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Rabelo BS, de Alvarenga KAF, Fernando Lopes L, Guimarães Ribeiro A, de Sá Rodrigues KE. Strategies to improve diagnosis and access to treatment of retinoblastoma in low- and middle-income countries: A systematic review. Pediatr Blood Cancer 2024; 71:e30987. [PMID: 38594882 DOI: 10.1002/pbc.30987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
Retinoblastoma, the most common intraocular tumor in childhood, still faces challenges in diagnosis and treatment, particularly in low- and middle-income countries. Identifying strategies to improve the time to diagnosis and access to treatment is crucial to enhance survival rates and preserve ocular health. We conducted a systematic review to identify interventions that have demonstrated potential in addressing these challenges. We performed a comprehensive search across databases until March 2023. Out of the studies reviewed, 21 met the inclusion criteria and were categorized into five main areas: surveillance strategies, genetic counseling, education, public assistance, and international partnership. Despite the obstacles faced, the initiatives identified in this review present acts toward improving the time to diagnosis and access to treatment for retinoblastoma. Based on the extracted data, we propose a comprehensive chain of initiatives. We firmly believe that implementing this chain of initiatives can lead to improved clinical outcomes for retinoblastoma patients.
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Affiliation(s)
- Bruna Salgado Rabelo
- Hospital do Câncer de Barretos, Barretos, São Paulo, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil
| | - Kevin Augusto Farias de Alvarenga
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil
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2
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Maryam D, Wu LM, Su YC, Hsu MT, Harianto S. The journey of embracing life: Mothers' perspectives of living with their children with retinoblastoma. J Pediatr Nurs 2022; 66:e46-e53. [PMID: 35718669 DOI: 10.1016/j.pedn.2022.06.004] [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: 03/22/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to explore the experience and views of mothers with children who have been diagnosed with retinoblastoma. DESIGN AND METHODS A descriptive qualitative study was conducted in the period of 2019-2021. Interviews were conducted with 21 mothers of children diagnosed with retinoblastoma in Indonesia. Data were collected by semi-structured interviews and examined by content analysis. RESULTS Mothers evolved from a sense of unacceptability to accepting challenges and gaining inner strength. Three themes were identified: 1) physical and psychological suffering, 2) awareness of changes and demands, and 3) keep moving forward. Mothers developed positive adaptive mechanisms for coping with the problems associated with having a child with retinoblastoma. Psychological adjustment and religious beliefs were key elements in their journeys toward embracing life in the moment. CONCLUSION Findings illuminated psychological adaptation and coping strategies of mothers with seriously ill children and highlighted how difficulties and cultural norms shaped the adaptative process. Religion and health beliefs played varied and important roles in helping mothers to manage their stress and enhance their coping strategies. PRACTICE IMPLICATIONS Our findings revealed that it is important to routinely assess social support, traditional health beliefs, and spirituality on mothers, facilitate mentoring to help mothers find their inner strengths, and develop intervention programs designed to promote psychological adjustment without delaying treatment.
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Affiliation(s)
- Dewi Maryam
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC, and Dr Soetomo Hospital, Surabaya, Indonesia.
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, and Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
| | - Yi-Ching Su
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Min-Tao Hsu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Susilo Harianto
- Faculty of Nursing, Airlangga University, Surabaya Indonesia, Faculty of Vocational, Airlangga Indonesia, Mulyorejo, Surabaya 60115, Indonesia.
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Kruger M, van Elsland SL, Afungchwi GM, Bardin R, Njodzeka B, Kouya F, Nfor P, Nana P, Wharin P, Hesseling PB. Outcome of retinoblastoma treatment protocol in Cameroon as per SIOP-PODC recommendation for a low-income setting. Pediatr Blood Cancer 2022; 69:e29642. [PMID: 35403812 DOI: 10.1002/pbc.29642] [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: 07/20/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The International Society of Paediatric Oncology-Paediatric Oncology in Developing Countries (SIOP-PODC) group recommended graduated-intensity retinoblastoma treatment for children in low- and middle-income countries with limited local resources. AIM The aim was to improve outcome of children with retinoblastoma by means of a treatment protocol for low-income settings as recommended by the SIOP-PODC recommendation in Cameroon. METHODS Children diagnosed with retinoblastoma between 2012 and 2016 were treated in two Baptist Mission hospitals in Cameroon, staging according to the International Retinoblastoma Staging System. Treatment included local therapy and combination chemotherapy (vincristine, cyclophosphamide, and doxorubicin) with or without surgery as per SIOP-PODC guidelines for low-income countries. Endpoint was survival at 24 months. Kaplan-Meier curves with log-rank (Mantel-Cox) chi-square (χ2 ) with respective p-values were prepared. RESULTS Eighty-two children were included, of whom 79.3% had unilateral disease. The majority were males (61.0%) with median age 24 months (range 1-112 months; standard deviation [SD] 19). Limited disease was diagnosed in 58.5%, metastatic disease in 35.4%, and unknown stage in 6.1%. Overall survival (OS) was 50.0% at 24 months post diagnosis, but 68.8% for limited disease. Estimated cumulative survival at 24 months was 0.528 (standard error [SE] 0.056). Causes of death included disease progression/relapses (60.5%), neutropenic sepsis (15.9%), unknown causes (18.4%), unrelated infection (2.6%), and death post surgery (2.6%). Stage was significantly associated with OS (p < .001). CONCLUSION Stage was the most significant factor for good OS and demonstrated the efficacy and feasibility of the SIOP-PODC-proposed management guidelines for retinoblastoma in a lower middle-income setting.
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Affiliation(s)
- Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sabine L van Elsland
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Glenn M Afungchwi
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.,Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Richard Bardin
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Bernard Njodzeka
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Francine Kouya
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Patience Nfor
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Philippa Nana
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Paul Wharin
- Beryl Thyer Memorial Africa Trust, Warkton, UK
| | - Peter B Hesseling
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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López JP, Barriga MM, Lecea D, Parada C, Stephens G. Ophthalmology examination during well-child visits in primary care health centres: Knowledge and difficulties experienced by health workers. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:26-31. [PMID: 33067032 DOI: 10.1016/j.oftal.2020.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The red reflex examination (RRE) and visual acuity testing (VA) is a mandatory part of the examination during the well-child visits (WCV) in primary health care centres of the public system of health in Chile. The eye examination is aimed at the early detection of severe eye diseases in children, such as retinoblastoma, congenital cataracts, and amblyopia. The knowledge and difficulties experienced by health workers in primary care health centres for evaluating the red reflex during WCV in Chile is unknown. MATERIAL AND METHODS A survey was performed in primary community health centres of XXX Santiago de Chile. RESULTS The WCV were mainly performed by physicians (45.2%) and nurses (35.8%). Only 34% of health workers performed the red reflex test, and 42.3% checked VA during the WCV. The main reasons for not doing it include the lack of direct ophthalmoscopes and VA charts (55.2% and 43.9%, respectively) at their centres, and not having the knowledge or skills (29.3% and 22%, respectively) to properly perform these clinical tests. CONCLUSION In this series, the eye examination of children attending WCV was unfrequently performed. A better implementation of the health centres and training of the health workers are needed in order to improve the access and quality of the paediatric eye examination in primary health care institutions in Chile.
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Affiliation(s)
- J P López
- Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile.
| | - M M Barriga
- Facultad de Medicina, Universidad del Desarrollo-Clínica Alemana, Santiago, Chile
| | - D Lecea
- Facultad de Medicina, Universidad del Desarrollo-Clínica Alemana, Santiago, Chile
| | - C Parada
- Facultad de Medicina, Universidad del Desarrollo-Clínica Alemana, Santiago, Chile
| | - G Stephens
- Departamento de Gestión de Redes, SSMS, Santiago, Chile
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Bossacoma F, Cuadrado-Vilanova M, Vinent J, Correa MG, Gavrus D, Castillo-Ecija H, Catala-Mora J, Mora J, Schaiquevich P, Chantada GL, Carcaboso AM. Optimizing the storage of chemotherapeutics for ophthalmic oncology: stability of topotecan solution for intravitreal injection. Ophthalmic Genet 2020; 41:397-400. [PMID: 32490703 DOI: 10.1080/13816810.2020.1776336] [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: 10/24/2022]
Abstract
BACKGROUND . Intravitreal administration of topotecan shows activity against tumor vitreous seeding in the conservative treatment of retinoblastoma, a malignant tumor originated in the retina of small children. Adequate storage of the intravitreal topotecan solution would allow immediate availability for patients at health care institutions. The goal of the work was to address the stability of the intravitreal topotecan formulation upon reconstitution. MATERIALS AND METHODS . Intravitreal topotecan solutions were reconstituted (at a concentration of 0.2 mg topotecan in 1 mL saline solution vehicle, aliquoted in 1 mL plastic syringes) and stored either frozen or at room temperature for different times. Topotecan content was analyzed at time zero and at different conditions using a high performance liquid chromatography method to quantify topotecan lactone (active) and to detect its pH-dependent hydrolysis product, the open carboxylate. RESULTS . We found that intravitreal topotecan syringes remained stable at room temperature at least for 24 h, at least for 167 days upon stored frozen at -20°C, and up to 8 h after thawing at day 6. The degradation carboxylate product did not appear in the analyzed thawed samples during the whole study. CONCLUSIONS . This study confirms the stability of frozen intravitreal topotecan syringes and will help optimize the use of this chemotherapy modality at institutions with low resources. Storage of aliquots will also help reduce personnel exposure to chemotherapy at hospital pharmacies.
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Affiliation(s)
- F Bossacoma
- Department of Pharmacy, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Deu , Barcelona, Spain.,Department of Pharmacy, Hospital Fundació Salut Empordà , Figueras, Girona, Spain
| | - M Cuadrado-Vilanova
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Institut de Recerca Sant Joan de Deu , Barcelona, Spain
| | - J Vinent
- Department of Pharmacy, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Deu , Barcelona, Spain
| | - M G Correa
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Institut de Recerca Sant Joan de Deu , Barcelona, Spain
| | - D Gavrus
- Department of Pharmacy, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Deu , Barcelona, Spain
| | - H Castillo-Ecija
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Institut de Recerca Sant Joan de Deu , Barcelona, Spain
| | - J Catala-Mora
- Ophthalmology, Hospital Sant Joan de Deu, Institut de Recerca Sant Joan de Deu , Barcelona, Spain
| | - J Mora
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Institut de Recerca Sant Joan de Deu , Barcelona, Spain
| | - P Schaiquevich
- Precision Medicine, Hospital de Pediatria J.P. Garrahan , Buenos Aires, Argentina.,National Scientific and Technical Research Council, CONICET , Buenos Aires, Argentina
| | - G L Chantada
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Institut de Recerca Sant Joan de Deu , Barcelona, Spain.,Precision Medicine, Hospital de Pediatria J.P. Garrahan , Buenos Aires, Argentina.,National Scientific and Technical Research Council, CONICET , Buenos Aires, Argentina
| | - A M Carcaboso
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Institut de Recerca Sant Joan de Deu , Barcelona, Spain
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Choucair ML, Brisse HJ, Fréneaux P, Desjardins L, Dorfmüller G, Puget S, Dendale R, Chevrier M, Doz F, Lumbroso-Le Rouic L, Aerts I. Management of advanced uni- or bilateral retinoblastoma with macroscopic optic nerve invasion. Pediatr Blood Cancer 2020; 67:e27998. [PMID: 31571399 DOI: 10.1002/pbc.27998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/05/2019] [Accepted: 09/04/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Retinoblastoma with macroscopic optic nerve (ON) invasion depicted by imaging at diagnosis remains a major problem and carries a poor prognosis. We sought to describe the treatment and outcome of these high-risk patients. METHODS Retrospective mono-institutional clinical, radiological, and histological review of patients with uni- or bilateral retinoblastoma with obvious ON invasion, defined by radiological optic nerve enlargement (RONE) depicted by computed tomography scan or magnetic resonance imaging (MRI), was performed. RESULTS Between 1997 and 2014, among the 936 patients with retinoblastoma treated at Institut Curie, 11 had detectable RONE. Retinoblastoma was unilateral in 10 and bilateral in one. Median age at diagnosis was 28 months (range, 11-96). ON enlargement extended to the orbital portion in three patients, to the optic canal in five, to the prechiasmatic portion in two, and to the optic chiasm in one. Nine patients received neoadjuvant chemotherapy and partial response was obtained in all. Enucleation was performed in 10/11 patients-by an anterior approach in three and by anterior and subfrontal approaches in seven. Three patients had a positive ON resection margin (2/3 after primary enucleation). All enucleated patients received adjuvant treatment (conventional chemotherapy: 10, high-dose chemotherapy: seven, radiotherapy: five). Leptomeningeal progression occurred in four patients. Seven are in first complete remission (median follow up: 8 years [3.5-19.4]). CONCLUSION Neoadjuvant chemotherapy and microscopic complete resection have a pivotal role in the management of retinoblastoma with RONE. MRI is recommended for initial and pre-operative accurate staging. Surgery should be performed by neurosurgeons in case of posterior nerve invasion. Radiotherapy is required in case of incomplete resection.
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Affiliation(s)
- Marie-Louise Choucair
- Oncology Center SIREDO: Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France
| | - Hervé J Brisse
- Radiology Department, Institut Curie, Paris, France.,Paris Sciences et Lettres Research University, Paris, France
| | - Paul Fréneaux
- Paris Sciences et Lettres Research University, Paris, France.,Tumor Biology Department, Institut Curie, Paris, France
| | - Laurence Desjardins
- Paris Sciences et Lettres Research University, Paris, France.,Ocular Oncology, Institut Curie, Paris, France
| | - Georg Dorfmüller
- Pediatric Neurosurgery Department, Fondation Rothschild, Paris, France
| | - Stéphanie Puget
- Department of Pediatric Neurosurgery, Necker Hospital, Paris, France.,Université Paris Descartes, Paris, France
| | - Rémi Dendale
- Paris Sciences et Lettres Research University, Paris, France.,Radiation Oncology Department, Institut Curie, Paris, France
| | - Marion Chevrier
- Paris Sciences et Lettres Research University, Paris, France.,Biostatistics Department, Institut Curie, Paris, France
| | - François Doz
- Oncology Center SIREDO: Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France.,Université Paris Descartes, Paris, France
| | - Livia Lumbroso-Le Rouic
- Paris Sciences et Lettres Research University, Paris, France.,Ocular Oncology, Institut Curie, Paris, France
| | - Isabelle Aerts
- Oncology Center SIREDO: Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France.,Paris Sciences et Lettres Research University, Paris, France
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Garza-Garza LA, Ruiz-Lozano RE, Rebolledo-Méndez G, Ibarra-Nava I, Morales-Garza HJ, Ancona-Lezama D. Challenge of Retinoblastoma in Mexico in 2020: Perspectives and Solutions. J Ophthalmol 2020; 2020:1953602. [PMID: 32850140 PMCID: PMC7439193 DOI: 10.1155/2020/1953602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/28/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022] Open
Abstract
Early diagnosis and positive outcomes of retinoblastoma in childhood have been positively correlated with the economic wealth of high-income countries (HICs) worldwide. Adequate curability and survival rates, adherence to treatment, presence of poor prognostic initial clinical signs, and metastatic disease at diagnosis appear to have a less favorable picture in low-income countries (LICs). However, this is not always the case. An example is Argentina, where disease-free survival rates of retinoblastoma are notably higher than expected when taking into consideration its economic situation. Unfortunately, as in other Latin American LICs, retinoblastoma outcomes in Mexico are worrisome. Interestingly, the Human Development Index (HDI) in Mexico varies widely between its different geographical regions. While in some states, the HDI resembles those of high-income countries, and in others, the opposite is observed. A unifying picture of Mexico's developmental status, health resources, indicators, and other factors possibly influencing outcomes in retinoblastoma is currently unavailable. The present review explores the previously mentioned factors in Mexico and compares them to other countries. Additionally, it recommends solutions or enhancements where possible.
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Affiliation(s)
- Lucas A. Garza-Garza
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Raúl E. Ruiz-Lozano
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Genaro Rebolledo-Méndez
- 2Writing Lab, TecLabs, Vicerrectoria de Investigación y Transferencia de Tecnología, Tecnologico de Monterrey, Monterrey, Mexico
| | - Ismael Ibarra-Nava
- 3Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Héctor J. Morales-Garza
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
| | - David Ancona-Lezama
- 1Tecnologico de Monterrey, School of Medicine and Health Sciences, Ocular Oncology Service at Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion, San Pedro Garza Garcia, Nuevo León, Mexico
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Schroeder K, Saxton A, McDade J, Chao C, Masalu N, Chao C, Wechsler DS, Likonda B, Chao N. Pediatric Cancer in Northern Tanzania: Evaluation of Diagnosis, Treatment, and Outcomes. J Glob Oncol 2018; 4:1-10. [PMID: 30241177 PMCID: PMC6180837 DOI: 10.1200/jgo.2016.009027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The majority of new diagnoses of pediatric cancer are made in resource-poor countries, where survival rates range from 5% to 25% compared with 80% in high-resource countries. Multiple factors, including diagnostic and treatment capacities and complex socioeconomic factors, contribute to this variation. This study evaluated the available resources and outcomes for pediatric patients with cancer at the first oncology treatment center in northern Tanzania. METHODS Qualitative interviews were completed from July to August 2015 to determine available staff, hospital, diagnostic, treatment, and supportive care resources. A retrospective review of hospital admissions and clinic visits from January 2010 to August 2014 was completed. A total of 298 patients were identified, and data from 182 patient files were included in this review. RESULTS Diagnostic, treatment, and supportive capacities are limited for pediatric cancer care. The most common diagnoses were Burkitt lymphoma (n = 32), other non-Hodgkin lymphoma (n = 26), and Wilms tumor (n = 25). A total of 40% of patients (n = 72) abandoned care. There was a 20% 2-year event-free survival rate, which was significantly affected by patient age, method of diagnosis, and year of diagnosis. CONCLUSION To our knowledge, this is the first review of pediatric cancer outcomes in northern Tanzania. The study identified areas for future development to improve pediatric cancer outcomes, which included strengthening of training and diagnostic capacities, development of registries and research databases, and the need for additional research to reduce treatment abandonment.
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Affiliation(s)
- Kristin Schroeder
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Anthony Saxton
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Jessica McDade
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Christina Chao
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Nestory Masalu
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Colin Chao
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Daniel S Wechsler
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Beda Likonda
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
| | - Nelson Chao
- Kristin Schroeder, Anthony Saxton, Christina Chao, Daniel S. Wechsler, and Nelson Chao, Duke University, Durham, NC; Jessica McDade, Seattle Children's, Seattle, WA; Nestory Masalu and Beda Likonda, Bugando Medical Centre, Mwanza, Tanzania; and Colin Chao, Eastern Virginia Medical School, Norfolk, VA
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9
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Chawla B, Chaurasia S, Sharma S, Pattebahadur R, Hasan F, Seth R, Kashyap S, Sen S. Magnetic resonance imaging for tumor restaging after chemotherapy in retinoblastoma with optic nerve invasion. Ophthalmic Genet 2018; 39:584-588. [PMID: 30089224 DOI: 10.1080/13816810.2018.1502790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Extraocular retinoblastoma with optic nerve invasion is treated by a multimodal protocol consisting of neoadjuvant chemotherapy, enucleation, and adjuvant therapy. This study was conducted to evaluate the performance of magnetic resonance imaging (MRI) used for tumor restaging in these children after systemic chemotherapy administration. METHODS Contrast-enhanced MRI scan of orbits and brain was performed at diagnosis and patients were treated with neoadjuvant chemotherapy. After chemotherapy, MRI scan was repeated for tumor restaging and residual post-laminar thickening and/or enhancement of the affected optic nerve, if any, was recorded. MRI findings were correlated with histopathology in enucleated specimens. The main outcome measures were specificity, sensitivity, and accuracy of MRI in predicting post-laminar invasion after neoadjuvant chemotherapy. RESULTS A total of 46 eyes (46 patients) were studied. Optic nerve thickening on MRI had a sensitivity, specificity, and accuracy of 100% (95% Confidence Interval (CI): 64.6-100%), 76.9% (95% CI: 61.7-87.4%), and 80.4% (95% CI: 66.8-89.4%), respectively. Optic nerve enhancement had a sensitivity, specificity, and accuracy of 85.7% (95% CI: 48.7-97.4%), 79.5 % (95% CI: 64.5-89.2%), and 80.4% (95% CI: 66.8-89.4%), respectively. Combined thickening and enhancement of the optic nerve had a sensitivity, specificity, and accuracy of 100% (95% CI: 60.9-100%), 82.4% (95% CI: 66.5-91.7%), and 85% (95% CI: 70.9-92.9%), respectively. CONCLUSION MRI is a valuable tool for restaging of retinoblastoma and predicting residual optic nerve disease after neoadjuvant chemotherapy. Combined thickening and enhancement on MRI appeared to be a more reliable indicator of post-laminar invasion as compared to thickening or enhancement alone.
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Affiliation(s)
- Bhavna Chawla
- a Ocular Oncology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Shweta Chaurasia
- a Ocular Oncology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Sanjay Sharma
- b Ocular Radiology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rajesh Pattebahadur
- a Ocular Oncology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Fahmi Hasan
- a Ocular Oncology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Rachna Seth
- c Pediatric Oncology Division, Department of Paediatrics , All India Institute of Medical Sciences , New Delhi , India
| | - Seema Kashyap
- d Ocular Pathology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Seema Sen
- d Ocular Pathology Service, Dr. Rajendra Prasad Center for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
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Cassoux N, Lumbroso L, Levy-Gabriel C, Aerts I, Doz F, Desjardins L. Retinoblastoma: Update on Current Management. Asia Pac J Ophthalmol (Phila) 2017; 6:290-295. [PMID: 28558178 DOI: 10.22608/apo.201778] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/12/2017] [Indexed: 11/08/2022] Open
Abstract
Retinoblastoma is a rare cancer in children, where in less than a century of dire mortality there has been a cure in industrialized countries. Unfortunately, mortality remains high in emerging countries. The evolution of treatment makes it possible to go further by preserving the eyeball but this must not be done at the cost of the reappearance of metastases. Herein we outline the evolution of treatment from the beginning of the 20th century until the last recent evolutions, trying to imagine what could be the future treatments. In this pathology, the ophthalmologist is a doctor who must cure his patient and enucleation is considered a failure. This situation should not lead to shizophrenic situations where to keep an eye one would take risks with the life of the child. New international classifications, international prospective multicentric studies, and the search for blood biomarkers that can predict the risk of micrometastases could allow for better stratification of patients.
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Affiliation(s)
- Nathalie Cassoux
- Ocular Oncology, Institut Curie, Paris, France
- Paris Science Letter University, School of Medicine, Université René Descartes, Paris, France
| | | | | | | | - François Doz
- Paris Science Letter University, School of Medicine, Université René Descartes, Paris, France
- Pediatric Oncology, Institut Curie, Paris, France
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Ramírez-Ortiz MA, Lansingh VC, Eckert KA, Haik BG, Phillips BX, Bosch-Canto V, González-Pérez G, Villavicencio-Torres A, Etulain-González A. Systematic review of the current status of programs and general knowledge of diagnosis and management of retinoblastoma. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2017; 74:41-54. [PMID: 29364813 DOI: 10.1016/j.bmhimx.2016.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 07/06/2016] [Accepted: 08/10/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This systematic review aims to report the current knowledge of retinoblastoma (Rb) and its implications in Mexico. We analyzed clinical and demographic data of patients with Rb at select hospitals with Rb programs or that treat and refer patients with Rb, and identified the gaps in practice. We propose solutions to improve diagnosis, provide adequate treatment, and improve patient uptake. METHODS A general review was conducted on PubMed of peer-reviewed literature on Rb in Mexico. Ophthalmology Department Heads or Directors of Rb programs at seven hospitals in Mexico were contacted for data available on their patients with Rb. RESULTS Five hospitals provided clinical data on 777 patients with Rb in a period spanning 2000-2015. Of the 122 patients with treatment, 83.4% underwent enucleation. From 33 to 45.3% of Rb tumors in Mexico reach an advanced intraocular stage of development. Knowledge of the disease is limited, despite the fact that the Mexican Retinoblastoma Group has elaborated Rb treatment guidelines and is developing a national Rb registry. Especially in the Southern states, prevalence and outcomes are comparable to African and Asian countries, and only few patients are referred to national treatment centers. Only three institutions have comprehensive Rb programs. CONCLUSIONS There is an immediate need in Mexico to expand primary care providers' knowledge of Rb and to expand and upgrade current Rb programs to meet the needs of the population adequately. Diagnosis and care of Rb patients in Mexico can also be improved by the establishment of a national Rb registry and a national early detection program, and by increased use of the national treatment protocol.
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Affiliation(s)
- Marco A Ramírez-Ortiz
- Departmento de Oftalmología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
| | - Van C Lansingh
- Instituto Mexicano de Oftalmología, Querétaro, Querétaro, Mexico; Help Me See, NY, USA; Department of Ophthalmology, Hamilton Eye Institute, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kristen A Eckert
- Independent Public Health Consultant, Tapachula, Chiapas, Mexico
| | - Barrett G Haik
- Department of Ophthalmology, Hamilton Eye Institute, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Blanca X Phillips
- Department of Ophthalmology, Hamilton Eye Institute, The University of Tennessee Health Science Center, Memphis, TN, USA
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Mattosinho CCDS, Grigorovski N, Lucena E, Ferman S, Soares de Moura ATM, Portes AF. Prediagnostic Intervals in Retinoblastoma: Experience at an Oncology Center in Brazil. J Glob Oncol 2016; 3:323-330. [PMID: 28831440 PMCID: PMC5560453 DOI: 10.1200/jgo.2016.005595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose Retinoblastoma is the most common intraocular malignancy of childhood. In most cases, parents are the first to notice leukocoria and other symptoms before undergoing a prolonged period of stress before diagnosis. The purpose of this study was to determine prediagnostic intervals of patients with retinoblastoma at an oncology tertiary center (Instituto Nacional de Cancer) in Rio de Janeiro, Brazil, and relate them to stage at diagnosis, eye salvage, and survival. Methods Parents or caregivers of children with retinoblastoma registered between January 2006 and September 2013 were interviewed using a semistructured individually applied questionnaire, concerning their trajectory before registration. Results Out of 76 patients, 39 (51%) were girls, 52 (68%) had unilateral retinoblastoma, and 24 (32%) had bilateral retinoblastoma, totaling 100 affected eyes. The most common stage of diagnosis was the intraocular group, with 63 (83%) patients; nine (12%) were extraocular, and four (5%) had metastatic disease. During the follow-up time of 37 ± 24.5 months, 10 (13%) patients died and 70 (70%) eyes were enucleated. Mean family interval was 1.6 ± 2.6 months, mean medical interval was 5.0 ± 6.2 months, mean referral interval was 0.2 ± 1.4 months, and mean overall interval was 7.1 ± 6.9 months. In univariate analysis, age at diagnosis, maternal education, medical interval, and overall interval were significantly related to advanced stage at diagnosis and survival. In multivariate analysis, maternal education and medical interval were significantly related to advanced stage at diagnosis and survival. No variables affected eye salvage. Conclusion Medical interval was responsible for 70% of the overall interval; therefore, programs or campaigns targeting retinoblastoma early diagnosis should focus emphasize in medical awareness.
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Affiliation(s)
| | - Nathalia Grigorovski
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Evandro Lucena
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sima Ferman
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Arlindo Freire Portes
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
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Singh G, Daniels AB. Disparities in Retinoblastoma Presentation, Treatment, and Outcomes in Developed and Less-Developed Countries. Semin Ophthalmol 2016; 31:310-6. [PMID: 27127937 DOI: 10.3109/08820538.2016.1154177] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Retinoblastoma (RB) is the most common intraocular malignancy in children. In the past century, RB survival rates in developed countries (DCs) have improved from <5% to as high as 99%. In contrast, in less developed countries (LDCs) where the tumor burden is greatest, survival rates remain poor, with some countries reporting survival rates as low as 0-5%. In addition, there are disparities between DCs and LDCs in RB presentation, treatment modalities, and prognosis. These disparities are due to many underlying causes, including delays in diagnosis, access to medical care, patient and physician familiarity with the disease, availability and cost of treatment, and patient acceptance of enucleation. It is our belief that attempts to extend the improvements in prognosis achieved in DCs to various LDCs must be culturally sensitive and tailored to each country's specific challenges, and thus, a "one-size-fits-all" approach to improving patient outcomes in LDCs is unlikely to work well. We discuss several culturally sensitive approaches that have been successfully implemented in various LDCs, including those that make use of telemedicine and "twinning" with centers of excellence around the world.
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Affiliation(s)
- Gobind Singh
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Anthony B Daniels
- a Department of Ophthalmology and Visual Sciences , Vanderbilt University Medical Center , Nashville , TN , USA.,b Department of Radiation Oncology , Vanderbilt University Medical Center , Nashville , TN , USA.,c Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center , Nashville , TN , USA.,d Department of Cancer Biology , Vanderbilt University , Nashville , TN , USA
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Chantada GL, Dunkel IJ, Schaiquevich PS, Grynszpancholc EL, Francis J, Ceciliano A, Zubizarreta PA, Fandiño AC, Abramson DH. Twenty-Year Collaboration Between North American and South American Retinoblastoma Programs. J Glob Oncol 2016; 2:347-352. [PMID: 28717719 PMCID: PMC5493246 DOI: 10.1200/jgo.2015.002782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Guillermo L Chantada
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ira J Dunkel
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paula S Schaiquevich
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edith L Grynszpancholc
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jasmine Francis
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alejandro Ceciliano
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pedro A Zubizarreta
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adriana C Fandiño
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
| | - David H Abramson
- , and , Hospital Juan P. Garrahan; , National Scientific and Technical Research Council; , Fundacion Natali Dafne Flexer, de Ayuda al Niño con Cáncer; , Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina; and , and , Memorial Sloan Kettering Cancer Center, New York, NY
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Abstract
In the developed world, retinoblastoma is an uncommon yet highly curable ocular malignancy of childhood affecting 40-50 children in the UK each year. The presenting signs, most commonly leukocoria and squint, should alert the primary care physician or secondary care physician to examine for the red reflex, the absence of which is an indication for urgent ophthalmology assessment. Diagnosis is made by clinical examination and staging may include bone marrow sampling, lumbar puncture and MRI scanning. CT should be avoided to reduce radiation exposure in a population of whom a proportion are at considerable risk of second malignancies. Although enucleation is necessary for many children, over recent years there has been a growing emphasis on conservative management in an attempt to reduce the need for enucleation and avoid the adverse late effects associated with external beam radiotherapy. This review will describe approaches to treatment in the UK and how the stage, laterality and position of the tumour within the eye influence treatment choices.
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16
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Lansingh VC, Eckert KA, Haik BG, Phillipps BX, Bosch-Canto V, Leal-Leal C, Ramírez-Ortiz MA. Retinoblastoma in Mexico: part I. A review of general knowledge of the disease, diagnosis, and management. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:299-306. [DOI: 10.1016/j.bmhimx.2015.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/27/2015] [Accepted: 09/04/2015] [Indexed: 12/20/2022] Open
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Lumbroso-Le Rouic L, Savignoni A, Levy-Gabriel C, Aerts I, Cassoux N, Salviat F, Gauthier-Villars M, Freneaux P, Brisse H, Dendale R, Esteve M, Doz F, Desjardins L. Treatment of retinoblastoma: The Institut Curie experience on a series of 730 patients (1995 to 2009). J Fr Ophtalmol 2015; 38:535-41. [DOI: 10.1016/j.jfo.2015.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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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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Manjandavida FP, Honavar SG, Reddy VAP, Khanna R. Management and outcome of retinoblastoma with vitreous seeds. Ophthalmology 2013; 121:517-24. [PMID: 24572675 DOI: 10.1016/j.ophtha.2013.09.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 09/05/2013] [Accepted: 09/08/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To report the treatment response of retinoblastoma with vitreous seeds to high-dose chemotherapy coupled with periocular carboplatin. DESIGN Retrospective, interventional case series. PARTICIPANTS Consecutive patients with retinoblastoma with vitreous seeds managed over 10 years at a comprehensive ocular oncology center and followed up for at least 12 months after the completion of treatment were included in this study. Institutional review board approval was obtained. INTERVENTION High-dose chemotherapy with a combination of vincristine, etoposide, and carboplatin in patients with focal vitreous seeds and additional concurrent periocular carboplatin in patients with diffuse vitreous seeds. MAIN OUTCOME MEASURES Tumor regression, vitreous seed regression, and eye salvage. RESULTS After excluding the better eye of bilateral cases, 101 eyes of 101 patients were part of the final analysis. All the patients belonged to Reese-Ellsworth group VB, but on the International Classification of Retinoblastoma (ICRB), 21 were group C, 40 were group D, and 40 were group E. The mean basal diameter of the largest tumor was 11.8 ± 4.7 mm. Mean tumor thickness was 7.5 ± 4.0 mm. Vitreous seeds were focal in 21 eyes and diffuse in 80 eyes. Chemotherapy cycles ranged from 6 to 12 (median, 6). Seventy-three eyes with diffuse vitreous seeds received a 15-mg posterior sub-Tenon carboplatin injection (range, 1-13 mg; median, 6 mg). Follow-up duration ranged from 13.4 to 129.2 months (median, 48 months). External beam radiotherapy (EBRT) was necessary in 33 eyes with residual tumor, vitreous seeds, or both. In all, 20 eyes (95%) with ICRB group C retinoblastoma, 34 eyes (85%) with group D retinoblastoma, and 23 eyes (57.5%) with group E retinoblastoma were salvaged. Of 77 eyes that were salvaged, 74 (96%) had visual acuity of 20/200 or better. Twenty-four of 33 chemotherapy failures (73%) regressed with EBRT. None of the patients demonstrated second malignant neoplasm or systemic metastasis. Factors predicting tumor regression and eye salvage were bilateral retinoblastoma and absence of subretinal fluid. Factors predicting vitreous seed regression were absence of subretinal fluid and subretinal seeds. CONCLUSIONS Intensive management with primary high-dose chemotherapy and concurrent periocular carboplatin, and EBRT selectively in chemotherapy failures, provides gratifying outcome in retinoblastoma with vitreous seeds.
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Affiliation(s)
| | - Santosh G Honavar
- Ocular Oncology Service, L. V. Prasad Eye Institute, Hyderabad, India; Ocular Oncology Service, Centre for Sight, Hyderabad, India.
| | - Vijay Anand P Reddy
- Ocular Oncology Service, L. V. Prasad Eye Institute, Hyderabad, India; Ocular Oncology Service, Centre for Sight, Hyderabad, India
| | - Rohit Khanna
- Ocular Oncology Service, L. V. Prasad Eye Institute, Hyderabad, India
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Sethi S, Pushker N, Kashyap S, Sharma S, Mehta M, Bakhshi S, Khurana S, Ghose S. Extraocular retinoblastoma in Indian children: clinical, imaging and histopathological features. Int J Ophthalmol 2013; 6:481-6. [PMID: 23991383 DOI: 10.3980/j.issn.2222-3959.2013.04.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/17/2013] [Indexed: 11/02/2022] Open
Abstract
AIM TO STUDY EYES WITH EXTRAOCULAR DISSEMINATION (EORB), WITH THE FOLLOWING AIMS: first to establish the mean lag period and to understand various reasons for delayed presentation, second to study their imaging profiles and third to analyze histopathological features of eyes enucleated after neoadjuvant chemotherapy. METHODS Prospective study of clinical and imaging features of EORBs (stage III and IV International Retinoblastoma Staging System) presenting to a tertiary eye care centre. Histopathological features of eyes enucleated after receiving neoadjuvant chemotherapy were analyzed. A pictorial illustration of the varied imaging profile of EORB was also presented. RESULTS Over a period of one year, 97 eyes were diagnosed with retinoblastoma; 32 children (36 eyes) (37.1%) had EORB. Mean age 3.6±1.9 years, 71.9% males, 71.9% unilateral, 3.1% with positive family history and 40.6% with metastasis. On imaging, there was extrascleral involvement in 22.2%, involvement of orbital part of optic nerve in 33.3%, involvement of central nervous system in 27.8% and orbital wall involvement in 2.9% eyes. On histopathological analysis of eyes enucleated after neoadjuvant chemotherapy, 25.0% had no residual viable tumour tissue and rest all tumours were poorly differentiated. CONCLUSION There are very few human malignancies where definitive treatment is started without any confirmed histopathological diagnosis and imaging plays an important role in diagnosis and appropriate staging of the disease. Chemotherapy has a variable effect on EORB, 75.0% of eyes with EORB had residual viable tumour tissue when enucleated after receiving neoadjuvant chemotherapy.
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Affiliation(s)
- Sumita Sethi
- Oculoplasty and Pediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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