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Munier FL, Beck-Popovic M, Chantada GL, Cobrinik D, Kivelä TT, Lohmann D, Maeder P, Moll AC, Carcaboso AM, Moulin A, Schaiquevich P, Bergin C, Dyson PJ, Houghton S, Puccinelli F, Vial Y, Gaillard MC, Stathopoulos C. Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. "Alive, with good vision and no comorbidity". Prog Retin Eye Res 2019; 73:100764. [PMID: 31173880 DOI: 10.1016/j.preteyeres.2019.05.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.
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Affiliation(s)
- Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland.
| | - Maja Beck-Popovic
- Unit of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Guillermo L Chantada
- Hemato-Oncology Service, Hospital JP Garrahan, Buenos Aires, Argentina; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - David Cobrinik
- The Vision Center and The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA; USC Roski Eye Institute, Department of Biochemistry & Molecular Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tero T Kivelä
- Department of Ophthalmology, Ocular Oncology and Pediatric Ophthalmology Services, Helsinki University Hospital, Helsinki, Finland
| | - Dietmar Lohmann
- Eye Oncogenetics Research Group, Institute of Human Genetics, University Hospital Essen, Essen, Germany
| | - Philippe Maeder
- Unit of Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Annette C Moll
- UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Angel Montero Carcaboso
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Alexandre Moulin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paula Schaiquevich
- Unit of Clinical Pharmacokinetics, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Ciara Bergin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paul J Dyson
- Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015, Lausanne, Switzerland
| | - Susan Houghton
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Francesco Puccinelli
- Interventional Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yvan Vial
- Materno-Fetal Medicine Unit, Woman-Mother-Child Department, University Hospital of Lausanne, Switzerland
| | - Marie-Claire Gaillard
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
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AlAli A, Kletke S, Gallie B, Lam WC. Retinoblastoma for Pediatric Ophthalmologists. Asia Pac J Ophthalmol (Phila) 2018; 7:160-168. [PMID: 29737052 DOI: 10.22608/apo.201870] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Retinoblastoma can present in 1 or both eyes and is the most common intraocular malignancy in childhood. It is typically initiated by biallelic mutation of the RB1 tumor suppressor gene, leading to malignant transformation of primitive retinal cells. The most common presentation is leukocoria, followed by strabismus. Heritable retinoblastoma accounts for 45% of all cases, with 80% being bilateral. Treatment and prognosis of retinoblastoma is dictated by the disease stage at initial presentation. The 8th Edition American Joint Committee on Cancer (AJCC) TNMH (tumor, node, metastasis, heritable trait) staging system defines evidence-based clinical and pathological staging for overall prognosis for eye(s) and child. Multiple treatment options are available in 2018 for retinoblastoma management with a multidisciplinary team, including pediatric ocular oncology, medical oncology, radiation oncology, genetics, nursing, and social work. Survival exceeds 95% when disease is diagnosed early and treated in centers specializing in retinoblastoma. However, survival rates are less than 50% with extraocular tumor dissemination. We summarize the epidemiology, genetics, prenatal screening, diagnosis, classification, investigations, and current therapeutic options in the management of retinoblastoma.
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Affiliation(s)
- Alaa AlAli
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada
| | - Stephanie Kletke
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada
| | - Brenda Gallie
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada
- Techna Institute, University Health Network, Toronto, Canada
- Departments of Molecular Genetics and Medical Biophysics, University of Toronto, Toronto, Canada
| | - Wai-Ching Lam
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada
- Department of Ophthalmology, The University of Hong Kong, Hong Kong
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Challenges and differences in external radiation therapy for retinoblastoma: from standard techniques to new developments. TUMORI JOURNAL 2017; 103:438-442. [PMID: 26350182 DOI: 10.5301/tj.5000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/20/2022]
Abstract
AIMS The purpose of this study is to calculate the treatment plans and to compare the dose distributions and dose-volume histograms (DVH) for 6 external radiotherapy techniques for the treatment of retinoblastoma as well as intensity-modulated radiotherapy (IMRT) and fractionated stereotactic radiotherapy (Cyberknife). METHODS Treatment plans were developed using 6 techniques, including an en face electron technique (ET), an anterior and lateral wedge photon technique (LFT), a 3D conformal (6 fields) technique (CRT), an inverse plan IMRT, tomotherapy, and conventional focal stereotactic external beam radiotherapy with Cyberknife (SBRT). Dose volume analyses were carried out for each technique. RESULTS All techniques except electron provided similar target coverage. When comparing conformal plan with IMRT and SBRT, there was no significant difference in planning target volume dose distribution. The mean volume of ipsilateral bony orbit received more than 20 Gy, a suggested threshold for bone growth inhibition. The V20 Gy was 73% for the ET, 57% for the LFT, 87% for the CRT, 65% for the IMRT, 66% for the tomotherapy, and 2.7% for the SBRT. CONCLUSIONS This work supports the potential use of IMRT and SBRT to spare normal tissues in these patients.
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Soliman SE, Dimaras H, Khetan V, Gardiner JA, Chan HSL, Héon E, Gallie BL. Prenatal versus Postnatal Screening for Familial Retinoblastoma. Ophthalmology 2016; 123:2610-2617. [PMID: 27712844 DOI: 10.1016/j.ophtha.2016.08.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/21/2016] [Accepted: 08/23/2016] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To compare overall outcomes of conventional postnatal screening of familial retinoblastoma and prenatal RB1 mutation identification followed by planned early-term delivery. DESIGN Retrospective, observational study. PARTICIPANTS Twenty children with familial retinoblastoma born between 1996 and 2014 and examined within 1 week of birth. METHODS Cohort 1 included spontaneously delivered neonates examined within 1 week of birth and confirmed postnatal to carry their family's RB1 mutant allele. Cohort 2 included infants identified by amniocentesis to carry their family's RB1 mutant allele, and therefore scheduled for early-term delivery (36-38 weeks' gestation). Treatment for retinoblastoma was performed at the Hospital for Sick Children, Toronto, Canada. MAIN OUTCOME MEASURES Age at first tumor in each eye, eye stage, treatments given, ocular salvage, treatment success (defined as avoidance of enucleation, external-beam irradiation, or both), visual outcome, number of anesthetics, pregnancy or delivery complications, and estimated treatment burden. RESULTS Vision-threatening tumors were present at birth in 4 of 8 infants in cohort 1 and in 3 of 12 infants in cohort 2. Eventually, all infants demonstrated tumors in both eyes. At the first treatment, 1 of 8 infants in cohort 1 had eyes in stage cT1a/cT1a or cT1a/cT0 (smallest and least vision-threatening tumors), compared with 8 of 12 infants in cohort 2 (P = 0.02). Null RB1 germline alleles induced earlier tumors than low-penetrance alleles (P = 0.03). Treatment success was achieved in 3 of 8 children in cohort 1 compared with 11 of 12 children in cohort 2 (P = 0.002). Acceptable vision (better than 0.2 decimal) was achieved for 8 of 16 eyes in cohort 1 compared with 21 of 24 eyes in cohort 2 (P = 0.014). Useful vision (better than 0.1, legal blindness) was achieved for 8 of 9 children in cohort 1 compared with 12 of 12 children in cohort 2. There were no complications related to early-term delivery. Median follow-up was 5.6 years, cohort 1 and 5.8 years, cohort 2. CONCLUSIONS When a parent had retinoblastoma, prenatal molecular diagnosis with early-term delivery increased the likelihood of infants born with no detectable tumors, better vision outcomes, and less invasive therapy. Prenatal molecular diagnosis facilitates anticipatory planning for both the child and family.
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Affiliation(s)
- Sameh E Soliman
- Departments of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Helen Dimaras
- Departments of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology & Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Vikas Khetan
- Departments of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology, Sankara Nethralaya Hospital, Chennai, India
| | - Jane A Gardiner
- Departments of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Science, University of British Columbia, Vancouver, Canada
| | - Helen S L Chan
- Division of Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elise Héon
- Departments of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology & Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Visual Sciences, Toronto Western Research Institute, Toronto, Canada
| | - Brenda L Gallie
- Departments of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology & Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada; Departments of Molecular Genetics and Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Canada.
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Soliman SE, Dimaras H, Souka AA, Ashry MH, Gallie BL. Socioeconomic and psychological impact of treatment for unilateral intraocular retinoblastoma. J Fr Ophtalmol 2015; 38:550-8. [PMID: 25982424 DOI: 10.1016/j.jfo.2015.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/12/2015] [Accepted: 03/20/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE To identify the socioeconomic and psychosocial impacts of clinical treatment decisions for advanced unilateral intraocular retinoblastoma. DESIGN Retrospective observational case series. METHODS SETTING institutional study at Alexandria Main University Hospital. STUDY POPULATION records of 66 unilateral retinoblastoma cases treated from May 2005 to May 2013 were retrospectively reviewed. Sixty cases were eligible (International Intraocular Retinoblastoma Classification [IIRC] group C, D or E). PROCEDURES two treatment groups were compared: enucleation vs. salvage treatment. Salvage treatment eyes were further subdivided based on IIRC group. Six socioeconomic parameters (financial burden, financial impact, psychological, social, medical and tumor impacts) were scored. Parameter scores ranged from 0 to 3, for overall score range 0 (no adverse impact) to 18 (severe adverse impact). MAIN OUTCOME MEASURES derived Socioeconomic scores were correlated with treatment and outcomes. RESULTS The enucleation group (28 eyes) had a median overall Socioeconomic score of 4/18, significantly lower than the salvage treatment group (32 eyes), median score 11/18 (P<0.01). Socioeconomic score varied with IIRC group. Attempted eye salvage failed in 25 children, due to uncontrolled tumor (44%) and socioeconomic impact of cumulative therapies (56%). Treatment duration and Socioeconomic score were higher for the 5 children in the salvage treatment group who developed metastatic disease compared to those without metastasis (P<0.01). CONCLUSIONS The socioeconomic and psychosocial impacts of attempted ocular salvage for unilateral intraocular retinoblastoma are severe, in comparison to primary enucleation. Primary enucleation is a good treatment for unilateral retinoblastoma.
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Affiliation(s)
- S E Soliman
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt; Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, 555 University Avenue, Room 7265, Toronto ON M5G 1X8, Canada.
| | - H Dimaras
- Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, 555 University Avenue, Room 7265, Toronto ON M5G 1X8, Canada; Division of Visual Science, Toronto Western Research Institute, Toronto, Canada
| | - A A Souka
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - M H Ashry
- Community Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - B L Gallie
- Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, 555 University Avenue, Room 7265, Toronto ON M5G 1X8, Canada; Division of Visual Science, Toronto Western Research Institute, Toronto, Canada; Department of Ophthalmology & Visual Science, Hospital for Sick Children, Toronto, Canada; Princess Margaret Cancer Centre, Toronto, Canada; Departments of Ophthalmology & Visual Sciences, Medical Biophysics and Molecular Genetics, University of Toronto, Toronto, Canada
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Abstract
Retinoblastoma is an aggressive eye cancer of infancy and childhood. Survival and the chance of saving vision depend on severity of disease at presentation. Retinoblastoma was the first tumour to draw attention to the genetic aetiology of cancer. Despite good understanding of its aetiology, mortality from retinoblastoma is about 70% in countries of low and middle income, where most affected children live. Poor public and medical awareness, and an absence of rigorous clinical trials to assess innovative treatments impede progress. Worldwide, most of the estimated 9000 newly diagnosed patients every year will die. However, global digital communications present opportunities to optimise standards of care for children and families affected by this rare and often devastating cancer. Parents are now leading the effort for widespread awareness of the danger of leucocoria. Genome-level technologies could make genetic testing a reality for every family affected by retinoblastoma. Best-practice guidelines, online sharing of pathological images, point-of-care data entry, multidisciplinary research, and clinical trials can reduce mortality. Most importantly, active participation of survivors and families will ensure that the whole wellbeing of the child is prioritised in any treatment plan.
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Affiliation(s)
- Helen Dimaras
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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Eldebawy E, Patrocinio H, Evans M, Hashem R, Nelson S, Sidi R, Freeman C. Stereotactic radiotherapy as an alternative to plaque brachytherapy in retinoblastoma. Pediatr Blood Cancer 2010; 55:1210-2. [PMID: 20589649 DOI: 10.1002/pbc.22653] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Radioactive plaque brachytherapy has an established role for selected patients with retinoblastoma. Newer non-invasive radiotherapy techniques such as stereotactic conformal radiotherapy (SCR) that uses highly accurate positioning to deliver treatment with small beams may be an interesting alternative to brachytherapy. We report a case treated with SCR and compare the dosimetry with that achievable with brachytherapy. With advantages and disadvantages to both, SCR should more often be considered in the management of RB because of the more homogeneous dose within the target volume and similar or lower doses to surrounding normal tissues.
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Affiliation(s)
- Eman Eldebawy
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
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Preliminary experience in treatment of papillary and macular retinoblastoma: evaluation of local control and local complications after treatment with linear accelerator-based stereotactic radiotherapy with micromultileaf collimator as second-line or salvage treatment after chemotherapy. Int J Radiat Oncol Biol Phys 2010; 81:1380-6. [PMID: 20932660 DOI: 10.1016/j.ijrobp.2010.07.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 07/08/2010] [Accepted: 07/13/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the local control and complication rates for children with papillary and/or macular retinoblastoma progressing after chemotherapy and undergoing stereotactic radiotherapy (SRT) with a micromultileaf collimator. METHODS AND MATERIALS Between 2004 and 2008, 11 children (15 eyes) with macular and/or papillary retinoblastoma were treated with SRT. The mean age was 19 months (range, 2-111). Of the 15 eyes, 7, 6, and 2 were classified as International Classification of Intraocular Retinoblastoma Group B, C, and E, respectively. The delivered dose of SRT was 50.4 Gy in 28 fractions using a dedicated micromultileaf collimator linear accelerator. RESULTS The median follow-up was 20 months (range, 13-39). Local control was achieved in 13 eyes (87%). The actuarial 1- and 2-year local control rates were both 82%. SRT was well tolerated. Late adverse events were reported in 4 patients. Of the 4 patients, 2 had developed focal microangiopathy 20 months after SRT; 1 had developed a transient recurrence of retinal detachment; and 1 had developed bilateral cataracts. No optic neuropathy was observed. CONCLUSIONS Linear accelerator-based SRT for papillary and/or macular retinoblastoma in children resulted in excellent tumor control rates with acceptable toxicity. Additional research regarding SRT and its intrinsic organ-at-risk sparing capability is justified in the framework of prospective trials.
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National Retinoblastoma Strategy Canadian Guidelines for Care: Stratégie thérapeutique du rétinoblastome guide clinique canadien. Can J Ophthalmol 2010; 44 Suppl 2:S1-88. [PMID: 20237571 DOI: 10.3129/i09-194] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Choi SY, Kim MS, Yoo S, Cho C, Ji Y, Kim K, Seo Y, Park KD, Lee J, Lee TW. Long term follow-up results of external beam radiotherapy as primary treatment for retinoblastoma. J Korean Med Sci 2010; 25:546-51. [PMID: 20357996 PMCID: PMC2844604 DOI: 10.3346/jkms.2010.25.4.546] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 08/18/2009] [Indexed: 11/20/2022] Open
Abstract
The authors reviewed their experiences of external beam radiotherapy (EBR) as an initial treatment in retinoblastoma patients to determine its long-term effect on subsequent tumor control and complications. A total of 32 eyes in 25 patients that underwent EBR for retinoblastoma were reviewed retrospectively. The patients consisted of 21 boys and 4 girls of median age at treatment of 7.1 months. Radiation doses ranged from 35 to 59.4 Gy. The 10-yr ocular and patient survivals were 75.4% and 92.3%, respectively. Nine of the 32 eyes progressed; 7 of these were enucleated and 2 were salvaged by focal treatment. According to the Reese-Ellsworth classification, 4 of 5 eyes of Group II, 13 of 16 Group III eyes, 2 of 4 Group IV eyes, and 5 of 7 Group V eyes were retained, and of the 32 eyes, 13 had visual acuity better than 20/200. Eleven patients experienced a radiation-induced complication. No patient developed a second malignancy during follow-up. Despite the limited number of patients enrolled, EBR may provide a mean of preserving eyeball and vision for some advanced lesions.
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Affiliation(s)
- Sang Yul Choi
- Department of Ophthalmology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - SungYul Yoo
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - ChulKoo Cho
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - YoungHoon Ji
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - KumBae Kim
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - YoungSeok Seo
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Kyung Duk Park
- Department of Pediatrics, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - JunAh Lee
- Department of Pediatrics, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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Sahgal A, Ma L, Chang E, Shiu A, Larson DA, Laperriere N, Yin FF, Tsao M, Menard C, Basran PS, Létourneau D, Heydarian M, Beachey D, Shukla V, Cusimano M, Hodaie M, Zadeh G, Bernstein M, Schwartz M. Advances in technology for intracranial stereotactic radiosurgery. Technol Cancer Res Treat 2009; 8:271-80. [PMID: 19645520 DOI: 10.1177/153303460900800404] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Stereotactic radiosurgery (SRS) refers to a single radiation treatment delivering a high dose to an intra-cranial target localized in three-dimensions by CT and/or MRI imaging. Traditionally, immobilization of the patient's head has been achieved using a rigid stereotactic head frame as the key step in allowing for accurate dose delivery. SRS has been delivered by both Cobalt-60 (Gamma Knife) and linear accelerator (linac) technologies for many decades. The focus of this review is to highlight recent advances and major innovations in SRS technologies relevant to clinical practice and developments allowing for non-invasive frame SRS.
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Affiliation(s)
- Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, the Princess Margaret Hospital, and the Joey Toby Tanenbaum family Gamma Knife Center, University of Toronto, Toronto, Ontario, Canada.
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Gallie BL, Zhao J, Vandezande K, White A, Chan HSL. Global issues and opportunities for optimized retinoblastoma care. Pediatr Blood Cancer 2007; 49:1083-90. [PMID: 17943957 DOI: 10.1002/pbc.21350] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The RB1 gene is important in all human cancers. Studies of human retinoblastoma point to a rare retinal cell with extreme dependency on RB1 for initiation but not progression to full malignancy. In developed countries, genetic testing within affected families can predict children at high risk of retinoblastoma before birth; chemotherapy with local therapy often saves eyes and vision; and mortality is 4%. In less developed countries where 92% of children with retinoblastoma are born, mortality reaches 90%. Global collaboration is building for the dramatic change in mortality that awareness, simple expertise and therapies could achieve in less developed countries.
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Affiliation(s)
- Brenda L Gallie
- Retinoblastoma Program, Hospital for Sick Children and Applied Molecular Oncology, Ontario Cancer Institute/Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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