1
|
Benisek DA, Manzitti J, Scorsetti D, Rousselot Ascarza AM, Ascarza AA, Gomez Rancaño D, Quercia R, Ramirez Gismondi M, Carpio Total MA, Scorsetti ML, Spitzer E, Lombas C, Deprati M, Penna MI, Fernández F, Tinelli MA. Safety and clinical effectiveness of intravitreal administration of bevacizumab (Lumiere ®) in patients with neovascular age-related macular degeneration. Exp Ther Med 2020; 20:162. [PMID: 33093900 PMCID: PMC7571337 DOI: 10.3892/etm.2020.9291] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/24/2020] [Indexed: 11/05/2022] Open
Abstract
The present study was an open-label, prospective, uncontrolled and multicenter clinical trial to investigate the safety and effectiveness of bevacizumab (Lumiere®) administered by the intravitreal route for the treatment of neovascular age-related macular degeneration (nAMD). A total of 22 patients without previous treatment with anti-vascular endothelial growth factor were recruited. Monthly therapy with 1.25 mg intravitreal bevacizumab was applied. Adverse events (AE), visual acuity (VA) and central retinal thickness (CRT) were assessed at baseline, day 1 and day 28 after each injection. A total of 87 AEs were reported; most of them were not serious (96.6%), expected (65.5%) and occurred after the third injection (56.3%). The most frequent AE was 'conjunctival hemorrhage' (29.9% of AEs), attributed to the injection procedure. Treatment was not suspended due to safety reasons in any case. After six months, a statistically significant gain of +8.2 (SD±8.8) letters and a CRT reduction of -75.50 µm (SD±120.3) were achieved with unilateral therapy. VA improvement and CRT reduction were also achieved with bilateral therapy, although to a lesser extent. The results of the present study suggested that therapy with a minimum of 3 doses of bevacizumab over a 6-month period was well tolerated and resulted in a sustained response regarding VA improvement and CRT reduction from the beginning of therapy compared with the baseline value. The study protocol was registered at clinicaltrials.gov (ref. no. NCT03668054).
Collapse
Affiliation(s)
- Daniel A Benisek
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina
| | - Julio Manzitti
- Consultorio Oftalmológico Julio Manzitti, Ciudad Autonóma de Buenos Aires, C1124AAG Buenos Aires, Argentina
| | - Daniel Scorsetti
- Instituto Scorsetti, Ciudad Autónoma de Buenos Aires, C1120AAC Buenos Aires, Argentina
| | - Andres M Rousselot Ascarza
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina
| | - Amalia A Ascarza
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina
| | - Diego Gomez Rancaño
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina
| | - Romina Quercia
- Consultorio Oftalmológico Julio Manzitti, Ciudad Autonóma de Buenos Aires, C1124AAG Buenos Aires, Argentina
| | - Matias Ramirez Gismondi
- Consultorio Oftalmológico Julio Manzitti, Ciudad Autonóma de Buenos Aires, C1124AAG Buenos Aires, Argentina
| | - Mateo A Carpio Total
- Instituto Scorsetti, Ciudad Autónoma de Buenos Aires, C1120AAC Buenos Aires, Argentina
| | - María L Scorsetti
- Instituto Scorsetti, Ciudad Autónoma de Buenos Aires, C1120AAC Buenos Aires, Argentina
| | - Eduardo Spitzer
- Clinical Research Department, Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| | - Carola Lombas
- Clinical Research Department, Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| | - Matías Deprati
- Health Department, Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| | - María Ines Penna
- Health Department, Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| | - Francisco Fernández
- Pharmacovigilance Department Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| | - Marcelo A Tinelli
- Clinical Research Department, Laboratorio Elea-Phoenix S.A., Los Polvorines, B1613AUE Buenos Aires, Argentina
| |
Collapse
|
2
|
Hariharan L, Gilbert CE, Quinn GE, Barg FK, Lomuto C, Quiroga A, McLeod-Omawale J, Zin A, Ortiz Z, Alda E, Bouzas L, Brussa M, Cattaino A, Dinerstein A, Erpen N, Fandiño A, Galina L, Manzitti J, Marinaro S, Sepúlveda T, Visintín P, Silva JC, Magluta C, Benitez A. Reducing Blindness from Retinopathy of Prematurity (ROP) in Argentina Through Collaboration, Advocacy and Policy Implementation. Health Policy Plan 2018; 33:654-665. [PMID: 29668967 DOI: 10.1093/heapol/czy004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 11/12/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a largely avoidable cause of blindness in children worldwide, requiring high-quality neonatal care, early detection and treatment. In middle-income countries throughout Latin America, Eastern Europe and South Asia, there has been a rise in ROP blindness due to a combination of increased survival of preterm infants, resource-scarce medical environments and lack of policies, training and human resources. However, Argentina is an example of country where rates of ROP blindness have declined and ROP programmes have been successfully and effectively embedded within the health and legal system. The purpose of this study is to describe the activities and stakeholders, including Ministry of Health (MoH) and UNICEF, involved in the process, from recognition of an epidemic of ROP blindness to the development of national guidelines, policies and legislation for control. Using a retrospective mixed methods case study design, data on rates of severe ROP was collected from 13 neonatal intensive care units from 1999 to 2012, and on the proportion of children blind from ROP in nine blind schools in seven provinces. Legislative document review, focus group discussions and key informant interviews were conducted with neonatologists, ophthalmologists, neonatal nurses, parents, MoH officials, clinical societies, legislators and UNICEF officials in seven provinces. Results are presented combining the stages heuristic policy framework and Shiffman including: agenda setting, policy formulation, implementation and evaluation. By 2012, ROP had declined as a cause of blindness in children in schools for the blind as had rates of severe ROP needing treatment in the NICUs visited. Multiple factors played a role in reducing blindness from ROP in Argentina and successfully coordinating its control including national advocacy, leadership, legislation and international collaboration. Lessons learned in Argentina can potentially be scaled to other LMICs in Latin America and beyond with further context-specific research.
Collapse
Affiliation(s)
- Luxme Hariharan
- Division of Ophthalmology, Children's Hospital of Philadelphia (CHOP), Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Clare E Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Graham E Quinn
- Division of Ophthalmology, Children's Hospital of Philadelphia (CHOP), Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Frances K Barg
- Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA
| | - Celia Lomuto
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Ana Quiroga
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | | | - Andrea Zin
- Instituto Fernandes Figueira, FIOCRUZ, Av. Rui Barbosa, 716 - Flamengo, Rio de Janeiro - RJ 20021-140, Brazil
| | - Zulma Ortiz
- UNICEF Argentina, Junin 1940 - Planta Baja, Codigo Postal C1113AAX, Buenos Aires, Argentina
| | - Ernesto Alda
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Liliana Bouzas
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Marina Brussa
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Adriana Cattaino
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Alejandro Dinerstein
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Norma Erpen
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Adriana Fandiño
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Lidia Galina
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Julio Manzitti
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Silvia Marinaro
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Teresa Sepúlveda
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Patricia Visintín
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Juan Carlos Silva
- Division of Blindness Prevention, Pan American Health Organization (PAHO), Calle (Street) 66, No.11-50, 6th Floor Building, Apartado Aéreo 253367, Bogotá, DC, Colombia
| | - Cynthia Magluta
- Instituto Fernandes Figueira, FIOCRUZ, Av. Rui Barbosa, 716 - Flamengo, Rio de Janeiro - RJ 20021-140, Brazil
| | - Alicia Benitez
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| |
Collapse
|
3
|
Funes S, Sampor C, Villasante F, Fandiño A, Manzitti J, Sgroi M, Neira P, Peralta L, Lagomarsino E, Schaiquevich P, Ceciliano A, Chantada GL. Feasibility and results of an intraarterial chemotherapy program for the conservative treatment of retinoblastoma in Argentina. Pediatr Blood Cancer 2018; 65:e27086. [PMID: 29693791 DOI: 10.1002/pbc.27086] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/28/2018] [Accepted: 03/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The feasibility and results of intraarterial chemotherapy, also termed ophthalmic artery chemosurgery (OAC), for retinoblastoma in less developed countries have seldom been reported. PROCEDURE A retrospective evaluation of a program of OAC in Argentina from 2010 to 2015. RESULTS Ninety-seven eyes from 81 patients (61 bilateral) were analyzed. In 35 eyes, OAC was given as primary therapy and in 62 it was used for the treatment of tumors with partial response or those relapsing after systemic chemoreduction with focal therapy or external-beam radiotherapy. Twenty-two primarily treated eyes had group D and 13 groups B/C. A total of 400 procedures were carried out. Chemotherapy used included combinations of melphalan, carboplatin, and topotecan. There was no mortality associated with OAC. Toxicity included fever and neutropenia in five (1.25%), hypotension and bradycardia during anesthesia in two and femoral thrombosis in one, eyelid edema in nine, and neutropenia or thrombocytopenia in 28 cycles. With a median follow-up of 48.7 months (range 12-79), the 3-year probability of event-free survival (pEFS) (enucleation and/or radiotherapy were considered events) was comparable for patients who received first-line therapy and those treated at relapse (0.65 vs. 0.63, P = 0.5). In the former, the pEFS was 0.91 and 0.43 for groups B/C and D, respectively (P = 0.01). Two patients died of extraocular dissemination after refusal of enucleation. CONCLUSIONS OAC was feasible with low toxicity. pEFS improved in all groups compared to the previous experience with systemic chemotherapy reducing the use of radiotherapy. The overall mortality associated with OAC is comparable to our previous experience with systemic chemoreduction.
Collapse
Affiliation(s)
- Santiago Funes
- Pediatric Hemato-Oncology Service, Hospital Universitario Austral, Pilar, Argentina
| | - Claudia Sampor
- Hematology-Oncology Service, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Francisco Villasante
- Department of Interventional Neuroradiology, Hospital Universitario Austral, Pilar, Argentina
| | - Adriana Fandiño
- Department of Ophthalmology, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Julio Manzitti
- Department of Ophthalmology, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Mariana Sgroi
- Department of Ophthalmology, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Pablo Neira
- Department of Pediatrics, Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - Laura Peralta
- Department of Clinical Pediatrics, Hospital JP Garrahan, Buenos Aires, Argentina
| | | | - Paula Schaiquevich
- Clinical Pharmacokinetics Unit, Hospital JP Garrahan, CONICET, Buenos Aires, Argentina
| | - Alejandro Ceciliano
- Department of Interventional Neuroradiology, Hospital Universitario Austral, Pilar, Argentina
| | - Guillermo L Chantada
- Pediatric Hemato-Oncology Service, Hospital Universitario Austral, Pilar, Argentina.,Hematology-Oncology Service, Hospital JP Garrahan, Buenos Aires, Argentina
| |
Collapse
|
4
|
Chantada GL, Fandiño AC, Schvartzman E, Raslawski E, Schaiquevich P, Manzitti J. Impact of chemoreduction for conservative therapy for retinoblastoma in Argentina. Pediatr Blood Cancer 2014; 61:821-6. [PMID: 24243706 DOI: 10.1002/pbc.24857] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/18/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few studies were reported from developing countries regarding patient outcome and ocular survival in children with bilateral retinoblastoma treated with chemoreduction compared to external beam radiotherapy (EBRT). PROCEDURE We undertook a retrospective study of three treatment eras: (1) (1988-1995) n = 68 when EBRT was used as primary conservative therapy; (2) (1995-2003) n = 46 when carboplatin-based systemic chemoreduction was introduced and (3) (2003-2009) (n = 83) when additional periocular chemotherapy was added for advanced tumors and pre-enucleation chemotherapy was given for those with massive buphthalmia. RESULTS The probability of 5-year disease-free survival was 0.94 (95% confidence interval [CI] 0.91-0.98%) without significant differences among the three eras. Chemoreduction reduced the use of EBRT from 84.6% to 68.7% in eras 1 and 3, respectively (P = 0.008), which was more evident in cases with less advanced disease. Chemoreduction also significantly improved the 5-year probability of preservation of eyes with advanced disease from 0.13 (95% CI 0.04-0.27) during era 1 to 0.49 (95% CI 0.34-0.62) in era 3 (P < 0.0001). Chemoreduction was not associated with changes in the probability of extraocular relapse, which was reduced after the introduction of pre-enucleation chemotherapy. Second malignancies occurred in nine cases, acute myeloid leukemia being the most fatal one. Trilateral retinoblastoma occurred in three cases and all of them had been exposed to chemotherapy. CONCLUSIONS Chemoreduction reduced the need for EBRT in eyes with less advanced disease and improved the preservation of eyes with advanced disease while its effects on secondary malignancies or trilateral disease remain unclear.
Collapse
|
5
|
Chantada GL, Fandiño AC, Guitter MR, Raslawski EC, Dominguez JL, Manzitti J, de Dávila MTG, Zubizarreta P, Scopinaro M. Results of a prospective study for the treatment of unilateral retinoblastoma. Pediatr Blood Cancer 2010; 55:60-6. [PMID: 20486172 DOI: 10.1002/pbc.22503] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Few prospective studies about the management of unilateral retinoblastoma with pathology risk factors (PRFs) have been published. METHODS Patients (n = 114) were divided into four groups: Group 1 (initial chemoreduction) (n = 17). Groups 2 and 3, included patients initially enucleated with no, or lower risk PRFs: (n = 65) and with higher risk PRFs (n = 30), respectively. The later included postlaminar optic nerve involvement (PLONI) (n = 23), tumor at resection margin of optic nerve (n = 5) or isolated scleral invasion (n = 2). Group 3 received adjuvant chemotherapy including a total eight cycles of carboplatin and etoposide, alternating with cyclophosphamide, idarubicin, and vincristine. Orbital radiotherapy (45 Gy) was given to patients with invasion to the resection margin. Group 4 included patients with metastatic disease (n = 2). They were given neoadjuvant therapy followed by surgery and high-dose chemotherapy and autologous stem cell rescue. RESULTS Five-year event-free survival is 0.94 (1 for Group 1, 0.94 for Group 2, 0.96 for Group 3, and 0 for Group 4). Events included. Group 2: Systemic relapse (n = 2) and combined orbital and CNS relapse (n = 1). Relapsing patients had PLONI (n = 2) and isolated focal choroidal invasion (n = 1). Group 3: CNS relapse (n = 1) in a patient with tumor at the resection margin of optic nerve. Group 4: CNS relapse (n = 2). Only one relapsed patient survived. Eight of 17 eyes treated conservatively were preserved. CONCLUSIONS The survival of patients with unilateral retinoblastoma was excellent and 60% were spared from adjuvant treatment. Our intensive regimen was likely to be effective for prevention of metastasis in patients with higher risk PRFs.
Collapse
|
6
|
Manzitti J, Mansilla MC. [Retinoblastoma]. ARCH ARGENT PEDIATR 2010; 108:255-257. [PMID: 20544142 DOI: 10.1590/s0325-00752010000300018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 01/20/2010] [Indexed: 05/29/2023]
Affiliation(s)
- Julio Manzitti
- Servicio de Oftalmología, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan.
| | | |
Collapse
|
7
|
Lomuto CC, Galina L, Brussa M, Quiroga A, Alda E, Benítez AM, Bouzas L, Dinerstein NA, Erpen N, Falbo J, Manzitti J, Marinaro S, Nieto R, Sepúlveda T, Visintín P. [Laser treatment for retinopathy of prematurity in 27 public services of Argentina]. ARCH ARGENT PEDIATR 2010; 108:136-40. [PMID: 20467709 DOI: 10.1590/s0325-00752010000200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 07/24/2009] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Retinopathy of prematurity may lead to partial loss of vision and blindness; laser photocoagulation is the elective treatment, but universal access to it is not yet guaranteed in Argentina. OBJECTIVES To estimate prevalence of children requiring laser for retinopathy, their clinical and demographic characteristics, place of origin and place of treatment. POPULATION, MATERIAL AND METHOD: Observational, descriptive and retrospective study. POPULATION premature newborns who required treatment at public services during 2008. VARIABLES Birth weight and gestational age, prognosis, unusual cases and missed opportunities. SOURCE 27 public services from 18/24 provinces. RESULTS 235 patients who required treatment were recorded (Garrahan Hospital: 86; Gutiérrez Hospital: 45, and 104 from 25 other hospitals) from 77 public services and 13 private services from 22/24 provinces, where 210,720 babies born at the same period. Cases from Buenos Aires Province were referred mainly to Garrahan Hospital, all cases from Buenos Aires City and 2/3 from the rest of the country were treated in situ. Prognosis was defined as reserved at 15% and 5 missed opportunities occurred all in referred babies. Unusual cases were 27% of the total reported. CONCLUSION In this population retinopathy prevalence was 1/900 birth in 2008. The proportion of unusual cases, reserved prognosis and missed opportunities was high. A national record and improved access to treatment in situ are urgently needed.
Collapse
Affiliation(s)
- Celia C Lomuto
- Grupo de Trabajo Colaborativo Multicéntrico: Prevención de la ceguera en la infancia por retinopatía del prematuro -ROP, Dirección de Maternidad e Infancia, Ministerio de Salud de la Nación.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Lomuto CC, Galina L, Brussa M, Quiroga A, Alda E, Benítez AM, Bouzas L, Dinerstein NA, Erpen N, Falbo J, Manzitti J, Marinaro S, Nieto R, Sepúlveda T, Visintín P. [Epidemiology of retinopathy of prematurity in public services from Argentina during 2008]. ARCH ARGENT PEDIATR 2010; 108:24-30. [PMID: 20204236 DOI: 10.1590/s0325-00752010000100006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 09/19/2009] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Increasing survival of preterm newborns and current care deficits result in high rates of retinopathy of prematurity (ROP), affecting patients with higher birth weight (BW) and gestational age (GA) than those at developed countries; unusual cases (UC) and missed opportunities (MO) are reported. OBJECTIVE To describe epidemiology of ROP during 2008 compared with the previous year. POPULATION, MATERIAL AND METHOD: Observational, descriptive and retrospective study. POPULATION Preterm babies with BW < 1,500 g and/or < or = 32 w GA and > or = 1,500 g and/or 33-36 w who received oxygen therapy. SOURCE 31 public services from 20/24 Provinces. VARIABLES BW, GA, ophthalmologic screening, age at 1st control, ROP Grade, treatment requirement, place of treatment and time of complete ROP screening. RESULTS Responses were obtained from 24/31 services from 16 Provinces (84,200 newborns) identifying 3,371 newborns at risk, 956 < 1,500 g BW. Screening was done in 90%; it was late in 6%. Neonatal discharge before complete ROP screening occurred in 93%. ROP rate was 11.93%; 26.25% in < 1,500 g BW. Treatment was required at 2.60%; of them, 7% were < 1,500 g BW; 20.3% were UC, one infant was a MO. Treatment need increased 20% at 2008 vs. 2007, without significant difference. Changes were not observed at median BW and GA and UC. Treatment in situ was 75% in 2008, similar to 2007. CONCLUSIONS Incidence of ROP in public hospitals of Argentina is worrisome. Rates in 2008 have not improved compared with 2007, expressing that criteria for prevention are not yet consolidated. Screening and access to treatment must improve.
Collapse
Affiliation(s)
- Celia C Lomuto
- Grupo de Trabajo Colaborativo Multicéntrico, Prevención de la ceguera en la infancia por retinopatía del prematuro, Dirección de Maternidad e Infancia, Ministerio de Salud de la Nación.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Chantada GL, Fandino AC, Carcaboso AM, Lagomarsino E, de Davila MTG, Guitter MR, Rose AB, Manzitti J, Bramuglia GF, Abramson DH. A Phase I Study of Periocular Topotecan in Children with Intraocular Retinoblastoma. ACTA ACUST UNITED AC 2009; 50:1492-6. [DOI: 10.1167/iovs.08-2737] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Angel M. Carcaboso
- Pharmacology Department, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Argentina; and the
| | | | | | | | | | | | - Guillermo F. Bramuglia
- Pharmacology Department, Facultad de Farmacia y Bioquimica, Universidad de Buenos Aires, Argentina; and the
| | - David H. Abramson
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
10
|
Chantada GL, Casco F, Fandiño AC, Galli S, Manzitti J, Scopinaro M, Schvartzman E, de Dávila MTG. Outcome of Patients with Retinoblastoma and Postlaminar Optic Nerve Invasion. Ophthalmology 2007; 114:2083-9. [PMID: 17459482 DOI: 10.1016/j.ophtha.2007.01.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Revised: 01/10/2007] [Accepted: 01/11/2007] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the outcome of patients with retinoblastoma and postlaminar optic nerve invasion (PLONI). DESIGN Retrospective interventional case series. PARTICIPANTS Sixty-one consecutive patients included in 3 successive protocols were analyzed. METHODS Pathologic review was done in each case. Patients were stratified into 2 risk groups: the high-risk group included those with concomitant full choroidal and/or scleral invasion and were given adjuvant chemotherapy. Those without these features were considered low risk and chemotherapy was withheld after 1994. MAIN OUTCOME MEASURES Extraocular relapse and survival according to stratification. RESULTS The probability of event-free survival (pEFS) was 0.91 and the probability of overall survival (pOS) was 0.94 at 5 years. Patients in the high-risk group (n = 22) had pEFS of 0.86. Three had extraocular relapse (involving the central nervous system; all died of disease). Microscopic scleral invasion was associated to extraocular relapse (P = 0.05). Lower risk patients (n = 39) had a pEFS of 0.94 and pOS of 1. Eighteen received postenucleation chemotherapy and none relapsed. Twenty-one received no adjuvant therapy and 2 had a systemic relapse but were successfully retrieved. Relapsing patients had a higher ratio of affected optic nerve (>25% of it overall length; P = 0.02). CONCLUSIONS Patients with PLONI have an excellent outcome with current therapy. Risk stratification according to the presence of concomitant choroidal and/or scleral invasion may help in the decision of giving adjuvant therapy.
Collapse
Affiliation(s)
- Guillermo L Chantada
- Department of Hemato-oncology, Hospital J. P. Garrahan, Buenos Aires, Argentina.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Bouzas L, Bauer G, Novali L, Dilger A, Galina L, Falbo J, Díaz González L, Manzitti J, Sola A. La retinopatía del prematuro en el siglo XXI en un país en desarrollo: una urgencia que debe ser resuelta. An Pediatr (Barc) 2007; 66:551-8. [PMID: 17583615 DOI: 10.1157/13107388] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Retinopathy of prematurity (ROP) is the first cause of childhood blindness in Argentina and is reaching epidemic proportions. To gain greater insight into the issues involved in this epidemic, we analyzed the characteristics of the infants referred for treatment of very severe ROP to the Dr. Juan P. Garrahan Pediatric Hospital, located in the city of Buenos Aires. METHODS We performed a retrospective study of patients referred for ROP from 01/01/96 to 12/31/03. Very severe ROP was defined as threshold disease or worse in both eyes, plus disease in zones 1 or 2, or Rush disease. Unusual patients were defined as those with very severe ROP with a gestational age (GA) of > 31 weeks or birth weight (BW) > 1500 g. Patients were divided into two groups according to the distance between the referring center and our hospital: group A consisted of those from nearby areas (<or= 70 km) and group B comprised those from areas > 70 km from the hospital. RESULTS During the study period, the number of cases progressively increased while the proportion of "unusual" patients slightly decreased. The total number of infants referred was 809 and 14 % were unusual patients; 55 % had very severe ROP, 89 % were treated, and 7 % were referred too late and lost the opportunity for treatment. Group B comprised 61 % of the infants referred. Very severe ROP was present in 53 % of patients in group A and in 56 % of those in group B. The mean GA was 29.5 +/- 3.1 weeks in group A and 30.8 +/- 2.6 in group B (p < 0.001); 90.5 % of the patients in group A and 64 % of those in group B required mechanical ventilation (p < 0.001). No predictors for very severe ROP were found in multifactorial analysis. CONCLUSIONS We report a childhood epidemic of blindness in which the prevalence of very severe ROP increased during the study period and the disease occurred in large, fairly mature newborns. The differences found in relation to the referring center and the lack of correlation between very severe ROP and prematurity or the use of mechanical ventilation suggests substantial disparity in healthcare, which should be taken into account when planning prevention strategies.
Collapse
Affiliation(s)
- L Bouzas
- Area de Neonatología y Seguimiento de Alto Riesgo, Buenos Aires, Argentina.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Chantada GL, Fandiño AC, Raslawski EC, Manzitti J, de Dávila MTG, Casak SJ, Scopinaro MJ, Schvartzman E. Experience with chemoreduction and focal therapy for intraocular retinoblastoma in a developing country. Pediatr Blood Cancer 2005; 44:455-60. [PMID: 15558702 DOI: 10.1002/pbc.20259] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chemoreduction is used for the treatment of retinoblastoma in industrialized nations; however, there are fewer data from developing countries. Before the implementation of this program, radiotherapy was used in almost all preserved eyes. METHODS Retrospective evaluation from 1995 to 2001 at the Hospital Garrahan (Argentina). Carboplatin 18.7 mg/kg/day 1 and vincristine (0.05 mg/kg/day 1) were offered to patients with Reese-Ellsworth (RE) groups I-III and all unilateral cases. Etoposide (3.3 mg/kg/day 1 and 2) was added for groups IV and V. The number of cycles was tailored according to response. RESULTS Fifty-eight patients (78 eyes) were evaluated (39 bilateral, 19 unilateral). With a median follow-up of 47 months, 40 patients had unilateral enucleation, 14 were not enucleated, and 4 had bilateral enucleation. Nineteen patients had unilateral initial enucleation. Eye preservation at 5 years was: RE groups I-III (n = 24 eyes), 0.9 (SE: 0.095) IV-V (n = 54), 0.45 (SE 0.07). Patients received a median of four cycles of chemotherapy. Acute toxicity was mild. External beam radiotherapy was avoided in 41% of eyes with groups I-III. Etoposide was avoided in 24 patients. Two patients died of metastasis. No secondary malignancy occurred. CONCLUSIONS Compared to our previous experience, eye preservation was better and even though less radiotherapy was used, it was prescribed more often than currently recommended in eyes with less advanced disease because of limited availability of sophisticated local therapy.
Collapse
Affiliation(s)
- Guillermo L Chantada
- Department of Hematology/Oncology, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
PURPOSE To report our experience with topotecan in children with relapsed/refractory metastatic and intraocular retinoblastoma. PATIENTS AND METHODS Topotecan was administered intravenously as a 30-min infusion at a dose of 2 mg/m2/d for five consecutive days and repeated after three weeks. If obvious progression was detected by physical examination in patients with overt extraocular disease or if progressive disease was noted after fundoscopic examination in patients with intraocular disease, a second cycle was not administered. Response was evaluated at Week 6. RESULTS Nine patients (6 extraocular, 3 intraocular) were treated from November 1998 to March 2002. A total of 16 cycles were administered. In patients with extraocular disease, there were three partial responses, two cases of stable disease, and one case of progressive disease. Two patients with relapsed/resistant intraocular disease had partial response. allowing local therapy to be performed, and the third patient had progressive disease. The drug was well-tolerated. No patient developed fever or documented infections. No other serious toxicity was found. CONCLUSION Topotecan is active in extraocular and relapsed/resistant intraocular retinoblastoma. The role of this drug in the treatment of retinoblastoma should be explored in further studies.
Collapse
Affiliation(s)
- Guillermo L Chantada
- Department of Hematooncology, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina.
| | | | | | | | | | | |
Collapse
|
14
|
Chantada G, Fandiño A, Dávila MTG, Manzitti J, Raslawski E, Casak S, Schvartzman E. Results of a prospective study for the treatment of retinoblastoma. Cancer 2004; 100:834-42. [PMID: 14770442 DOI: 10.1002/cncr.11952] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objectives of this prospective study were to avoid adjuvant treatment for patients with intraocular disease and patients with postlaminar optic nerve invasion (PL-ONI) without full choroidal or scleral invasion. Adjuvant chemotherapy (Regimen 1) was given to patients with scleral invasion, PL-ONI without cut section, and full choroidal and/or scleral invasion. A more intensive regimen of higher dose intravenous chemotherapy (Regimen 2) and local radiotherapy was given to patients with PL-ONI and compromise at the cut end and to patients with overt extraocular disease. METHODS Six-month intravenous chemotherapy included carboplatin plus etoposide alternating with cyclophosphamide plus vincristine (Regimen 1) and the same drugs at higher dosage plus idarubicin (Regimen 2). Chemoreduction with carboplatin and vincristine with or without etoposide was given to selected patients (n = 39 patients). RESULTS From 1994 to 2001, 169 patients were evaluable at the Hospital Garrahan (Buenos Aires, Argentina). One hundred eighteen patients with intraocular disease had a 5-year disease free survival (DFS) rate of 0.98, including 54 patients with choroidal invasion. None of 22 patients with isolated PL-ONI developed recurrent disease, whereas 2 of 8 patients with concomitant risk factors had tumor recurrences and died. Three of 5 patients with scleral invasion survived, and 7 of 10 patients with cut-end ONI survived. The only patient with metastatic disease that survived (n = 6) had only lymph node invasion. CONCLUSIONS Adjuvant therapy can be avoided in patients with intraocular and isolated PL-ONI. Patients with PL-ONI who also had other risk factors required intensive adjuvant therapy, such as patients with cut-end and overt extraocular disease. Metastatic disease was not found to be curable with this approach.
Collapse
Affiliation(s)
- Guillermo Chantada
- Department of Hematology/Oncology, Hospital de Pediatría J. P. Garrahan, Buenos Aires, Argentina.
| | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
BACKGROUND Overt extraocular retinoblastoma is common in developing countries and little information about its treatment is available. The aim of this study is to report our experience in the treatment of these cases using a uniform approach. PROCEDURE Patients with overt extraocular retinoblastoma including orbital extension, preauricular lymph node invasion and/or metastatic disease on diagnosis or after extraocular relapse admitted to the Hospital JP Garrahan from August 1987 to December 2000 were retrospectively reviewed. Patients were treated according to two different protocols (1987-1993 and 1994-2000). Treatment included: neoadjuvant combination chemotherapy followed by limited surgery in case of orbital extension (enucleation or resection of residual orbital mass) and adjuvant chemotherapy and radiotherapy. Chemotherapy included cyclophosphamide, vincristine, etoposide, doxorubicin (in protocol 87), idarubicin (in protocol 94), cisplatin (in protocol 87), and carboplatin (in protocol 94). RESULTS Forty-one patients were included. Fifteen of them had orbital or preauricular disease and had a 5-year event-free survival (pEFS) of 84%. Twenty-six had distant metastatic disease and non survived 5-years. One patient died of toxicity and one died in complete remission. One patient had a secondary leukemia. The remaining adverse events included CNS and/or systemic relapse. CONCLUSIONS This treatment strategy was highly efficacious for patients with orbital and/or lymph node extension. Orbital exenteration is not necessary for these patients. Those patients with distant metastatic or CNS disease were not curable with this approach.
Collapse
Affiliation(s)
- Guillermo Chantada
- Department of Hematology/Oncology, Hospital de Pediatría JP Garrahan, Combate de los Pozos 1881, Buenos Aires, 1245, Argentina.
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
OBJECTIVE To define a subgroup of patients with retino-blastoma and low risk of extraocular relapse through histopathological and clinical variables. PATIENTS AND METHODS Inclusion criteria consisted of stage I (intraocular disease), stage IIb1 (without concomitant choroid and/or scleral invasion), and nonenucleated patients (according to the Grabowski-Abramson classification). A total of 112 consecutive patients admitted to Hospital JP Garrahan from 1987 to 1997 were evaluable. Treatment included enucleation or local therapy and no chemotherapy. RESULTS Forty-one patients had stage Ia (intraretinal), 8 stage Ib (prelaminar optic nerve invasion), 40 stage Ic (uveal invasion), and 12 stage IIb1 (postlaminar optic nerve invasion and cut end free of tumor). Eleven patients had neither eye enucleated. Median follow-up was 60 months. Only two events occurred: one patient had progressive disease in the contralateral globe and died of CNS metastasis and another had an orbital relapse that was successfully treated. Both had choroidal invasion. Five-year pEFS and pOS were 0.97 and 0.98, respectively. Neither length of the optic nerve stump, tumor size, anterior chamber invasion, degree of differentiation, nor degree of ocular coat invasion correlated with increased risk of metastasis. CONCLUSIONS A subset of patients with retinoblastoma with low risk of relapse can be determined using histopathological evaluation of the invasion of ocular coats. Adjuvant chemotherapy is not warranted for patients with intraretinal extension and prelaminar optic nerve invasion. It is also probable that those patients with isolated choroidal invasion and those with postlaminar optic nerve extension with surgical margins clear of tumor do not need chemotherapy.
Collapse
Affiliation(s)
- G L Chantada
- Hematology-Oncology Unit, Hospital de Pediatría SAMIC, Buenos Aires, Argentina.
| | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
OBJECTIVES To assess the diagnostic process of retinoblastoma in a developing country. STUDY DESIGN Prospective survey of 95 consecutive parents of patients with retinoblastoma. RESULTS Fifty six parents consulted initially with a paediatrician. Their children tended to be younger, with a significantly higher frequency of advanced disease. Only half of the patients who consulted with a paediatrician were appropriately referred to an ophthalmologist; the paediatrician underestimated the complaints in the remainder. Children taken to an ophthalmologist were older and had less advanced disease. In about three quarters of these children, a diagnosis of retinoblastoma was suspected by the ophthalmologist on the first visit. Parents of patients with more advanced disease consulted significantly later. Poor parental education correlated significantly with late consultation. Lack of health insurance and living outside Buenos Aires City correlated significantly with an increased risk of extraocular disease. CONCLUSIONS Paediatricians are the first health professional seen by most children with retinoblastoma. However, the diagnosis is not readily established. There is also a delay in consultation by parents, which is significantly longer in cases with advanced extraocular disease. Socioeconomic factors and access to health care might play a role in delayed diagnosis.
Collapse
Affiliation(s)
- G Chantada
- Servicio de Hemato-oncología, Hospital JP Garrahan, Buenos Aires, Argentina.
| | | | | | | | | |
Collapse
|
18
|
Arbetman A, Abdala M, Fandiño A, Herrera J, Baranzini S, Borelina D, Parma D, Manzitti J, Barreiro C, Giliberto F, Szijan I. Clinical, cytogenetic, and molecular testing of Argentine patients with retinoblastoma. J AAPOS 1998; 2:102-7. [PMID: 10530971 DOI: 10.1016/s1091-8531(98)90072-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study is to determine the clinical, chromosomal, and molecular characteristics of Argentine patients with unilateral and bilateral retinoblastoma. STUDY DESIGN Eighty-six patients belonging to 82 families were studied; 59% of them were examined during the first year of life. Leukocoria was the most common reason for consultation. Other presenting signs were strabismus and glaucoma. Enucleation of the affected eye was performed in 85% of the cases and the complication rate was 13%. RESULTS An appropriate therapy allowed the survival of 84 of the 86 patients. Two children with malformations and growth retardation had an abnormal karyotype with a deletion in 13q14. Segregation analysis of polymorphic sites within the retinoblastoma gene and the parental origin of the allele lost in the tumor were analyzed in 30 of the 82 families. Five mutant alleles transmitted through the germline and six de novo germline mutant alleles were identified in 12 patients with hereditary retinoblastoma. Most de novo germline mutant alleles were paternally derived. Molecular analysis of nonhereditary retinoblastoma showed loss of heterozygosity in three of eight cases. From these, two maternal alleles and one paternal allele were lost, thus not indicating a significant difference in the parental origin for the lost allele. CONCLUSIONS These data are useful for deoxyribonucleic acid diagnosis of susceptibility to retinoblastoma in relatives of hereditary patients, even if mutations have not been identified.
Collapse
Affiliation(s)
- A Arbetman
- Genética y Biología Molecular, Facultad de Farmacia y Bioquímica, University of Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Schvartzman E, Chantada G, Fandiño A, de Dávila MT, Raslawski E, Manzitti J. Results of a stage-based protocol for the treatment of retinoblastoma. J Clin Oncol 1996; 14:1532-6. [PMID: 8622068 DOI: 10.1200/jco.1996.14.5.1532] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To describe the treatment of retinoblastoma at a single institution using a prospective protocol based on histopathologic staging. PATIENTS AND METHODS We included 116 consecutive patients (101 eligible, 46 bilateral) from August 1987 to December 1993. Treatment was enucleation or conservative therapy for intraocular disease (stage I patients). Stage II patients (orbital or postlaminar invasion) received vincristine, cyclophosphamide, and doxorubicin for 57 weeks. Patients with orbital mass and extension beyond the cut end of the optic nerve also received orbital radiotherapy (45 Gy). The latter received intrathecal therapy. In those with CNS (stage III) or hematogenous metastasis (stage IV), cisplatin and etoposide were added along with cranial (in patients with a CNS mass and prophylactically in stage IV) or craniospinal (in patients with positive CSF) radiotherapy. RESULTS The median follow-up time was 39 months (range, 12 to 84). The overall survival rate was 0.84. Survival rates according to stage were as follows: stage I probability of overall survival [pOS] = 0.97) (alive/total), 59 of 60; stage II (pOS = 0.85) including patients with scattered episcleral cells, three of three; orbital mass, one of one; postlaminar invasion up to and beyond the cut end of optic nerve, 10 of 11 and 11 of 14, respectively; of stage III (pOS = 0), zero of six; and stage IV (pOS = 0.50), three of six. Only those patients with preauricular adenopathy as the only metastatic site survived in the latter group. Acute toxicity was mild. CONCLUSION Chemotherapy is not warranted to prevent systemic metastasis for intraocular disease. Patients with extraocular orbital disease and had a good outcome with this therapy. Patients with metastatic disease fared poorly, except for those with isolated malignant preauricular adenopathy.
Collapse
Affiliation(s)
- E Schvartzman
- Department of Hematooncology, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | | | | | | | | | | |
Collapse
|
20
|
Meli FJ, Boccaleri CA, Manzitti J, Lylyk P. Meningeal dissemination of retinoblastoma: CT findings in eight patients. AJNR Am J Neuroradiol 1990; 11:983-6. [PMID: 2121004 PMCID: PMC8334100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Thirty-seven patients with retinoblastoma were evaluated prospectively by clinical examination, lumbar puncture, and CT. Eight (22%) of the 37 were found to have meningeal dissemination. The tumor was bilateral in three patients. Two cases showed no CT signs of local recurrence. Headache, nausea/vomiting, and restlessness were the most common symptoms. CT scans in these patients showed diffuse meningeal contrast enhancement, nodular masses, ependymal-subependymal enhancement, and ventricular dilatation. Our series of eight patients with meningeal spread illustrates a considerable range of dissemination patterns referable to retinoblastoma. One case illustrated the CT finding of multiple epidural metastases.
Collapse
Affiliation(s)
- F J Meli
- Department of Neuroimaging, Raul Carrea Institute for Neurological Research, Buenos Aires, Argentina
| | | | | | | |
Collapse
|