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Khodabande A, Ghassemi F, Asadi Amoli F, Riazi‐Esfahani H, Mahmoudzadeh R, Mehrpour M, Valipour N. Ocular safety of repeated intravitreal injections of Carboplatin and Digoxin: A preclinical study on the healthy rabbits. Pharmacol Res Perspect 2021; 9:e00814. [PMID: 34250764 PMCID: PMC8273607 DOI: 10.1002/prp2.814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
To evaluate the ocular safety of intravitreal carboplatin and digoxin injections as a new intravitreal chemotherapy option for retinoblastoma tumor vitreous seeds. Eighteen rabbits were divided randomly into three groups to receive intravitreal injection of Digoxin (6 rabbits), Carboplatin (7 rabbits), or Saline (5 rabbits). In every group, one eye randomly treated with 10 µg Digoxin in 0.1 cc or 1 µg Carboplatin or Saline, and the contralateral eye was considered as the control. All groups underwent three consecutive injections of the drugs with 1-week intervals. Baseline electroretinography (ERG) was recorded from both eyes of all the animals prior to injection and was repeated 1st day, 1st week, and 1st month after the last injection. All rabbits were sacrificed 1 month after the last injection, and histological studies were done. Mean a and b wave amplitudes decreased significantly at 1st day, 1st week, and 1st month after the last intravitreal injection of 10 µg Digoxin in comparison with other groups (p-value: .02). Contradictory, 1 µg Carboplatin injected eyes had minimal ERG changes. There were some nonspecific ERG changes with unclear clinical significance in non-injected contralateral control eyes of Digoxin and Carboplatin groups in comparison with the control eyes of the Saline group. Histological studies revealed considerable neural retinal atrophy in injected eyes of the Digoxin group. Intravitreal 10 µg Digoxin might have more local ocular toxicity in comparison with intravitreal Carboplatin in albino rabbit eyes. Future studies should assess the induced toxicity of intravitreal injection of these drugs on the non-injected contralateral eye.
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Affiliation(s)
- Alireza Khodabande
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
| | - Fariba Ghassemi
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
| | - Fahimeh Asadi Amoli
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
| | - Hamid Riazi‐Esfahani
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
| | - Raziyeh Mahmoudzadeh
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
- Wills Eye HospitalMid Atlantic RetinaThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Mohammad Mehrpour
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
| | - Niloufar Valipour
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
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2
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Soliman S, Feng ZX, Gallie B. Primary laser therapy as monotherapy for discrete retinoblastoma. Br J Ophthalmol 2021; 106:878-883. [PMID: 33536230 DOI: 10.1136/bjophthalmol-2020-317885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/26/2020] [Accepted: 01/19/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND/AIM Laser photocoagulation is less invasive than chemotherapy (systemic, intra-arterial or periocular) and brachytherapy. We studied the safety and efficacy of laser as primary monotherapy for discrete retinoblastoma with well-defined borders and attached retina. METHODS A single-institution retrospective non-comparative review (2004-2018) of discrete retinoblastoma tumours managed with primary laser (532 or 810 nm wavelength, 0.5-1 s duration and power titrated until desired tumour whitening). Efficacy was evaluated by tumour long-term stability avoiding non-laser therapies. Safety was evaluated by frequency of laser-related complications and uncontrollable tumour progression. RESULTS Eligible were 112 tumours in 55 eyes of 44 patients. Laser monotherapy (median 2 sessions) achieved initial remission in 95/112 (85%) tumour. Initial encircling only laser photocoagulation was associated with tumour progression (9/11, one tumour had vitreous seeding) compared with direct or combined photocoagulation techniques (0/94 and 0/7 tumours, respectively, p<0.001). Direct laser had no vitreous seeding, haemorrhage or injury to vital structures. Tumour recurrences developed in 52/112 (46%) tumour but repeat laser achieved long-term stability, except five tumour recurrences that required invasive therapy. Receiver operating characteristic analysis identified threshold largest basal diameter of 3 disc diameters (DD) for successful laser monotherapy, where 92/106 (87%) of tumours ≤3 DD and 0/6>3 DD achieved long-term stability with laser monotherapy (p<0.001). Overall, 35/55 (64%) eyes and 24/44 (55%) patients achieved long-term stability with laser monotherapy. No eye was enucleated for uncontrollable tumour progression. CONCLUSIONS Discrete retinoblastoma ≤3 DD can be effectively and safely managed with laser monotherapy, sparing a significant proportion of patients/eyes from more invasive therapies.
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Affiliation(s)
- Sameh Soliman
- Ophthalmology, Alexandria University Faculty of Medicine, Alexandria, Egypt .,Ophthalmology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zhao Xun Feng
- Ophthalmology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brenda Gallie
- Ophthalmology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Ophthalmology, The University of Toronto, Toronto, Ontario, Canada
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3
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Reynolds MM, Sein J, Hayashi R, Lueder G. Treatment of small and medium retinoblastoma tumors with Iris diode laser. Eur J Ophthalmol 2021; 31:3318-3323. [PMID: 33530736 DOI: 10.1177/1120672121991390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Differing techniques have been reported for focal laser therapy for patients with small and medium retinoblastoma. We report the technique used at our center; and report the functional and anatomical outcomes for small and medium retinoblastomas treated with focal laser therapy with or without systemic chemotherapy. METHODS A retrospective case study was conducted including pediatric patients with macular retinoblastoma treated with systemic chemotherapy and laser ablation from July 1990 to July 2015 at Washington University School of Medicine/Saint Louis Children's Hospital. RESULTS Fourteen eyes (11 patients) with small and medium retinoblastoma tumors were treated with repetitive indirect laser hyperthermia and seven of those patients were treated with systemic chemotherapy as well. Using the International Retinoblastoma classification, one eye was stage A, 10 eyes were stage B, and three eyes were stage C. The mean follow-up time was 7.7 years. There were no recurrences of tumor in the patients. Final visual acuity outcomes were 20/20 to 20/50 in four eyes, 20/60 to 20/200 in four eyes, and 20/400 or less in six eyes. None of the patients developed metastatic disease. CONCLUSIONS The evidence for systemic chemotherapy and diode laser therapy is limited to case series and retrospective reviews, but evidence suggests that it is an effective treatment for small and medium sized retinoblastoma tumors involving the macula with the potential for good visual outcomes.
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Affiliation(s)
- Margaret M Reynolds
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Julia Sein
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert Hayashi
- Department of Hematology and Oncology, Saint Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregg Lueder
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Khaqan HA, Anil RR, Rocha de Lossada C, Martín FZ, Lorente MG, Pennisi F, Bonzano C, Borroni D. Globe salvage treatment in group D and group E retinoblastoma. Rom J Ophthalmol 2021; 65:20-24. [PMID: 33817429 PMCID: PMC7995513 DOI: 10.22336/rjo.2021.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 11/18/2022] Open
Abstract
Importance: Globe salvage marks the treatment success of retinoblastoma. Background: To evaluate four treatment strategies in group D and group E retinoblastoma. Design: Retrospective case series in a tertiary hospital. Participants: 81 patients with Group D and Group E retinoblastoma. Methods: Participants were divided into four sets. In set I, eyes received primary intravenous chemotherapy (IVC), cryotherapy (CT), laser therapy (LT) and Intravitreal Chemotherapy with Melphalan (IViC). In set II, primary IVC was combined with second line IVC, CT, LT and IVT-M. Set III eyes received primary IVC and Intra-arterial chemotherapy (IAC), CT, LT and IViC. Set IV eyes received IAC, CT, LT and IViC. Treatment failure was defined as inadequate response during or after IVC or IAC. Main Outcome Measures: globe salvage and enucleation rates. Results: 52 eyes were included in group D and 29 in group E. In group D, globe salvage was obtained in 8 out of 11 eyes in Set I, 13 out of 19 eyes in set II, 5 out 6 eyes in set III, and 13 out of 16 eyes in set IV. In group E, enucleation was performed in 17 eyes. Global salvage was obtained in 0 out of 2 eyes in set I, 2 out of 3 eyes in set II, 3 out of 5 in set III, and in 1 out of 2 eyes in set IV. Conclusions: IVC with adjuvant IAC, LT, CT and IViC has shown favorable results as a treatment method for group D and group E retinoblastoma.
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Affiliation(s)
- Hussain Ahmad Khaqan
- Ameer Ud Din Medical College, Lahore General Hospital, Post Graduate Medical Institute, Lahore, Pakistan
| | - Rahul Rachwani Anil
- Ameer Ud Din Medical College, Lahore General Hospital, Post Graduate Medical Institute, Lahore, Pakistan
| | | | | | - María García Lorente
- Department of Ophthalmology, Regional University Hospital of Malaga, Malaga, Spain
| | - Flavia Pennisi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Bonzano
- Eye Clinic, DiNOGMI, University of Genoa and IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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Stacey AW, Tsukikawa M, Fabian ID, Turner S, Jenkinson H, Smith V, Naeem Z, Morland B, Ainsworth JR, Reddy MA, Parulekar M, Sagoo MS. Adjuvant use of laser in eyes with macular retinoblastoma treated with primary intravenous chemotherapy. Br J Ophthalmol 2020; 105:1599-1603. [PMID: 32933939 DOI: 10.1136/bjophthalmol-2020-316862] [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: 05/15/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Adjuvant use of laser with systemic chemotherapy for treatment of retinoblastoma may reduce recurrence rates while also causing local side effects. Information is lacking on the effect of laser on visual outcomes. METHODS A retrospective review of two retinoblastoma centres in the United Kingdom was conducted. Patients were included if there was a macular tumour in at least one eye. Eyes that received chemotherapy alone were compared with eyes that received chemotherapy plus adjuvant laser. RESULTS A total of 76 patients and 91 eyes were included in the study. Systemic chemotherapy alone was used in 71 eyes while chemotherapy plus laser was used in 20 eyes. Demographic characteristics of both groups were similar. Macular relapse rates were similar between groups: 22/71 (31%) eyes in chemotherapy group and 9/20 (45%) eyes in laser group (p=0.29). There was no increase in vitreous relapses in the laser group (2/20 eyes), compared with the chemotherapy group 10/71 eyes (p=0.99). Survival analysis demonstrated similar time to first relapse between groups. Final visual acuity was equal between groups with 6/15 or better present in 31.1% of eyes in the chemotherapy group and 37.5% of eyes in the laser group (p=0.76). Presence of tumour at the fovea was predictive of final visual acuity, regardless of treatment group. CONCLUSION Adjuvant laser in the treatment of retinoblastoma is safe and does not lead to increased rate of vitreous recurrence. Final visual acuity is determined by the presence of tumour at the fovea and not the use of laser.
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Affiliation(s)
- Andrew W Stacey
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Mai Tsukikawa
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Ido Didi Fabian
- Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv, Israel
| | - Sarah Turner
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Helen Jenkinson
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | | | - Bruce Morland
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - John R Ainsworth
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - M Ashwin Reddy
- Royal London Hospital, London, London, UK.,Paediatric Ophthalmology, Moorfields Eye Hospital NHS Trust, London, UK
| | - Manoj Parulekar
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Mandeep S Sagoo
- Royal London Hospital, London, London, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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6
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Yousef YA, Noureldin AM, Sultan I, Deebajah R, Al-Hussaini M, Shawagfeh M, Mehyar M, Mohammad M, Jaradat I, AlNawaiseh I. Intravitreal Melphalan Chemotherapy for Vitreous Seeds in Retinoblastoma. J Ophthalmol 2020; 2020:8628525. [PMID: 32047663 PMCID: PMC7003283 DOI: 10.1155/2020/8628525] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/30/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate our experience with intravitreal melphalan chemotherapy as a second-line regimen for RB patients with refractory or recurrent vitreous seeds. METHODS A retrospective case series of 16 eyes from 16 patients with intraocular RB who received intravitreal melphalan chemotherapy using the antireflux injection technique. Data included demographics, stage at diagnosis, treatment modalities, side effects, eye salvage, and survival. RESULTS The total number of injections was 64 (median, 3 injections per eye; range, 3-8), and the median age at time of injection was 22 months (range, 9-63 months). Nine (56%) patients were males, and 13 (81%) patients had bilateral RB. Complete response was seen in 13 (81%) eyes: in 9 (100%) eyes with focal vitreous seeds and in 4 (57%) eyes with diffuse vitreous seeds (P=0.062). At a median follow-up of 18 months (range, 6-48 months), the eye salvage rate was 81%, local retinal toxicity confined to the site of injection was seen in 2/3 of the eyes, 2 (12%) eyes had cataract, and none of the patients had orbital recurrence and distant metastasis or was dead. CONCLUSION Intravitreal melphalan is a promising modality for treatment of vitreous seeds, and the dose of 20-30 μg of melphalan sounds to be safe and effective for refractory and recurrent vitreous seeds.μg of melphalan sounds to be safe and effective for refractory and recurrent vitreous seeds.
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Affiliation(s)
- Yacoub A. Yousef
- Departments of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Queen Rania Al-Abdullah Street, P.O. Box 1269, Amman 11941, Jordan
| | - Amal M. Noureldin
- Departments of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Queen Rania Al-Abdullah Street, P.O. Box 1269, Amman 11941, Jordan
| | - Iyad Sultan
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Queen Rania Al-Abdullah Street, P.O. Box 1269, Amman 11941, Jordan
| | - Rasha Deebajah
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Queen Rania Al-Abdullah Street, P.O. Box 1269, Amman 11941, Jordan
| | - Maysa Al-Hussaini
- Pathology, King Hussein Cancer Centre (KHCC), Queen Rania Al-Abdullah Street, P.O. Box 1269, Amman 11941, Jordan
| | - Munir Shawagfeh
- Anesthesia, King Hussein Cancer Centre (KHCC), Queen Rania Al-Abdullah Street, P.O. Box 1269, Amman 11941, Jordan
| | - Mustafa Mehyar
- Departments of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Queen Rania Al-Abdullah Street, P.O. Box 1269, Amman 11941, Jordan
| | - Mona Mohammad
- Departments of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Queen Rania Al-Abdullah Street, P.O. Box 1269, Amman 11941, Jordan
| | - Imad Jaradat
- Radiation Oncology, King Hussein Cancer Centre (KHCC), Queen Rania Al-Abdullah Street, P.O. Box 1269, Amman 11941, Jordan
| | - Ibrahim AlNawaiseh
- Departments of Surgery/Ophthalmology, King Hussein Cancer Centre (KHCC), Queen Rania Al-Abdullah Street, P.O. Box 1269, Amman 11941, Jordan
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7
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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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Said AMA, Aly MG, Rashed HO, Rady AM. Safety and efficacy of posterior sub-Tenon's carboplatin injection versus intravitreal melphalan therapy in the management of retinoblastoma with secondary vitreous seeds. Int J Ophthalmol 2018; 11:445-455. [PMID: 29600179 DOI: 10.18240/ijo.2018.03.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/02/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the safety and efficacy of posterior sub-Tenon's carboplatin injection compared to intravitreal melphalan injection in the management of retinoblastoma (RB) with secondary vitreous seeds. The outcome measures were vitreous seeds regression, need for other treatment modalities to achieve ocular salvage and treatment side effects. METHODS A prospective interventional comparative nonrandomized study included RB eyes developed secondary vitreous seeds during the period of follow up. They subdivided into two groups: study group I where posterior sub-Tenon's carboplatin (20 mg/2 mL) was injected and study group II where intravitreal melphalan (20 µg /0.1 mL) was injected. The injections repeated every 2-4wk. RESULTS Thirty-three eyes were included in the study. Seventeen eyes (16 patients) in study group I and 16 eyes (16 patients) in study group II. Ten eyes (30.3%) were completely salvaged following local chemotherapies. Ocular salvage was 23.5% following posterior sub-Tenon's carboplatin injection versus 37.5% following intravitreal melphalan raised to 47.1% and 75% with addition of external beam radiotherapy (EBR) with no statistically significant difference between the study groups (P=0.16). A statistically significant correlation was found between ocular salvage rate and type of vitreous seeds either dust, spheres and clouds (r=0.42, P=0.015) and eyes harbor new solid tumor growth (r=0.35, P=0.045). The mean and median follow up periods following local chemotherapy injections were 2.0y in the study group I and 2.37y in the study group II. Few complications were reported: periorbital edema in all eyes and ocular motility disturbances in 13 eyes (76.5%) following posterior sub-Tenon's carboplatin injection. Vitreous hemorrhage developed in 2 eyes (12.5%) and localized retinopathy in 5 eyes (31.25%) following intravitreal melphalan. CONCLUSION Local chemotherapy for treatment of RB with secondary vitreous seeds is safe and can salvage 30.3% of eyes without EBR. There is a superiority of intravitreal melphalan in ocular salvage however, no statistically significant difference between both groups.
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Affiliation(s)
| | - Mohamed Gamil Aly
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Hazem Omar Rashed
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Anwaar Mahmoud Rady
- Oncology and Radiation Medicine Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
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9
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Friedman DL, Krailo M, Villaluna D, Gombos D, Langholz B, Jubran R, Shields C, Murphree L, O’Brien J, Kessel S, Rodriguez-Galindo C, Chintagumpala M, Meadows AT. Systemic neoadjuvant chemotherapy for Group B intraocular retinoblastoma (ARET0331): A report from the Children's Oncology Group. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26394. [PMID: 28019092 PMCID: PMC5651987 DOI: 10.1002/pbc.26394] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE To evaluate a chemoreduction regimen using systemic vincristine and carboplatin (VC) and local ophthalmic therapies to avoid external-beam radiotherapy (EBRT) or enucleation in patients with Group B intraocular retinoblastoma. PATIENTS AND METHODS Twenty-one patients (25 eyes) were treated with six cycles of VC, accompanied by local ophthalmic therapies after cycle 1. The primary study objective was to determine the 2-year event-free survival (EFS) where an event was defined as the use of systemic chemotherapy in addition to vincristine or carboplatin, EBRT, and/or enucleation. RESULTS All patients had tumor regression after the first cycle of VC and only two patients had progression during therapy. There were seven treatment failures within 2 years of study enrollment, resulting in 2-year EFS of 65% and early study closure in accordance with the statistical design. The 2-year cumulative incidence of enucleation was 15%; for external beam radiation therapy, it was 10%; and for chemotherapy to control progressive disease, it was 10%. All patients sustaining a treatment failure were salvaged with additional therapy. CONCLUSIONS For the majority of patients with Group B intraocular retinoblastoma, chemoreduction with VC, without etoposide, in conjunction with local therapy provides excellent opportunity for ocular salvage. Local therapy given with every chemotherapy cycle and incorporation of etoposide may provide improved ocular salvage rates. Central review of group at diagnosis is critical in assigning appropriate therapies.
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Affiliation(s)
- Debra L. Friedman
- Vanderbilt University School of Medicine, Nashville, TN,Vanderbilt-Ingram Cancer Center, Nashville TN
| | - Mark Krailo
- University of Southern California, Los Angeles, CA,Children’s Oncology Group, Monrovia, CA
| | | | | | - Bryan Langholz
- University of Southern California, Los Angeles, CA,Children’s Oncology Group, Monrovia, CA
| | - Rima Jubran
- Children’s Hospital of Los Angeles, Los Angeles, CA
| | | | - Linn Murphree
- University of Southern California, Los Angeles, CA,MD Anderson Cancer Center, Houston TX
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10
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Fabian ID, Johnson KP, Stacey AW, Sagoo MS, Reddy MA. Focal laser treatment in addition to chemotherapy for retinoblastoma. Cochrane Database Syst Rev 2017; 6:CD012366. [PMID: 28589646 PMCID: PMC6481366 DOI: 10.1002/14651858.cd012366.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Retinoblastoma is the most common primary intraocular malignancy of childhood. Systemic chemotherapy is a common treatment for intraocular retinoblastoma, and laser treatment is used as adjuvant therapy during or immediately after chemotherapy courses in selected cases. OBJECTIVES To compare the effectiveness and safety of adding focal laser therapy to systemically-delivered chemotherapy in treating intraocular retinoblastoma. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 9), MEDLINE Ovid (1946 to 20 October 2016), Embase Ovid (1980 to 20 October 2016), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 20 October 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 20 October 2016, ClinicalTrials.gov (www.clinicaltrials.gov); searched 20 October 2016, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 20 October 2016. We did not use any date or language restrictions in the electronic searches for trials. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of systemic chemotherapy with versus without adjuvant laser therapy for postequatorial retinoblastoma. DATA COLLECTION AND ANALYSIS We planned to use standard methodological procedures expected by Cochrane. We planned to meta-analyse the primary outcome, that is the proportion of eyes with recurrence of tumours within three years from treatment MAIN RESULTS: No studies met the inclusion criteria for this review. AUTHORS' CONCLUSIONS No evidence from randomised controlled trials was found to support or refute laser therapy in addition to systemic chemotherapy for postequatorial retinoblastoma.
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Affiliation(s)
- Ido D Fabian
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Kenneth P Johnson
- Royal London Hospital, Barts Health NHS TrustWhitechapel RoadLondonUKE1 1BB
| | - Andrew W Stacey
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Mandeep S Sagoo
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - M A Reddy
- Royal London Hospital, Barts Health NHS TrustWhitechapel RoadLondonUKE1 1BB
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11
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Intravitreal chemotherapy in the management of vitreous disease in retinoblastoma. Eur J Ophthalmol 2017; 27:423-427. [PMID: 28106239 DOI: 10.5301/ejo.5000921] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the therapeutic outcome of intravitreal melphalan injection in the management of vitreous disease in patients with retinoblastoma. We particularly aimed to assess whether higher melphalan dose with lower number of injections was more effective and associated with fewer side effects. METHODS This retrospective, interventional, noncomparative, and nonrandomized study included 39 eyes of 37 patients. Vitreous seeds were classified as dust, sphere, and cloud types. Intravitreal injections were performed through pars plana free of any visible tumor using 30-G needle. Response of the seeds (disappearance, conversion into inactive debris, or progression) and enucleation rate were determined as outcome measures. RESULTS All patients previously received systemic or intra-arterial chemotherapy. Vitreous seeding was primary in 54% of eyes and secondary in 46% of eyes. Vitreous seeds were classified as dust in 9 (23.1%) eyes, sphere in 24 (61.5%) eyes, and cloud in 6 (15.4%) eyes. Melphalan dose varied between 20 and 40 µg and 20 (51.3%) eyes received >30 µg. The total number of injections was 70 (range 1-5, mean 1.8 per eye). Various types of regression were obtained in 27 (69.2%) eyes. Sphere-type seeds were the most responsive to melphalan. Nonresponse and disease progression were noted in 12 (30.8%) eyes. After a mean follow-up of 11.8 months, 17 (44%) eyes were enucleated. Vitreous hemorrhage (18%) and retinal pigment epithelial alterations (8%) were the most common side effects. CONCLUSIONS Intravitreal melphalan at 30-40 µg in 1 or 2 injections proved effective in 69.2% of eyes with vitreous disease.
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12
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Vasalaki M, Fabian ID, Reddy MA, Cohen VML, Sagoo MS. Ocular oncology: advances in retinoblastoma, uveal melanoma and conjunctival melanoma. Br Med Bull 2017; 121:107-119. [PMID: 28069617 DOI: 10.1093/bmb/ldw053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/04/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Retinoblastoma, uveal and conjunctival melanomas are important malignancies within the remit of ocular oncology. Outlined are the diagnostic features and management principles, as well as advancements in the field and current challenges. SOURCES OF DATA Original papers, reviews and guidelines. AREAS OF AGREEMENT Most eyes with retinoblastoma (International Intraocular Retinoblastoma Classification (IIRC) Group A-D) are salvaged, whereas advanced cases (Group E) remain a challenge. Despite a high rate of local tumour control in uveal melanoma, metastatic spread commonly occurs. Conjunctival melanoma is treated by complete resection, but high rates of local recurrence occur, with the possibility of systemic relapse and death. AREAS OF CONTROVERSY Use of the IIRC in retinoblastoma, and systemic screening in melanomas. GROWING POINTS Utilization of novel treatment modalities in retinoblastoma and an increasing understanding of the genetic basis of melanomas. AREAS TIMELY FOR DEVELOPING RESEARCH Improvements in chemotherapy delivery in retinoblastoma and prognostic tests in melanomas.
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Affiliation(s)
- Marina Vasalaki
- UCL Institute of Ophthalmology, Bath Street, London EC1V 9EL, UK.,Retinoblastoma Service, Royal London Hospital, Whitechapel Road, London E1 1BB, UK
| | - Ido D Fabian
- Retinoblastoma Service, Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Ocular Oncology Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK.,Ocular Oncology Service, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - M Ashwin Reddy
- Retinoblastoma Service, Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Paediatric Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK
| | - Victoria M L Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK.,Ocular Oncology Service, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Mandeep S Sagoo
- Retinoblastoma Service, Royal London Hospital, Whitechapel Road, London E1 1BB, UK.,Ocular Oncology Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK.,Ocular Oncology Service, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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13
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Fabian ID, Stacey AW, Johnson KP, Onadim Z, Chowdhury T, Duncan C, Reddy MA, Sagoo MS. Primary intravenous chemotherapy for group D retinoblastoma: a 13-year retrospective analysis. Br J Ophthalmol 2016; 101:82-88. [PMID: 27965263 DOI: 10.1136/bjophthalmol-2016-309710] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/13/2016] [Accepted: 11/15/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Eye salvage rate for group D retinoblastoma using intravenous chemotherapy (IVC) as a primary modality is <50%. To report on 13 years' experience with the use of primary IVC for group D retinoblastoma. METHODS A retrospective analysis of 64 group D eyes (52 patients) treated with primary IVC, from 2002 to 2014. RESULTS The median age at presentation was 11.0 months (mean: 18.6, range: 0.6-144.0), 35 (67%) patients had bilateral disease, 38 (73%) germline disease and 8 (15%) cases were familial. In addition to IVC, patients received a median number of three treatments (mean: 6, range: 0-24), including thermotherapy/cryotherapy, plaque radiotherapy, intra-ophthalmic artery chemotherapy (IAC) and/or intravitreous chemotherapy. External beam radiotherapy (EBRT) was used in five eyes, all of which were eventually enucleated. In a median follow-up time of 55 months (mean: 64, range: 14-156), 63% of eyes were salvaged. By the Kaplan-Meier survival analysis, globe salvage rate was 83%, 70%, 59% and 45% at 1, 3, 5 and 10 years, respectively. There were no cases of metastatic spread from intraocular retinoblastoma and no deaths. IVC-related adverse events included febrile neutropenia in 21 (40%) patients and anaphylactic reaction to carboplatin in 2 (4%), all conservatively resolved. Of the patients receiving IAC, third and sixth nerve palsies were documented in two (10%) and one (5%) eyes, respectively. CONCLUSIONS Primary IVC for group D eyes, with adjuvant treatments as required, was found to be a safe and efficient approach, achieving 63% eye salvage rate, no metastatic spread from intraocular retinoblastoma and no deaths. IAC has now replaced EBRT as a successful salvage treatment.
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Affiliation(s)
- Ido D Fabian
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Retinoblastoma Service, Royal London Hospital, London, UK
| | - Andrew W Stacey
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Retinoblastoma Service, Royal London Hospital, London, UK.,Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | | | - Zerrin Onadim
- Retinoblastoma Service, Royal London Hospital, London, UK
| | - Tanzina Chowdhury
- Retinoblastoma Service, Royal London Hospital, London, UK.,Paediatric Oncology Department, Great Ormond Street Hospital, London, UK
| | - Catriona Duncan
- Retinoblastoma Service, Royal London Hospital, London, UK.,Paediatric Oncology Department, Great Ormond Street Hospital, London, UK
| | - M Ashwin Reddy
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Retinoblastoma Service, Royal London Hospital, London, UK
| | - Mandeep S Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Retinoblastoma Service, Royal London Hospital, London, UK.,University College London, Institute of Ophthalmology, London, UK
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14
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Jacobsen BH, Berry JL, Jubran R, Kim JW. Orbital Recurrence following Aggressive Laser Treatment for Recurrent Retinoblastoma. Ocul Oncol Pathol 2015; 2:76-9. [PMID: 27171650 DOI: 10.1159/000439055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/21/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To report a case of a 29-month-old male with familial, bilateral retinoblastoma with orbital recurrence following aggressive laser treatment. METHODS This is a retrospective case report of a single patient. RESULTS A 3-week-old male was diagnosed with familial, bilateral retinoblastoma (group D OD, group A OS), and treated with 6 cycles of systemic chemotherapy and laser treatment. The patient exhibited full regression of tumors in both eyes. Two years after diagnosis, a small tumor recurrence within the macular laser scar of the right eye was discovered. The tumor recurrence was treated with argon and diode laser over 6 months. The tumor recurrence completely resolved following the laser treatments. Ten weeks after the last laser treatment, MRI revealed a large intraconal orbital mass, contiguous with the sclera of the right eye. Orbital biopsy and systemic work-up confirmed the diagnosis of retinoblastoma with no other metastatic foci. B-scan ultrasonography showed thinning of the sclera at the site of recurrence. CONCLUSION This is an unusual orbital recurrence after successful treatment of intraocular disease with aggressive laser therapy. Clinicians should be aware of the rare possibility of orbital recurrence following chemoreduction with local consolidation even when fundus examinations are normal.
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Affiliation(s)
- Bradley H Jacobsen
- University of California, Irvine School of Medicine, Irvine, Calif., USA
| | - Jesse L Berry
- USC Eye Institute, Keck School of Medicine, University of Southern California, USA; Children's Hospital Los Angeles, Los Angeles, Calif., USA
| | - Rima Jubran
- Children's Hospital Los Angeles, Los Angeles, Calif., USA
| | - Jonathan W Kim
- USC Eye Institute, Keck School of Medicine, University of Southern California, USA; Children's Hospital Los Angeles, Los Angeles, Calif., USA
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15
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Munier FL. Classification and management of seeds in retinoblastoma. Ellsworth Lecture Ghent August 24th 2013. Ophthalmic Genet 2014; 35:193-207. [PMID: 25321846 PMCID: PMC4245997 DOI: 10.3109/13816810.2014.973045] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/27/2014] [Accepted: 10/01/2014] [Indexed: 11/13/2022]
Abstract
Retinoblastoma has the unique capacity to accelerate its own intra-ocular propagation by adopting semi-solid or even liquid growth properties through seeding. Until recently, the presence of any degree of seeding was mostly incompatible with successful conservative management, due to the multiresistant nature of the seeds. Surprisingly, this well-recognized retinoblastoma behavior has not undergone any detailed description of seeding patterns and anatomic sites. In this paper, we describe the phenotypic variability of seeds across the four possible intraocular seeding compartments and classify them into three fundamental types: namely dust, spheres, and clouds. We also provide an overview of the different therapeutic strategies developed for seeding, with special attention to intravitreal chemotherapy as the treatment of choice for vitreous and retro-hyaloid seeding. Finally, we propose criteria to enable assessment of the response to treatment by reporting seed regression patterns, as well as a clinical grading system for the retinal toxicity observed following intravitreal melphalan.
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16
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Francis JH, Gobin YP, Dunkel IJ, Marr BP, Brodie SE, Jonna G, Abramson DH. Carboplatin +/- topotecan ophthalmic artery chemosurgery for intraocular retinoblastoma. PLoS One 2013; 8:e72441. [PMID: 23991112 PMCID: PMC3749169 DOI: 10.1371/journal.pone.0072441] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/09/2013] [Indexed: 12/15/2022] Open
Abstract
Purpose Carboplatin administered systemically or periocularly can result in dramatic and prompt regression of retinoblastoma. However, both routes are rarely curative alone and have undesirable side effects. We aimed to assess the efficacy and toxicity of carboplatin +/− topotecan delivered by ophthalmic artery chemosurgery whereby chemotherapy is infused into the eye via the ophthalmic artery. Methods This retrospective, IRB-approved study investigated retinoblastoma patients whom received carboplatin +/− topotecan ophthalmic artery chemosurgery. Patient survival, ocular survival, hematologic toxicity, ocular toxicity, second cancer development and electroretinogram response were all evaluated. Results 57 carboplatin +/− topotecan infusions (of 111 total) were performed in 31 eyes of 24 patients. The remaining infusions were melphalan-containing. All patients were alive and no patient developed a second malignancy at a median follow up of 25 months. The Kaplan-Meier estimate of ocular survival at two years was 89.9% (95% confidence interval [CI], 82.1–97.9%) for all eyes. Grade 3 or 4 neutropenia developed in two patients and one patient developed metastatic disease. By univariate analysis, neither increasing maximum carboplatin/topotecan dose nor cumulative carboplatin/topotecan dose was associated with statistically significant reduction in the electroretinogram responses. Conclusion Carboplatin +/− topotecan infusions are effective for ophthalmic artery chemosurgery in retinoblastoma: they demonstrate low hematologic and ocular toxicity and no statistically significant influence on electroretinogram responses, and used in conjunction with melphalan-containing OAC, demonstrate excellent patient survival and satisfactory ocular survival.
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Affiliation(s)
- Jasmine H Francis
- Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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17
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Venturi C, Bracco S, Cerase A, Cioni S, Galluzzi P, Gennari P, Vallone IM, Tinturini R, Vittori C, De Francesco S, Caini M, D'Ambrosio A, Toti P, Renieri A, Hadjistilianou T. Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments. Acta Ophthalmol 2013; 91:335-42. [PMID: 22268993 DOI: 10.1111/j.1755-3768.2011.02296.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To report our experience in superselective ophthalmic artery infusion of melphalan (SOAIM) for intraocular retinoblastoma. METHODS From June 2008 to October 2010, 38 patients (18 women, 20 men; age range at first treatment, 7 months to 22 years) with 41 eyes with retinoblastoma were scheduled for SOAIM, for 17 newly diagnosed retinoblastomas Tumour, Node and Metastasis (TNM) 7th Edition 1a (n = 1), 1b (n = 1), 2a (n = 7), 2b (n = 4) and 3a (n = 4) and 24 retinoblastomas with partial remission/relapse TNM 7th Edition 1b (n = 13), 2a (n = 1) and 2b (n = 10). Eight patients (ten eyes) have been treated by SOAIM alone. Follow-up was 6-27 months in 28 patients (30 eyes). RESULTS Ophthalmic artery cannulation failed in two patients. Thirty-six patients underwent 140 treatments by internal (n = 112) or external (n = 28) carotid arteries. No major procedural complications occurred. Two patients have been lost to follow-up. Remaining 34 patients (37 eyes) had no metastatic disease. Four patients suffered permanent ocular complications: chorioretinal dystrophy (n = 2), ptosis (n = 1) and strabismus/exotropia (n = 1). Eight (22%) eyes in eight (24%) patients underwent enucleation: 7/16 (43%) newly diagnosed retinoblastomas and 1/22 (4.5%) retinoblastomas undergoing partial remission/relapse. For all treated eyes, Kaplan-Meier eye enucleation-free rates (K-M) were 85.4% (95% CI, 73.3-97.5%), 74.4% (95% CI, 57-91.8%) and still stable at 6, 12 months and 2 years, respectively. For eyes with partial remission/relapse, and eyes at presentation, K-M at 2 years were 95.5% (95% CI, 86.9-100%) and 45.6% (95% CI, 16.6-74.6%), respectively. CONCLUSION Superselective ophthalmic artery infusion of melphalan was safe and powerful, especially following other therapies. Superselective ophthalmic artery infusion of melphalan should be added to focal therapies spectrum. In selected cases, melphalan should be combined with other chemotherapeutic agents.
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Affiliation(s)
- Carlo Venturi
- Unit NINT Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy.
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Schaiquevich P, Ceciliano A, Millan N, Taich P, Villasante F, Fandino AC, Dominguez J, Chantada GL. Intra-arterial chemotherapy is more effective than sequential periocular and intravenous chemotherapy as salvage treatment for relapsed retinoblastoma. Pediatr Blood Cancer 2013; 60:766-70. [PMID: 23024125 DOI: 10.1002/pbc.24356] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 09/10/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Treatment of eyes with retinoblastoma failing systemic chemoreduction and external beam radiotherapy is seldom efficacious. This study compares the efficacy and toxicity of intra-arterial ophthalmic artery chemotherapy (IAO) to our historical cohort of sequential periocular and systemic chemotherapy in such patients. PATIENTS AND METHODS Eighteen eyes (15 consecutive patients) were retrospectively evaluated. Eight eyes received IAO for a median of four cycles (range: 2-9) including melphalan alone (n = 3) or after topotecan and carboplatin (n = 4) or topotecan and carboplatin without melphalan (n = 1). Ten eyes received a median of two cycles (range: 1-3) of periocular topotecan (n = 9) or carboplatin (n = 1) followed by intravenous topotecan and cyclophosphamide in three patients if at least stable disease was achieved. Both groups were comparable for disease extension and prior therapy. RESULTS No extraocular dissemination or second malignancy occurred and all patients are alive. The probability of enucleation-free eye survival at 12 months was 0.87 (95% CI: 0.42-0.97) for the IAO group, compared to 0.1 (95% CI: 0.06-0.35) for the periocular group (P < 0.01). Ocular toxicity was mild and similar in both groups (mostly mild orbital edema). Systemic toxicity was low for IAO and periocular injection, but children who received sequentially intravenous chemotherapy (n = 12 cycles) had five episodes of grade 4 neutropenia, three of which resulted in hospitalizations. No case in the IAO group presented these complications. CONCLUSIONS IAO is significantly superior to sequential periocular-intravenous topotecan-containing regimens in eyes with relapsed intraocular retinoblastoma with a more favorable toxicity profile.
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Affiliation(s)
- Paula Schaiquevich
- CONICET-Clinical Pharmacokinetics Unit, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
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