1
|
Meel R, Kulkarni S, Singh L, Chinnaswamy G, Radhakrishnan V, Madan R, Sasi A, Kaur T, Dhaliwal RS, Bakhshi S. Management of Intraocular Retinoblastoma: ICMR Consensus Guidelines. Indian J Pediatr 2024:10.1007/s12098-024-05095-0. [PMID: 38609685 DOI: 10.1007/s12098-024-05095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/01/2024] [Indexed: 04/14/2024]
Abstract
Retinoblastoma (RB) is the most common childhood intraocular malignancy. Delayed presentation due to a lack of awareness and advanced intraocular tumors are a common scenario in low-middle income countries (LMICs). Remarkable treatment advances have been made in the past few decades allowing globe salvage in advanced intraocular RB (IORB) including systemic chemotherapy with focal consolidation and targeted treatments like intraarterial chemotherapy and intravitreal chemotherapy. However, a lack of availability and affordability limits the use of such advances in LMICs. External beam radiotherapy, despite risk of second cancers in RB with germline mutations, still remains useful for recalcitrant RB not responding to any other treatment. When choosing conservative treatment for advanced IORB, the cost and long duration of treatment, morbidity from multiple evaluation under anesthesias (EUAs), side effects of treatment and risk of treatment failure need to be taken into account and discussed with the parents. In this article, the authors discuss the ICMR consensus guidelines on the management of IORB.
Collapse
Affiliation(s)
- Rachna Meel
- Department of Oculoplasty and Ocular Oncology Services, Dr. Rajendra Prasad Centre of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110 029, India.
| | - Suyash Kulkarni
- Department of Interventional Radiology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Lata Singh
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Venkatraman Radhakrishnan
- Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Tanvir Kaur
- Division of Non-communicable Diseases (NCD Division), Indian Council of Medical Research (ICMR), New Delhi, India
| | - R S Dhaliwal
- Division of Non-communicable Diseases (NCD Division), Indian Council of Medical Research (ICMR), New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
2
|
Naseripour M, Mirshahi R, Kasraei H, Sedaghat A, Azimi F. Spotlight on Targeted Chemotherapy in Retinoblastoma: Safety, Efficacy, and Patient Outcomes. Onco Targets Ther 2022; 15:1545-1561. [PMID: 36579184 PMCID: PMC9792108 DOI: 10.2147/ott.s370878] [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: 08/02/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
As the most common primary intraocular malignancy of childhood, retinoblastoma (RB) has had a complex journey in its management, following a course from enucleation as the first life-saving treatment to numerous globe-salvaging therapies during the last century. Currently, this potentially lethal disease has achieved high survival rates owing to multidisciplinary management and the introduction of neoadjuvant and multimodal chemotherapy. Therefore, the goal of treatment is shifting toward conserving the globe and vision as much as possible. Up until recently, many advanced cases of RB were enucleated primarily; however, targeted chemotherapy via the ophthalmic artery and management of intraocular seeding by local administration of chemotherapeutic agents have revolutionized the globe-conserving therapies. The added benefit of avoiding systemic complications of cytotoxic drugs resulted in these methods gaining popularity, and they are becoming a main part of care in many referral centers. Initially, there were some safety concerns regarding these approaches; however, increasing experience has shown that these modalities are relatively safe procedures and many complications can be averted by changing the choice of the drug and using some prophylactic measures. It is hoped that, in the near future, with advances in early diagnosis and patient-targeted molecular therapies, as well as gene-editing techniques, the patient's vision can be saved even in advanced RB.
Collapse
Affiliation(s)
- Masood Naseripour
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran,Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran,Correspondence: Masood Naseripour, Department of Ophthalmology, Iran University of Medical Sciences (IUMS), Rassoul Akram Hospital, Niayesh Ave, 14455-364, Tehran, Iran, Fax +98 21 66509162, Email
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran,Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hengameh Kasraei
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Sedaghat
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Azimi
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
The Safety and Effectiveness of Melphalan-Based Intra-Arterial Chemotherapy for Retinoblastoma: An Updated Single-Arm Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3156503. [PMID: 35198033 PMCID: PMC8860512 DOI: 10.1155/2022/3156503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/18/2022]
Abstract
Melphalan-based intra-arterial chemotherapy was considered an innovative treatment for retinoblastoma patients because high rates of globe salvage could be obtained. Now it has been widely applied for primary or secondary treatment of retinoblastoma. This meta-analysis summarizes the most up-to-date evidence regarding the safety and effectiveness of melphalan-based intra-arterial chemotherapy in the treatment of retinoblastoma. The authors searched PubMed, EMBASE, and the Web of Science electronic databases for studies investigating the safety and effectiveness of melphalan-based intra-arterial chemotherapy in the treatment of retinoblastoma. Studies reporting outcomes and complications of melphalan-based intra-arterial chemotherapy for the treatment of retinoblastoma patients would be included. A total of 33 observational studies that involved 1900 patients and 2336 eyes were included. The overall globe salvage rate was 79.6% (773/971 eyes, 0.74 [95% CI: 0.66, 0.80]) for patients treated with IAC as primary therapy in 28 studies. The overall globe salvage rate was 66.4% (923/1391 eyes, 0.68 [95% CI: 0.60, 0.76]) for patients treated with IAC as secondary therapy in 25 studies. The most common ocular complications were retinopathy (32%) and palpebral edema (29.7%). The most common systemic complications were nausea/vomiting (20.9%). The overall metastasis rate was 1.1% (21/1793 patients, 0.038 [95% CI: 0.020, 0.038]). Twenty-nine studies that involved 1783 patients reported the mortality and the overall mortality was 1.5% (26/1783 patients, 0.029 [95% CI: 0.020, 0.048]). Our meta-analysis showed that melphalan-based IAC treatment was an option for retinoblastoma patients with acceptable efficacy according to retrospective studies. Further high-quality randomized control trials are necessary to provide more accurate and reliable results.
Collapse
|
4
|
Promelle V, Muthusami P, Kletke SN, Shaikh F, Gallie BL, Mallipatna A. Correspondence on 'Intra-arterial chemotherapy for retinoblastoma: an updated systematic review and meta-analysis' by Ravindran et al. J Neurointerv Surg 2022; 14:e6. [PMID: 35017205 DOI: 10.1136/neurintsurg-2021-018409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/12/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Veronique Promelle
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Prakash Muthusami
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephanie N Kletke
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Furqan Shaikh
- Department of Hematology Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brenda L Gallie
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Ashwin Mallipatna
- Department of Ophthalmology and Visual Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada .,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Liao A, Hsieh T, Francis JH, Lavery JA, Mauguen A, Brodie SE, Abramson DH. TOXICITY AND EFFICACY OF INTRAVITREAL MELPHALAN FOR RETINOBLASTOMA: 25 µg Versus 30 µg. Retina 2021; 41:208-212. [PMID: 32106160 PMCID: PMC7483207 DOI: 10.1097/iae.0000000000002782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare retinal toxicity as measured by electroretinogram, ocular, and patient survival in retinoblastoma treated with intravitreal melphalan at two concentrations (25 vs. 30 µg). METHODS Single-center, retrospective analysis of retinoblastoma eyes receiving 25-µg or 30-µg intravitreal melphalan from September 2012 to January 2019. Ocular toxicity was measured by electroretinogram of evaluable injections in 449 injections in 136 eyes. A repeated-measures linear mixed model with a random intercept and slope was applied to account for repeated measures for each eye. RESULTS Average decline in electroretinogram after each additional injection was -4.9 µV (95% confidence interval -6.3 to -3.4); electroretinogram declined by -4.6 µV (95% confidence interval -7.0 to -2.2) after 25-µg injections and -5.2 µV (95% confidence interval -6.6 to -3.8) after 30-µg injections (P = 0.66). Injection at a new clock site hour was associated with a -3.91-µV lower average (95% confidence interval -7.8 to -0.04). CONCLUSION Electroretinogram-measured toxicity in retinoblastoma eyes treated with intravitreal injections was not found to be different across 25-µg and 30-µg injections. There were no cases of extraocular extension or metastatic deaths in our patient population.
Collapse
Affiliation(s)
- Albert Liao
- Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York NY 10065
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA 30322
| | - Terry Hsieh
- Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York NY 10065
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095
| | - Jasmine H. Francis
- Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York NY 10065
- Dept. of Ophthalmology, Weill-Cornell Medical Center, New York, NY 10065
| | - Jessica A. Lavery
- Dept. of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York NY 10065
| | - Audrey Mauguen
- Dept. of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York NY 10065
| | - Scott E. Brodie
- Dept. of Ophthalmology, NYU Langone Health, New York, N.Y. 10017
| | - David H. Abramson
- Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York NY 10065
- Dept. of Ophthalmology, Weill-Cornell Medical Center, New York, NY 10065
| |
Collapse
|
6
|
Sweid A, El Naamani K, Sajja KC, Hammoud B, Knapp MD, Moylan DD, Joffe D, Morse CE, Habbal D, Weinberg JH, Tjoumakaris SI, Shields CL, Lezama DA, Lim LAS, Dalvin LA, Rosenwasser R, Jabbour P. Incidence and predictors of ophthalmic artery occlusion in intra-arterial chemotherapy for retinoblastoma. J Neurointerv Surg 2020; 13:652-656. [PMID: 33122349 DOI: 10.1136/neurintsurg-2020-016759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Retinoblastoma is the most common primary intraocular malignancy in children. OBJECTIVE To determine the incidence of ophthalmic artery (OA) occlusion in patients treated with selective ophthalmic artery catheterization (OAC) for chemotherapy infusion for retinoblastoma. Also, to evaluate technical, anatomical, tumorous, and patient-related factors that are predictors of OA occlusion. METHODS A retrospective chart review was performed for patients diagnosed with intraocular retinoblastoma and managed with intra-arterial chemotherapy (IAC). RESULTS The total study cohort included 208 retinoblastoma tumors of 208 eyes in 197 consecutive patients who underwent 688 attempted IAC infusions overall with a total of 624 successful OAC infusions. The total incidence of ophthalmic artery thrombosis was 11.1% (23/208). The numbers of successful OAC procedures before diagnosing OA occlusion were one OAC in six cases (27.3%), two in seven cases (31.8%), three in four cases (18.2%), four in one case (4.5%), five in two cases (9.1%), and six in one case (4.5%). CONCLUSIONS Local factors relating to the chemotherapy and selective microcatheterization of the OA are essential factors in the development of OA thrombosis, as seen by the association of OA thrombosis with the frequency of IAC.
Collapse
Affiliation(s)
- Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University - Center City Campus, Philadelphia, Pennsylvania, USA
| | - Kareem El Naamani
- School of Medicine, Lebanese American University, Beirut, Beirut, Lebanon
| | | | - Batoul Hammoud
- Department of Endocrinology, CHOP, Philadelphia, Pennsylvania, USA
| | - Michael D Knapp
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Daniel D Moylan
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Daniel Joffe
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Charles E Morse
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Daniel Habbal
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University - Center City Campus, Philadelphia, Pennsylvania, USA
| | - Stavropoula I Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University - Center City Campus, Philadelphia, Pennsylvania, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - David A Lezama
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Instituto de Oftalmologia y Ciencias Visuales, Tecnologico de Monterrey, Monterrey, Mexico
| | - Li-Anne S Lim
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University - Center City Campus, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University - Center City Campus, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Abstract
Background:
This review investigates the ophthalmic drugs that have been studied with
voltammetry in the web of science database in the last 10 years.
Introduction:
Ophthalmic drugs are used in the diagnosis, evaluation and treatment of various ophthalmological
diseases and conditions. A significant literature has emerged in recent years that investigates
determination of these active compounds via electroanalytical methods, particularly voltammetry. Low
cost, rapid determination, high availability, efficient sensitivity and simple application make voltammetry
one of the most used methods for determining various kinds of drugs including ophthalmic ones.
Methods:
In this particular review, we searched the literature via the web of science database for ophthalmic
drugs which are investigated with voltammetric techniques using the keywords of voltammetry,
electrochemistry, determination and electroanalytical methods.
Results:
We found 33 types of pharmaceuticals in nearly 140 articles. We grouped them clinically into
seven major groups as antibiotics, antivirals, non-steroidal anti-inflammatory drugs, anti-glaucomatous
drugs, steroidal drugs, local anesthetics and miscellaneous. Voltammetric techniques, electrodes, optimum
pHs, peak potentials, limit of detection values, limit of quantification values, linearity ranges,
sample type and interference effects were compared.
Conclusion:
Ophthalmic drugs are widely used in the clinic and it is important to determine trace
amounts of these species analytically. Voltammetry is a preferred method for its ease of use, high sensitivity,
low cost, and high availability for the determination of ophthalmic drugs as well as many other
medical drugs. The low limits of detection values indicate that voltammetry is quite sufficient for determining
ophthalmic drugs in many media such as human serum, urine and ophthalmic eye drops.
Collapse
Affiliation(s)
- Onur Inam
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ersin Demir
- Department of Analytical Chemistry, Faculty of Pharmacy, Afyonkarahisar University of Health Sciences, Afyonkarahisar, 03200, Turkey
| | - Bengi Uslu
- Department of Analytical Chemistry, Ankara University, Faculty of Pharmacy, Ankara, Turkey
| |
Collapse
|
8
|
Ravindran K, Dalvin LA, Pulido JS, Brinjikji W. Intra-arterial chemotherapy for retinoblastoma: an updated systematic review and meta-analysis. J Neurointerv Surg 2019; 11:1266-1272. [DOI: 10.1136/neurintsurg-2019-014909] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 01/25/2023]
Abstract
Background and purposeIntra-arterial chemotherapy for retinoblastoma has been adopted as a first-line treatment option by numerous tertiary centers. The effect of intra-arterial chemotherapy on future rates of metastatic disease as well as on globe salvage in advanced eyes remains relatively unknown.MethodsA search of PubMED, MEDLINE, EMBASE, and Web of Science electronic databases was conducted from inception until January 2019 for studies with a minimum of 10 patients reporting outcomes and complications following intra-arterial chemotherapy for retinoblastoma.ResultsA total of 20 studies met the inclusion criteria for analysis, comprising 873 patients and 1467 eyes. Only one study was comparative; there was substantial heterogeneity in reported outcomes and several overlapping patient cohorts that were published. Across all studies, 174 of 1467 eyes were enucleated (11.8%). Metastatic disease occurred in 8 of 513 patients (1.6%). Globe salvage was achieved in 318 of 906 (35.6%) cases of advanced retinoblastoma. The most common ocular complication was retinal detachment, occurring in 23% of eyes, and the most common systemic complications were transient fever and nausea/vomiting.ConclusionsThere is a paucity of higher-level evidence with adequate follow-up surrounding the long-term safety of intra-arterial chemotherapy and effect on metastasis in retinoblastoma. Studies to date have been limited by short-term follow-up. Longitudinal prospective studies could provide greater insight into the ability of intra-arterial chemotherapy to reduce the risk of retinoblastoma metastasis.
Collapse
|