising and conservative measures can be adopted in selected unilateral group D eyes.
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Affiliation(s)
- Saima Amin
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mays AlJboor
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mario D Toro
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, Lublin, Poland.,Faculty of Medical Sciences, Collegium Medicum Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Robert Rejdak
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Nowomiejska
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, Lublin, Poland
| | | | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Jakub Khzouz
- Department of Pathology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Sara Banat
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Reem AlJabari
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Imad Jaradat
- Department of Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Ibrahim AlNawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
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Yousef YA, Al-Nawaiseh I, Mehyar M, Sultan I, Al-Hussaini M, Jaradat I, Mohammad M, AlJabari R, Abu-Yaghi N, Rodriguez-Galindo C, Qaddoumi I, Wilson M. How Telemedicine and Centralized Care Changed the Natural History of Retinoblastoma in a Developing Country: Analysis of 478 Patients. Ophthalmology 2020; 128:130-137. [PMID: 32682835 DOI: 10.1016/j.ophtha.2020.07.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the efficacy of integrating a telemedicine-based twinning partnership and centralized care for retinoblastoma on survival and eye salvage. DESIGN Four hundred seventy-eight retinoblastoma patients treated at a tertiary referral cancer center (King Hussein Cancer Centre [KHCC]) from 2003 through 2019. PARTICIPANTS Four hundred seventy-eight retinoblastoma patients treated at KHCC after implementing a telemedicine-based program with St. Jude Children's Research Hospital. METHODS We reviewed the outcomes of retinoblastoma patients who were treated at KHCC after implementing a telemedicine-based eye salvage program with St. Jude Children's Research Hospital, and we compared that with outcomes for retinoblastoma patients who were treated before implementing a telemedicine-based retinoblastoma service at KHCC. MAIN OUTCOME MEASURES We analyzed patient demographics, clinical characteristics, treatments received, consultation type and duration, and long-term patient outcomes before and after implementing the twinning program. RESULTS Over 17 years, 813 eyes from 478 children with retinoblastoma were treated at KHCC. Three hundred thirty-five patients (70%) had bilateral disease. Six patients (4%) with unilateral disease and 66 patients (20%) with bilateral disease had a family history of retinoblastoma. After the twinning program was established in 2003, the mortality rate decreased from 38% to 5% (P < 0.0001), and the overall eye salvage rate increased from 4% to 61% (98% for group A, 93% for group B, 81% for group C, and 48% for group D; P < 0.0001). Initially, all cases were discussed via telemedicine, but as knowledge transfer increased, the proportion of cases that required discussion decreased to less than 3% 10 years later. Similarly, treatment changes based on consultations decreased from 70% to 7% after 10 years. Both survival and eye-salvage rates were comparable at the early and later stages of implementing the twinning program. At a median follow-up of 120 months, 5% of patients had died of metastases or secondary neoplasms, 81% were alive, and 14% were lost to follow-up. CONCLUSIONS Centralization of care at a single center in developing countries can achieve patient outcomes comparable with those of developed countries via twinning and telemedicine. This benefit can extend to a large region because two thirds of patients treated at KHCC were non-Jordanians.
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Affiliation(s)
- Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan.
| | - Ibrahim Al-Nawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Iyad Sultan
- Pediatric Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Maysa Al-Hussaini
- Pathology and Laboratory Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Imad Jaradat
- Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Reem AlJabari
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | | | | | | | - Matthew Wilson
- St. Jude Children's Research Hospital, Memphis, Tennessee; Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee
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Yousef YA, Alkhoms A, AlJabari R, AlJboor M, Mohammad M, Lahlouh M, Deebajah R, Halalsheh H, Al-Hussaini M, Jaradat I, Shawagfeh M, Sultan I, Mehyar M, AlNawaiseh I. Programmed screening for retinoblastoma enhances early diagnosis and improves management outcome for high-risk children. Ophthalmic Genet 2020; 41:308-314. [PMID: 32432497 DOI: 10.1080/13816810.2020.1766085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To study the impact of a Retinoblastoma (Rb) screening program in the absence of genetic testing on the management and outcome of high-risk children. METHODS This is a retrospective, clinical case series of 76 children from families involved in a Rb screening program as they had higher than normal risk as calculated by the conventional ways without genetic testing. Data included calculated risk, method of diagnosis, demographics, tumor features, treatment modalities, and management outcome. RESULTS Out of the 76 children screened, 46 children were diagnosed with Rb (12 by screening and 34 had signs of Rb), the other 30 were free of disease. Patients diagnosed by screening were younger (mean; 2.4 months vs 15.8 months for the group with signs of Rb), had significantly earlier tumor stage at diagnosis (p = .0001), higher eye salvage rate (p = .0001), less need for systemic chemotherapy (p = .022), and better visual outcome (p = .0017) than the other group. None of the eyes were group D or E, enucleated or irradiated. Six (50%) patients were cured without chemotherapy, and the visual acuity was 0.5 or better in 55% of eyes. Of interest, 71% of tumors were diagnosed by the age of 6 months, 90% by the age of 1 year, and no new tumor appeared after the age of 2 years. CONCLUSION Even in the absence of genetic testing, screening for children with high risk for Rb is effective in enhancing early diagnosis, improving visual outcome, and increasing eye salvage rate with limited exposure to treatment burden.
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Affiliation(s)
- Yacoub A Yousef
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Abdelrahman Alkhoms
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Reem AlJabari
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Mays AlJboor
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Mona Mohammad
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Maha Lahlouh
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Rasha Deebajah
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Hadeel Halalsheh
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Maysa Al-Hussaini
- Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Imad Jaradat
- Anesthesia, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Munir Shawagfeh
- Radiation Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Iyad Sultan
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Mustafa Mehyar
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Ibrahim AlNawaiseh
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
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Mehyar M, Mosallam M, Tbakhi A, Saab A, Sultan I, Deebajah R, Jaradat I, AlJabari R, Mohammad M, AlNawaiseh I, Al-Hussaini M, Yousef YA. Impact of RB1 gene mutation type in retinoblastoma patients on clinical presentation and management outcome. Hematol Oncol Stem Cell Ther 2020; 13:152-159. [PMID: 32222358 DOI: 10.1016/j.hemonc.2020.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 12/24/2019] [Accepted: 02/24/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE/BACKGROUND Retinoblastoma (RB), the most common intraocular malignancy in children, is caused by biallelic inactivation of the human retinoblastoma susceptibility gene (RB1). We are evaluating the impact of the type of RB1 gene mutation on clinical presentation and management outcome. METHODS A retrospective case series of 50 patients with RB. Main outcomes were clinical and pathologic features and types of RB1 gene mutations detected using quantitative multiplex polymerase chain reaction (PCR), allele-specific PCR, next-generation sequencing analysis, and Sanger sequencing. RESULTS Twenty (40%) patients had unilateral RB and 30 (60%) had bilateral RB. Overall, 36 (72%) patients had germline disease, 17 (47%) of whom inherited the disease. Of these 17 inherited cases, paternal origin of the RB1 mutation was seen in 15 (88%). The overall eye salvage rate was 74% (n = 49/66; 100% for Groups A + B + C, and 79% for Group D eyes). The most frequent type of mutation was a nonsense mutation generating a stop codon (15/36, 42%). Other mutations that result in a premature stop codon due to deletions or insertions with donor splice site or receptor splice site mutations were detected in 7/36 (19%), 10/36 (28%), and 2/26 (6%) patients, respectively. The remaining two (6%) patients had frameshift mutation. Patients with deletion, acceptor splice site, and frameshift mutations presented with more advanced ICRB (International Classification of Retinoblastoma) stage (75% diagnosed with Group D or E), even though there was no significant difference in eye salvage rate or tumor invasiveness between patients with different types of mutations. CONCLUSION Despite the heterogeneous nature of RB1 gene mutations, tumor stage remains the most important predictive factor for clinical presentation and outcome. Furthermore, acceptor splice site and frameshift mutations are associated with more advanced tumor stage at diagnosis.
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Affiliation(s)
- Mustafa Mehyar
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | | | - Abdelghani Tbakhi
- Department of Cell Therapy and Applied Genomics, King Hussein Cancer Center, Amman, Jordan
| | - Ala Saab
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Rasha Deebajah
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Imad Jaradat
- Department of Radiotherapy, King Hussein Cancer Center, Amman, Jordan
| | - Reem AlJabari
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Mona Mohammad
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Yacoub A Yousef
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
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Affiliation(s)
- Yacoub A. Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
| | - Tamara AlNawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
| | - Reem AlJabari
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
| | - Sana’ Muhsen
- Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Ibrahim Al-Nawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
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