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Lavasidis G, Papaioannou K, Anagnostou N, Ketteler P, Bechrakis NE, Ntzani E. Evidence in Focus: The Sparse Landscape of Randomized Trials on Retinoblastoma Treatment. Ocul Oncol Pathol 2024; 10:53-62. [PMID: 38751498 PMCID: PMC11095627 DOI: 10.1159/000536410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/15/2024] [Indexed: 05/18/2024] Open
Abstract
Background Retinoblastoma, although rare, is one of the most common intraocular malignancies worldwide. Its prognosis has improved significantly in the past few decades, thanks to modern treatments, like systemic, intra-arterial, and intravitreal chemotherapy. However, regarding survival, there are significant differences between high- and low-income countries, eye salvage is still a challenge worldwide, and treatment-related toxicity needs to be carefully and sufficiently managed. Summary To appraise the strength of supporting evidence, we performed a systematic review of randomized controlled trials investigating any therapeutic protocol for retinoblastoma. Four trials with 174 participants (188 eyes) were eligible, all pertaining to different intravenous chemotherapy regimens. Vincristine, etoposide, and carboplatin (VEC) appear superior to a 5-drug combination for stage III retinoblastoma. Moreover, etoposide and carboplatin as neoadjuvant chemotherapy followed by thermochemotherapy seem to offer better local control than vincristine and carboplatin. However, increasing carboplatin dose in the VEC protocol failed to improve treatment efficacy. Key Messages Retinoblastoma is a success story of modern medicine. However, only intravenous chemotherapy has been studied through randomized trials, while evidence for the most novel retinoblastoma treatments has mainly stemmed from observational studies. International collaborations for multicenter randomized trials could overcome difficulties and increase certainty and precision in the field.
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Affiliation(s)
- Georgios Lavasidis
- Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Ophthalmology, Elpis General Hospital of Athens, Athens, Greece
| | - Kyriaki Papaioannou
- Department of Pediatric Hematology and Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nikolaos Anagnostou
- Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Petra Ketteler
- Department of Pediatric Hematology and Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nikolaos E. Bechrakis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Evangelia Ntzani
- Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Wise J, Hayashi R, Wu T, Malone S, Badawi AA, King A, Gordon M, Kimera L, Lueder G, Reynolds M. Eye-related quality of life and activities of daily living in pediatric retinoblastoma patients: A single-center, non-controlled, cross-sectional analysis. Pediatr Blood Cancer 2023:e30479. [PMID: 37269496 DOI: 10.1002/pbc.30479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Childhood retinoblastoma (RB) survivors are known to experience long-term morbidity; however, eye-related quality of life (QoL), which may significantly impact activities of daily living (ADL), has not been extensively studied in this population. The purpose of this cross-sectional study was to assess QoL and ADL morbidity among school-age RB survivors. METHODS The Pediatric Eye Questionnaire (PedEyeQ) and Roll Evaluation Activities of Life (REAL) were administered to childhood RB survivors between ages 5 and 17 followed at St. Louis Children's Hospital. Visual outcomes and demographic predictors of ADL and QoL were examined. RESULTS Total 23 patients (mean age 9.6 years) consented for participation in this study. All children experienced at least one domain on the PedEyeQ ≤ 80%. Subjects and parents marked functional vision to be the most impacted domain with a median score of 82.5 and 83.4, respectively. Only 10.5% of participants scored above 75% on the ADL percentile rank. On multivariable analysis, decreased visual acuity (VA) was associated with worse "Child Functional" (odds ratio [OR] -59.2, p = .004) and "Parent Worry Function" (OR -66.5, p = .03) metrics. Decreased contrast sensitivity was associated with worse "Parent Impact" (OR 21.0, p = .02) and "Parent Worry Function" (OR 3.70, p = .04) metrics. Longer saccade horizontal latency was associated with a worse "Parent Worry Function" metric (OR 43.0, p = .009). On multivariable analysis, no variable was significantly associated with ADL. CONCLUSION RB survivors have impaired QoL and ADL. Screening for such difficulties should strongly be considered for all RB patients. Additional studies may help predict morbidity based on visual metrics and demographic data.
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Affiliation(s)
- Jacob Wise
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Robert Hayashi
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Tiffany Wu
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Sara Malone
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Amer Al Badawi
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Allison King
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Mae Gordon
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Lawrencia Kimera
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Gregg Lueder
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Margaret Reynolds
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
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Yousef YA, Abu Salim QF, Mohammad M, Jaradat I, Mehyar M, AlJabari R, Al-Habahbeh O, Saboubeh K, Halalsheh H, Khzouz J, Shawagfeh M, Sultan I, AlMasri M, Al-Nawaiseh I, Al-Hussaini M, Mansour A. Presentation and management outcomes of Retinoblastoma among Syrian refugees in Jordan. Front Oncol 2023; 12:1056963. [PMID: 36713556 PMCID: PMC9880551 DOI: 10.3389/fonc.2022.1056963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose The humanitarian crisis in Syria has had a profound impact on the entire region. In this study, we report the patterns of presentation and management outcomes of Syrian patients with Retinoblastoma (Rb) treated at a single tertiary cancer center in Jordan. Methods and Materials This is a retrospective comparative study of Syrian refugees and Jordanian citizens who had Rb between 2011 and 2020. Collected data included patient demographics, presentation, tumor stage, treatment modalities, eye salvage rate, metastasis, and mortality. Results Thirty Syrian refugees (16 (53%) had bilateral disease) and 124 Jordanian citizens (51(41%) had bilateral disease) were diagnosed with Rb during this period. The median age at diagnosis for refugees was 10 and 32 months for patients with bilateral and unilateral Rb consecutively, compared to 6 and 28 months for citizens. The median lag time between signs of disease and initiation of treatment was 3 months for refugees, compared to 1 month for citizens.Refugees were more likely to present with a more advanced stage (p=0.046). Out of 46 affected eyes in refugees; 32 (70%) eyes were group D or E, while out of 175 affected eyes among citizens; 98 (56%) eyes were group D or E. Therefore, refugees with Rb were more likely to mandate primary enucleation (48%) compared to citizens (25%) (p=0.003). However, out of 24 eyes among refugees who received conservative therapy, 15 (62%) eyes were successfully salvaged, while out of 131 affected eyes among citizens who received conservative therapy, 105 (80%) eyes were successfully salvaged (p=0.06). Two (7%) of the refugees and four (3.2%) of the citizens with Rb died from metastasis. Conclusion Syrian refugees with Rb presented with more advanced disease due to delay in diagnosis and referral that increased the treatment burden by decreasing the chance for eye globe salvage. However, patients who received the timely intervention had a similar outcome to citizens with Rb; probably a reflection of the management of all patients at a single specialized center. We advocate for the timely referral of refugees with this rare life-threatening tumor to a specialized cancer center for the best possible outcome.
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Affiliation(s)
- Yacoub A. Yousef
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan,*Correspondence: Yacoub A. Yousef,
| | | | - Mona Mohammad
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Imad Jaradat
- Department Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Reem AlJabari
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Omar Al-Habahbeh
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Khalid Saboubeh
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Hadeel Halalsheh
- Department Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Jakub Khzouz
- Department Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Munir Shawagfeh
- Department Anesthesia, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Iyad Sultan
- Department Pediatrics Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mahmoud AlMasri
- Department of Surgery, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | | | - Maysa Al-Hussaini
- Department Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Asem Mansour
- Department Diagnostic Radiology, King Hussein Cancer Centre (KHCC), Amman, Jordan
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Janic A, Vincent A, Stinson J, Dimaras H. Values of Retinoblastoma Survivors and Parents Regarding Treatment Outcomes: A Qualitative Study. JCO Oncol Pract 2022; 18:e1000-e1015. [PMID: 34985991 DOI: 10.1200/op.21.00474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Retinoblastoma is an aggressive pediatric eye cancer. Patient-reported outcome measures reveal important insights into how patients perceive their own health. Currently, there is no widely used or validated measure for assessment of retinoblastoma outcomes. The purpose of this research was to uncover which treatment outcomes that retinoblastoma survivors and their parents value, to inform the development of a future measure. METHODS This qualitative, cross-sectional study included retinoblastoma survivors age 6 years and older and parents of retinoblastoma survivors. Participants who did not demonstrate fluency in English were excluded. Study participants participated in semistructured interviews or focus groups, either in person at The Hospital for Sick Children, Toronto, Canada, or through secure videoconference, between March 3, 2019, and January 25, 2020. Iterative rounds of opening coding, codebook development, and coresearcher analysis were used to identify key emergent themes and subthemes. RESULTS Seventeen adults participated in six focus groups. Nine pediatric survivors participated in individual interviews. Four common themes emerged from all participant groups: (1) definition of treatment success, (2) enucleation-acceptance and challenges, (3) treatment outcomes to measure, and (4) need for outcome reporting. An additional, unique theme was identified in all pediatric discussions: worries and coping mechanisms. Treatment outcomes deemed valuable were related to the following domains: psychosocial outcomes, daily functioning, functional vision, retinoblastoma education, cosmetic outcomes, and secondary eye conditions. CONCLUSION This study represents the first stage in the development of a retinoblastoma-specific patient-reported outcome measure. The findings reveal insight into what outcomes are valued by survivors after treatment and offer promise to improve outcomes assessment for retinoblastoma.
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Affiliation(s)
- Ana Janic
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada
| | - Ajoy Vincent
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada.,Genetics and Genome Biology, SickKids Research Institute, Toronto, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada.,Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Helen Dimaras
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada.,The Centre for Global Child Health, SickKids Research Institute, Toronto, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Wei R, Li M, Yang W, Xu H, Choi J, Zhou X. Case Report: Phototherapeutic Keratectomy for Band Keratopathy Secondary to Chemo-Laser-Cryotherapy for Retinoblastoma. Front Med (Lausanne) 2021; 8:668762. [PMID: 34513859 PMCID: PMC8423897 DOI: 10.3389/fmed.2021.668762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/04/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: To report the clinical outcomes of phototherapeutic keratectomy (PTK) for pediatric band keratopathy after treatment for retinoblastoma. Methods: A 5-year-old boy presented with a 2-year history of poor visual acuity and a horizontal gray-white band across the central cornea in the right eye. He was diagnosed with band keratopathy after chemo-laser-cryotherapy for retinoblastoma. The band keratopathy was treated via PTK using the Mel-90 excimer laser with an optical treatment zone of 7.0 mm and ablation depth of 120 μm. The patient was followed at 1 week and 3 months postoperatively. Results: Surgery and postoperative follow-up were uneventful. At the 3-month follow-up, the uncorrected distant visual acuity of the right eye improved to 20/125, and the corrected distance visual acuity improved to 20/70 with a refraction of +10.00 D/−2.50 DC × 15. The clarity of the ablated area was evidently improved. The central corneal thickness decreases from 612 to 584 μm. The optical coherence tomography showed the thin band of hyperreflectivity in the ablated area disappeared, corneal transparency improved and the corneal surface smoothened. Conclusions: PTK is a safe and effective procedure to treat band keratopathy following treatment of retinoblastoma in children. Early intervention can reduce the risk of developing deprivation amblyopia.
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Affiliation(s)
- Ruoyan Wei
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Meiyan Li
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Weiming Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Haipeng Xu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Joanne Choi
- Kresge Eye Institute/Department of Ophthalmology, Wayne State University, Detroit, MI, United States
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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El Zomor H, Nour R, Saad A, Taha H, Shelil AE, Aleieldin A, Saad Zaghloul M, Alfaar AS. Unilateral retinoblastoma; natural history and an age-based protocol in 248 patients. Eye (Lond) 2021; 35:2564-2572. [PMID: 33188294 PMCID: PMC8377076 DOI: 10.1038/s41433-020-01275-2] [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: 02/28/2020] [Revised: 09/24/2020] [Accepted: 10/29/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES We aimed to study the clinical state and prognosis of patients with unilateral retinoblastoma who were being treated at a paediatric comprehensive cancer centre in a limited-resource country, to assess the different phases of treatment and the success of different, more complex real-life models. SUBJECTS In this retrospective study, we created a snapshot of our retinoblastoma database for the period between 2007 and 2015. Patients whose data were included in the study were followed up until 2016. Out of a total of 744 screened patients, we included data of 248 patients who had been diagnosed with unilateral retinoblastoma. RESULTS As classified as per the International Retinoblastoma Classification, 1 patient presented with group A, 21 with group B, 39 with group C, 104 with group D and 83 with group E retinoblastoma. Chemotherapy was the initial line of treatment in 115 patients and enucleation in 133 others. Later, 141 patients (56.9%) required further management. Patients had a mean ocular survival time of 20.8 months. Nine patients developed extraocular disease at a later stage of management: five after upfront enucleation and four after neoadjuvant chemotherapy. Mean overall survival time stood at 90.2 months. Four and three deaths were recorded in groups D and E, respectively. A single patient died in the initial chemotherapy arm, while six passed away in the initial enucleation arm. CONCLUSION Our study highlights the importance of initial chemotherapy and close follow-up after enucleation of classes D and E affected eyes even in absence of germline mutations.
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Affiliation(s)
- Hossam El Zomor
- Egyptian National Cancer Institute, Cairo, Egypt
- Children's Cancer Hospital Egypt, Cairo, 57357, Egypt
| | - Radwa Nour
- London School of Hygiene and Tropical Medicine, London, UK
| | - Anas Saad
- Cleveland Clinic Foundation, Cleveland, OH, USA
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala Taha
- Egyptian National Cancer Institute, Cairo, Egypt
- Children's Cancer Hospital Egypt, Cairo, 57357, Egypt
| | | | | | - M Saad Zaghloul
- Egyptian National Cancer Institute, Cairo, Egypt
- Children's Cancer Hospital Egypt, Cairo, 57357, Egypt
| | - Ahmad S Alfaar
- Experimental Ophthalmology, Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
- Ophthalmology Department, Faculty of Medicine, Leipzig University, Leipzig, Germany.
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Yousef YA, Mohammad M, Mehyar M, Sultan I, Al-Hussaini M, Alhourani J, Halalsheh H, Khzouz J, Jaradat I, Qaddoumi I, Al-Nawaiseh I. The Predictive Value of the Eighth Edition of the Clinical TNM Staging System for the Likelihood of Eye Salvage for Intraocular Retinoblastoma by Systemic Chemotherapy and Focal Therapy. J Pediatr Hematol Oncol 2021; 43:e841-e847. [PMID: 33769386 PMCID: PMC8373642 DOI: 10.1097/mph.0000000000002144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) cTNM staging is emerging as a universal staging for all cancers, including retinoblastoma. METHODS Here we evaluated the predictive value of the eighth edition AJCC/UICC cTNM staging in comparison with the International Intraocular Retinoblastoma Classification for eye globe salvage by primary systemic chemotherapy and focal therapy (CRD) using logistic regression model for the probability of treatment failure. RESULTS The eye salvage rate for 565 treated eyes was 95% (n=139/147) for T1 tumors (98% for T1a and 93% for T1b), 56% (n=230/410) for T2 (81% for T2a and 53% for T2b), and 0% for T3 tumors, and was 98%, 93%, 76%, and 44% for group A, B, C, and D tumors, respectively. As estimated by odds ratios, T2 were 13.6-fold more likely to fail treatment than T1, and T1b, T2a, and T2b were 2.8-, 9.4-, and 35.1-fold more likely to fail treatment than T1a, respectively. Group B, C, and D tumors were 2.8-, 12.7-, and 50.1-fold more likely to fail treatment than group A tumors, respectively. Eye salvage rate was 62% for eyes with focal seeds (3 mm close to the tumor), and 42% for eyes with diffuse seeds (clouds more than 3 mm from tumor edge) (P<0.0001). CONCLUSION Both, the eighth edition cTNM classification and the International Intraocular Retinoblastoma Classification systems, can effectively predict eye salvage rates for retinoblastoma by CRD. Eyes with higher cT stages are more likely to experience treatment failure. Because the cT2b group is very heterogeneous, our findings suggest further division of this group based on the severity of vitreous/subretinal seeds, this should be revised in the next edition of cTNM system.
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Affiliation(s)
- Yacoub A. Yousef
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Mona Mohammad
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Mustafa Mehyar
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | - Iyad Sultan
- Pediatrics Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Maysa Al-Hussaini
- Pathology and Laboratory Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Joud Alhourani
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
| | | | - Jakub Khzouz
- Pathology and Laboratory Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Imad Jaradat
- Radiation Oncology, King Hussein Cancer Centre, Amman, Jordan
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ibrahim Al-Nawaiseh
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan
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Gupta H, Malaichamy S, Mallipatna A, Murugan S, Jeyabalan N, Suresh Babu V, Ghosh A, Ghosh A, Santhosh S, Seshagiri S, Ramprasad VL, Kumaramanickavel G. Retinoblastoma genetics screening and clinical management. BMC Med Genomics 2021; 14:188. [PMID: 34294096 PMCID: PMC8296631 DOI: 10.1186/s12920-021-01034-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND India accounts for 20% of the global retinoblastoma (RB) burden. However, the existing data on RB1 gene germline mutations and its influence on clinical decisions is minimally explored. METHODS Fifty children with RB underwent complete clinical examination and appropriate multidisciplinary management. Screening of germline RB1 gene mutations was performed through next-generation sequencing and Multiplex Ligation-dependent Probe Amplification (MLPA) analysis. The mutation and non-mutation groups were compared for clinical parameters especially severity, progression and recurrence. RESULTS Twenty-nine patients had bilateral RB (BLRB) and 21 had unilateral RB (ULRB). The genetic analysis revealed 20 RB1 variations in 29 probands, inclusive of 3 novel mutations, known 16 mutations and heterozygous whole gene deletions. The mutation detection rate (MDR) was 86.2% in BLRB and 19% in ULRB. Associations of disease recurrence (p = 0.021), progression (p = 0.000) and higher percentage of optic nerve invasion, subretinal seeds and high-risk pathological factors were observed in the mutation group. Clinical management was influenced by the presence of germline mutations, particularly while deciding on enucleation, frequency of periodic follow up and radiotherapy. CONCLUSIONS We identified novel RB1 mutations, and our mutation detection rate was on par with the previous global studies. In our study, genetic results influenced clinical management and we suggest that it should be an essential and integral component of RB-care in India and elsewhere.
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Affiliation(s)
| | | | | | | | | | | | - Anuprita Ghosh
- Grow Lab, Narayana Nethralaya Foundation, Bangalore, India
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Hoang CQ, Duong HQ, Nguyen NT, Nguyen SAH, Nguyen C, Nguyen BD, Phung LT, Nguyen DT, Pham CTM, Le Doan T, Tran MH. Clinical evaluation of RB1 genetic testing reveals novel mutations in Vietnamese patients with retinoblastoma. Mol Clin Oncol 2021; 15:182. [PMID: 34277001 DOI: 10.3892/mco.2021.2344] [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: 01/21/2021] [Accepted: 06/08/2021] [Indexed: 01/01/2023] Open
Abstract
Clinical evaluation of the genetic testing strategy is essential for ensuring the correct determination of mutation carriers. The current study retrospectively analyzed genetic and clinicopathological data from 62 Vietnamese patients with retinoblastoma (RB) referred to the Vinmec Hi-Tech Center for RB transcriptional corepressor 1 (RB1) genetic testing between 2017 and 2019. The present study aimed to evaluate the sensitivity of the Next Generation Sequencing (NGS) method to identify novel RB1 mutations, and to consider using age at diagnosis as a risk factor. Genomic DNA was analyzed with custom panel based targeted NGS. NGS was performed on the Beijing Genomics Institute (BGI) sequencing platform, and pathogenic or likely pathogenic variants were confirmed by Sanger sequencing, quantitative PCR (qPCR) or Multiplex Ligation-dependent Probe Amplification assay (MLPA). Constitutional RB1 variants were identified in 100% (25/25) of the bilateral cases, while several common previously reported RB1 mutations were also recorded. In addition, in Vietnamese patients with RB, nine novel RB1 mutations were identified. Children aged between 0-36 months were more likely to be RB1 carriers compared with those aged >36 months. The current findings indicated that the NGS method implemented in the Vinmec Hi-Tech Center was highly accurate, and age at diagnosis may be used to assess the risk of hereditary RB. Furthermore, the newly identified RB1 mutations may provide additional data to improve the current understanding of the mechanisms underlying RB1 inactivation and the development of rapid assays for detecting RB1 mutations. Overall, the present study suggested that NGS may be applied for detecting germline RB1 mutations in routine clinical practice.
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Affiliation(s)
- Chinh Quoc Hoang
- Vinmec Hi-Tech Center, Vinmec Healthcare System, Hanoi 100000, Vietnam.,Department of Cancer Research, Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi 100000, Vietnam.,Center for Experimental Biology, National Center for Technological Progress, Hanoi 100000, Vietnam
| | - Hong-Quan Duong
- Department of Cancer Research, Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi 100000, Vietnam.,Laboratory Center, Hanoi University of Public Health, Hanoi 100000, Vietnam
| | - Nguyen Thanh Nguyen
- Department of Translational Biomedical Informatics, Vingroup Big Data Institute, Hanoi 100000, Vietnam
| | - Sy Anh Hao Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Cuong Nguyen
- Vinmec Hi-Tech Center, Vinmec Healthcare System, Hanoi 100000, Vietnam.,LOBI Vietnam Ltd., Hanoi 100000, Vietnam
| | - Bo Duy Nguyen
- Department of Pediatrics 3, Vinmec International Hospital in Times City, Vinmec Healthcare System, Hanoi 100000, Vietnam
| | - Lan Tuyet Phung
- Department of Pediatrics 3, Vinmec International Hospital in Times City, Vinmec Healthcare System, Hanoi 100000, Vietnam
| | - Dung Thuy Nguyen
- Department of Pediatrics 3, Vinmec International Hospital in Times City, Vinmec Healthcare System, Hanoi 100000, Vietnam
| | - Chau Thi Minh Pham
- Department of Pediatric Ophthalmology, Vietnam National Eye Hospital, Hanoi 100000, Vietnam
| | - Trang Le Doan
- Department of Pediatric Ophthalmology, Vietnam National Eye Hospital, Hanoi 100000, Vietnam
| | - Mai Hoang Tran
- Department of Cancer Research, Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi 100000, Vietnam.,Department of Translational Biomedical Informatics, Vingroup Big Data Institute, Hanoi 100000, Vietnam
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Gu X, Xie M, Jia R, Ge S. Publication Trends of Research on Retinoblastoma During 2001-2021: A 20-Year Bibliometric Analysis. Front Med (Lausanne) 2021; 8:675703. [PMID: 34095180 PMCID: PMC8175655 DOI: 10.3389/fmed.2021.675703] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Retinoblastoma is the most common primary intraocular malignancy of childhood. Despite high survival and eye salvage as the result of various types of therapies, retinoblastoma remains a disease that places a considerable burden on developing countries. Our study attempted to analyse the research trends in retinoblastoma research and compare contributions from different countries, institutions, journals, and authors. Methods: We extracted all publications concerning retinoblastoma from 2001 to 2021 from the Web of Science database. Microsoft Excel and VOSviewer were employed to collect publication data, analyse publication trends, and visualize relevant results. Results: A total of 1,675 publications with 30,148 citations were identified. The United States contributed the most publications (643) and citations (16,931 times) with the highest H-index value (67) as of February 4, 2021. China ranked second in the number of publications (259), while ranking fourth in both citations (2,632 times) and the H-index (26) ranked fourth. The British Journal of Ophthalmology was the most productive journal concerning retinoblastoma, and Abramson DH had published the most papers in the field. Keywords were categorized into three clusters; tumor-related research, clinical research, and management-related research. The keywords “intravitreal,” “intraarterial,” and “intravenous” appeared the most frequently, with the average appearing year being 2018.1, 2017.7, and 2017.1, respectively. Management-related research has been recognized as a heavily researched topic in the field. Conclusion: We conclude that the United States, China, and India made the most exceptional contributions in the field of retinoblastoma research, while China still has a disparity between the quantity and quality of publications. Management-related research, including intravitreal, intraarterial, and intravenous chemotherapy was considered as a potential focus for future research.
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Affiliation(s)
- Xiang Gu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Minyue Xie
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai JiaoTong University School of Medicine, Shanghai, China
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11
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Amin S, AlJboor M, Toro MD, Rejdak R, Nowomiejska K, Nazzal R, Mohammad M, Al-Hussaini M, Khzouz J, Banat S, AlJabari R, Jaradat I, Mehyar M, Sultan I, AlNawaiseh I, Yousef YA. Management and Outcomes of Unilateral Group D Tumors in Retinoblastoma. Clin Ophthalmol 2021; 15:65-72. [PMID: 33447011 PMCID: PMC7802086 DOI: 10.2147/opth.s282741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose Retinoblastoma presents most commonly as advanced unilateral disease, particularly in developing countries for which primary enucleation has been the preferred method of treatment. However, with the evolution of newer treatment modalities including intravitreal chemotherapy, intra-arterial chemotherapy and newer chemotherapeutic combinations, a trend towards more conservative approaches is being observed. Our aim is to evaluate outcomes of group D eyes following conservative and non-conservative treatment options. Patients and Methods The ocular oncology database was used to identify eyes with unilateral retinoblastoma that fulfilled the International Intraocular Retinoblastoma Classification (IIRC) group D criteria from August 2010 to August 2018 and these were retrospectively reviewed. Overall, 39 eyes were identified. Results Nineteen (49%) eyes underwent primary enucleation and 20 (51%) received eye-conserving treatment. Eye salvage was possible in 15 (75%) eyes in the attempted salvage group. None of the patient revealed signs of metastasis. All eyes received conventional chemotherapy (carboplatin, vincristine, etoposide) and focal laser therapy. Additional treatment modalities offered included intravitreal chemotherapy, intra-arterial chemotherapy and topotecan. Three (11%) eyes in the primary enucleation group showed high-risk features on histopathology and none developed metastasis. Conclusion The results of the study seem promising and conservative measures can be adopted in selected unilateral group D eyes.
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Affiliation(s)
- Saima Amin
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mays AlJboor
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mario D Toro
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, Lublin, Poland.,Faculty of Medical Sciences, Collegium Medicum Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Robert Rejdak
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Nowomiejska
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, Lublin, Poland
| | | | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Jakub Khzouz
- Department of Pathology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Sara Banat
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Reem AlJabari
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Imad Jaradat
- Department of Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Ibrahim AlNawaiseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
| | - Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman, Jordan
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12
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Zhang Z, Xiao YS, Shen R, Jiang HC, Tan L, Li RQ, Yang XH, Gu HY, He WJ, Ma J. Next generation sequencing of RB1gene for the molecular diagnosis of ethnic minority with retinoblastoma in Yunnan. BMC MEDICAL GENETICS 2020; 21:230. [PMID: 33225895 PMCID: PMC7682003 DOI: 10.1186/s12881-020-01150-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
Background Retinoblastoma is a rare intraocular malignancy and typically initiated by inactivating biallelic mutations of RB1 gene. Each year, ~ 8000 children worldwide are diagnosed for retinoblastoma. In high-income countries, patient survival is over 95% while low-income countries is ~ 30%.If disease is diagnosed early and treated in centers specializing in retinoblastoma, the survival might exceed 95% and many eyes could be safely treated and support a lifetime of good vision. In China, approximate 1100 newly diagnosed cases are expected annually and 28 hospitals covering 25 provinces established centers classified by expertise and resources for better treatment options and follow-up. Comparing with other province of eastern China, Yunnan province is remote geographically. This might result that healthcare staff have low awareness of the role of genetic testing in management and screening in families. Methods The patients with retinoblastoma were selected in Yunnan. DNA from blood was used for targeted gene sequencing. Then, an in-house bioinformatics pipeline was done to detect both single nucleotide variants and small insertions/deletions. The pathogenic mutations were identified and further confirmed by conventional methods and cosegregation in families. Results Using our approach, targeted next generation sequencing was used to detect the mutation of these 12 probands. Bioinformatic predictions showed that nine mutations were found in our study and four were novel pathogenic variants in these nine mutations. Conclusions It’s the first report to describe RB1 mutations in Yunnan children with retinoblastoma. This study would improve role of genetic testing for management and family screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12881-020-01150-7.
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Affiliation(s)
- Zhen Zhang
- Key Laboratory of Children's Major Disease Research, and Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China.,Department of Human Anatomy, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, 510080, PR China
| | - Yi-Shuang Xiao
- Department of Ophthalmology, Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Ru Shen
- Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Hong-Chao Jiang
- Key Laboratory of Children's Major Disease Research, and Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Li Tan
- Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Ren-Qiu Li
- Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Xiao-Hong Yang
- Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Huai-Yu Gu
- Department of Human Anatomy, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, 510080, PR China.
| | - Wen-Ji He
- Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China.
| | - Jing Ma
- Key Laboratory of Children's Major Disease Research, and Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China. .,Department of Otolaryngology-Head Neck Surgery, Kunming Children's Hospital, Kunming Medical University,, Kunming, Yunnan, 650228, PR China.
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13
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Janic A, Bowden S, Levy S, Stinson J, Dimaras H. Patient-reported outcome measures for retinoblastoma: a scoping review. J Patient Rep Outcomes 2020; 4:66. [PMID: 32770435 PMCID: PMC7415058 DOI: 10.1186/s41687-020-00232-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Retinoblastoma is a childhood retinal cancer with lifelong consequences such as vision loss and increased risk of second cancer. Patient-reported outcome measures (PROMs) are instruments that measure outcomes related to health directly reported by patients. The purpose of this study was to determine the scope, characteristics and quality of PROMs used in retinoblastoma and related fields of pediatric ophthalmology and pediatric oncology. METHODS Databases MEDLINE and Embase were searched for studies in the English language that reported on PROMs used in retinoblastoma, pediatric oncology, or pediatric ophthalmology; grey literature and studies reporting on developmental PROM phases were excluded. PROMs were grouped by the construct measured and domains assessed, and classified as condition-specific or generic. A subsequent search was then conducted in MEDLINE and Embase for studies assessing measurement properties of the identified PROMs. PROMs with associated studies were assessed for their methodologic quality using the COnsensus-based standard for the Selection of health Measurement INstruments (COSMIN) strategy. RESULTS Among 110 eligible studies uncovered by the database searches, 143 PROMs were identified: one retinoblastoma-specific, 56 ophthalmology- and 86 oncology-related. The most common construct measured was 'health-related quality of life' and the most common domain assessed was emotional well-being. Of the 143 PROMs, 100 had associated validation studies; the one retinoblastoma-specific PROM was not validated. Quality assessment revealed 34/100 PROMs received a score of sufficient quality in both subcategories of 'overall content validity'; 3/100 received a score of sufficient quality in both subcategories of 'internal structure'; 0/100 received a score of sufficient quality in all three subcategories of 'remaining measurement properties'. The Patient-Reported Outcome Measure Information System (PROMIS) Pediatric Profile-25 was the highest-scoring PROM identified, meeting COSMIN standards for 2/3 measurement property categories (and 5/7 subcategories). Eleven additional PROMs were identified which had sufficient scores in 1/3 measurement property categories (and 5/7 subcategories). CONCLUSION The study identified several PROMs from the pediatric ophthalmology and pediatric oncology literature that could be relevant to the retinoblastoma population, but many have limits to their validation. Future development of a retinoblastoma-specific PROM, performed in partnership with retinoblastoma patients to support optimal content validity, could first focus on the selection and definition of the optimal construct to measure, followed potentially by adaptation and further validation of the relevant PROMs with strong methodologic quality identified in this study.
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Affiliation(s)
- Ana Janic
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
| | - Sylvie Bowden
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
| | - Sarah Levy
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, M5T 1P8, Canada
| | - Helen Dimaras
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada.
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada.
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada.
- The Centre for Global Child Health, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada.
- Division of Clinical Public Health, University of Toronto, 150 College Street, Toronto, M5T 3M7, Canada.
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14
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Yousef YA, Alkhoms A, AlJabari R, AlJboor M, Mohammad M, Lahlouh M, Deebajah R, Halalsheh H, Al-Hussaini M, Jaradat I, Shawagfeh M, Sultan I, Mehyar M, AlNawaiseh I. Programmed screening for retinoblastoma enhances early diagnosis and improves management outcome for high-risk children. Ophthalmic Genet 2020; 41:308-314. [PMID: 32432497 DOI: 10.1080/13816810.2020.1766085] [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
PURPOSE To study the impact of a Retinoblastoma (Rb) screening program in the absence of genetic testing on the management and outcome of high-risk children. METHODS This is a retrospective, clinical case series of 76 children from families involved in a Rb screening program as they had higher than normal risk as calculated by the conventional ways without genetic testing. Data included calculated risk, method of diagnosis, demographics, tumor features, treatment modalities, and management outcome. RESULTS Out of the 76 children screened, 46 children were diagnosed with Rb (12 by screening and 34 had signs of Rb), the other 30 were free of disease. Patients diagnosed by screening were younger (mean; 2.4 months vs 15.8 months for the group with signs of Rb), had significantly earlier tumor stage at diagnosis (p = .0001), higher eye salvage rate (p = .0001), less need for systemic chemotherapy (p = .022), and better visual outcome (p = .0017) than the other group. None of the eyes were group D or E, enucleated or irradiated. Six (50%) patients were cured without chemotherapy, and the visual acuity was 0.5 or better in 55% of eyes. Of interest, 71% of tumors were diagnosed by the age of 6 months, 90% by the age of 1 year, and no new tumor appeared after the age of 2 years. CONCLUSION Even in the absence of genetic testing, screening for children with high risk for Rb is effective in enhancing early diagnosis, improving visual outcome, and increasing eye salvage rate with limited exposure to treatment burden.
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Affiliation(s)
- Yacoub A Yousef
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Abdelrahman Alkhoms
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Reem AlJabari
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Mays AlJboor
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Mona Mohammad
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Maha Lahlouh
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Rasha Deebajah
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Hadeel Halalsheh
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Maysa Al-Hussaini
- Pathology and Laboratory Medicine, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Imad Jaradat
- Anesthesia, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Munir Shawagfeh
- Radiation Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Iyad Sultan
- Pediatrics Oncology, King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Mustafa Mehyar
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
| | - Ibrahim AlNawaiseh
- Departments of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC) , Amman, Jordan
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15
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Xiao W, Ji X, Ye H, Zeng H, Gao Y, Chen R, Chen X, Mao Y, Yang H. Parent Knowledge of Screening and Genetic Testing in Retinoblastoma. J Ophthalmol 2020; 2020:3839792. [PMID: 32351720 PMCID: PMC7171634 DOI: 10.1155/2020/3839792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate parent knowledge of screening and genetic testing for retinoblastoma and its potential correlation with demographics, clinical features, and socioeconomical factors. METHODS It was a cross-sectional study conducted at the ocular oncology unit of a tertiary ophthalmic center in Southern China. A face-to-face interview was administered to parents of retinoblastoma children during hospitalization. Parent knowledge was assessed using the sum score of a 7-item questionnaire. Demographics and socioeconomic status were collected from the interview, and clinical data were retrieved from the medical records. RESULTS A total of 126 parents of retinoblastoma children were included. Parents accurately answered 66.7% to 84.9% of each item in the questionnaire. Only 37 (29.4%) parents correctly answered all 7 questions. Parent knowledge was positively correlated with education, but it was not associated with patients' laterality, sex, or household income. Physicians and the Internet were the major sources of parental health-related information. During the median follow-up of 492 days, 13 (61.9%) of 21 patients in the full-score group without genetic testing at baseline actually conducted testing during follow-up compared to 29 of 67 (43.3%) in the less-than-full-score group (P=0.136). CONCLUSION Overall parent knowledge about retinoblastoma screening and genetic testing was moderate. Higher education was associated with greater parent knowledge. Future studies should validate our findings in other populations, especially in those with different cultural background and healthcare systems.
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Affiliation(s)
- Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Xian Ji
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Huijing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Huiqi Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yang Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyun Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yuxiang Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Flegg K, Gelkopf MJ, Johnson SA, Dimaras H. The top 10 retinoblastoma research priorities in Canada as determined by patients, clinicians and researchers: a patient-oriented priority-setting partnership. CMAJ Open 2020; 8:E420-E428. [PMID: 32518094 PMCID: PMC7286623 DOI: 10.9778/cmajo.20190221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Retinoblastoma is a childhood cancer of the eye that can have lifelong effects on patients and families. The purpose of this study was for people affected by retinoblastoma, clinicians and researchers to jointly determine the top 10 retinoblastoma research priorities in Canada. METHODS An adaptation of the James Lind Alliance Priority Setting Partnership (PSP) methodology was employed. People were invited to participate in any stage of the priority-setting process if they were a resident of Canada, and were a patient with retinoblastoma (or a family member or friend of someone diagnosed with retinoblastoma) or a clinician or researcher interested in retinoblastoma. Patients were full partners in study design and implementation, and result dissemination, through involvement in a national working group (1 patient and 9 nonpatients) and steering committee (4 patients and 11 nonpatients). In phase 1 of the study, participants responded to an online survey that asked, "What questions about retinoblastoma would you like to see answered by research?" In phase 2, the steering committee reviewed and refined the list of survey responses and decided on a list of 30 questions to be ranked by means of the nominal group technique in phase 3, a priority-setting workshop. RESULTS In total, 175 retinoblastoma research questions were suggested by 59 survey participants (38 patients and 21 nonpatients). The categories with the greatest number of questions were genetics and molecular (45 [25.7%]), second cancer (29 [16.6%]) and psychosocial (27 [15.4%]). The top 10 questions as ranked by the workshop participants (10 patients and 10 nonpatients) fell into 7 categories: second cancer (2 questions), follow-up (2), psychosocial (2), treatment (1), diagnosis (1), global health (1) and miscellaneous (1). The early diagnosis of retinoblastoma was identified as the top retinoblastoma research priority in Canada. INTERPRETATION The list of priorities will serve as a resource for advocacy groups, research teams and funding agencies that focus on retinoblastoma. The inclusion of researchers as participants was an adaptation of the James Lind Alliance PSP methodology and enriched the research prioritization process.
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Affiliation(s)
- Kaitlyn Flegg
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont
| | - Maxwell J Gelkopf
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont
| | - Sarah A Johnson
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont.
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17
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Janic A, Kimani K, Olembo I, Dimaras H. Lessons for Patient Engagement in Research in Low- and Middle-Income Countries. Ophthalmol Ther 2020; 9:221-229. [PMID: 32222906 PMCID: PMC7196100 DOI: 10.1007/s40123-020-00246-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Indexed: 01/05/2023] Open
Abstract
Patient engagement in research is marked by partnership between clinicians, scientists, and people with lived experience of a disease, who jointly develop and implement research and disseminate results. Patient engagement in research has been shown to lead to more impactful and relevant findings. There is a global need for quality research contextualized for low- and middle-income countries (LMICs). Patient involvement in research could address this need, yet it remains a practice more commonly employed in high income countries. In this paper, the authors explore LMIC-specific challenges and opportunities for patient engagement in research. Limitations to patient engagement in research include gaps in health infrastructure, socioeconomic status, cultural stigma, and uncertain roles. Potential solutions to address these challenges include strategic national and international research partnerships, initiatives to combat stigma, and sensitization and training of stakeholders in patient engagement in research. Reflecting on their patient engagement experience with eye cancer research in Canada and Kenya, and supported by evidence of patient engagement in other low-resource settings, the authors provide a roadmap for patient engagement in research in LMICs.
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Affiliation(s)
- Ana Janic
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Isabel Olembo
- Syndications and Agency Operations Department, Eastern and Southern African Trade and Development Bank, Nairobi, Kenya
| | - Helen Dimaras
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada. .,Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada. .,The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada. .,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. .,Division of Clinical Public Health, University of Toronto, Toronto, ON, Canada.
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18
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Moses C, Flegg K, Dimaras H. Patient knowledge, experiences and preferences regarding retinoblastoma and research: A qualitative study. Health Expect 2020; 23:632-643. [PMID: 32113195 PMCID: PMC7321723 DOI: 10.1111/hex.13043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/27/2020] [Accepted: 02/07/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We launched a patient engagement strategy to facilitate research involvement of the retinoblastoma (childhood eye cancer) community in Canada. To inform our strategy, we aimed to uncover the experiences with retinoblastoma, knowledge of retinoblastoma and research engagement among retinoblastoma survivors and parents. METHODS Focus groups were held in Toronto and Calgary, including both in-person and remote participants (via videoconference). Discussions centred on experience with retinoblastoma, knowledge of the disease and engagement with research. Focus group transcripts were evaluated by inductive thematic analysis. RESULTS Four focus groups (3 in Toronto, 1 in Calgary) were held with a collective total of 34 participants. Retinoblastoma had a substantial impact on the life of participants, but overall, patients reported being able to adapt and persevere. Experiential knowledge of retinoblastoma was identified as distinct from the theoretical knowledge held by their clinicians. Participants indicated they often acted as a knowledge broker, communicating information about the cancer to their social networks. Participants were willing to engage in research as partners, but recognized barriers such as time and appropriate training. CONCLUSIONS Patients view their experiential knowledge of retinoblastoma as valuable to improving care and directing research. There is a unique role for research engagement in meeting the educational needs of patients.
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Affiliation(s)
- Catherine Moses
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,The Department of Health Studies, University of Toronto, Toronto, ON, Canada
| | - Kaitlyn Flegg
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Helen Dimaras
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Ophthalmology & Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, ON, Canada.,Center for Global Child Health, SickKids Research Institute, Toronto, ON, Canada
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19
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Dial C, Doh K, Thiam I, Roth PAN, Moreira C, Woto-Gaye G. Retinoblastoma in children: a case series from Senegal. Oxf Med Case Reports 2019; 2019:omz084. [PMID: 31772735 PMCID: PMC6792087 DOI: 10.1093/omcr/omz084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/28/2019] [Accepted: 07/22/2019] [Indexed: 11/13/2022] Open
Abstract
Retinoblastoma is the most common tumor of the eye in Senegalese children. Diagnosis occurs often at a late stage, when enucleation is unavoidable. In this report, we describe all recorded cases occurring in Senegal over a 10-year period (2005-14). For the 106 cases clinically and radiological identified, the mean age at diagnosis was 30 months (2 months / 10 years). Leucocoria (74.6%) and exophthalmos (42.3%) were common signs of the disease. For the 67 cases identified through patient-file examination, extra-ocular forms were present in 30% of cases at the time of diagnosis and retinal detachment in 19% of cases. Chemotherapy and surgery were the only available therapeutic methods. Overall survival at 5 years was 70%. Retinoblastoma is a serious illness that threatens the lives and sight of affected children. There are about 10 cases per year in Senegal. Management can be enhanced by improving existing technical platforms and training medical staff.
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Affiliation(s)
- Chérif Dial
- Laboratory of Anatomy and Cytology, Hospital of Grand Yoff, 15 Rue Robert Brun, 3270, Dakar, Senegal
| | - Kwame Doh
- Laboratory of Pathological Anatomy and Cytology, Aristide Dantec Hospital, Avenue Pasteur, 3001 Dakar, Senegal
| | - Ibou Thiam
- Laboratory of Pathological Anatomy and Cytology, Aristide Dantec Hospital, Avenue Pasteur, 3001 Dakar, Senegal
| | - Paul Aïda Ndoye Roth
- Department of Ophthalmology, Aristide Dantec Hospital, Avenue Pasteur, 3001 Dakar, Senegal
| | - Claude Moreira
- Oncology's Pediatric Department, Aristide Dantec Hospital, Avenue Pasteur, 3001 Dakar, Senegal
| | - Gisèle Woto-Gaye
- Laboratory of Pathological Anatomy and Cytology, Aristide Dantec Hospital, Avenue Pasteur, 3001 Dakar, Senegal
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20
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Ademola-Popoola DS, Opocher E, Reddy MA. Contemporary management of retinoblastoma in the context of a low-resource country. Niger Postgrad Med J 2019; 26:69-79. [PMID: 31187745 DOI: 10.4103/npmj.npmj_21_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Retinoblastoma (RB) is the most common ocular cancer, and it typically presents before the age of 5 years in over 90% of cases. In high resource countries, RB patients tend to survive and retain their sight. This is not the case in low-resource countries because of late presentation and delayed intervention arising mostly from sociocultural and socioeconomic challenges. RB has no gender or racial predilection; the incidence is estimated as 1:16,000-1:18,000 live-births or 11/1 million children under 5 years. Most of the world's RB cases are found in Asia and Africa while most RB treatment centres are in America and Europe. RB is easy to detect by caregivers as a glowing white 'cat eye reflex' at night or when captured on camera. Health workers at primary care level can detect RB in early life if red reflex test and/or squint (Hirschberg) tests are deployed as part of wellness checks done especially during routine immunisation and well-baby clinics in the first 24 months of life. In most cases of RB, biopsies for histological confirmation are not required for diagnosis and treatment decisions to be made. Clinical information, ophthalmic evaluation and imaging modalities are typically used. There have been significant changes in the management of RB using various treatment modalities such as enucleation with orbital implant, use of chemotherapy delivered through intravenous, intravitreal, periocular and intra-arterial routes and targeted treatment with laser, cryotherapy and brachytherapy. Algorithm for management and development of the national RB program within the context of a low-resource country is presented from review of data extracted from Mendeley library, PubMed library, Google Scholar and One Network; full-text articles were mostly retrieved through the American Academy of Ophthalmology.
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Affiliation(s)
- Dupe S Ademola-Popoola
- Department of Ophthalmology (Paediatric, Strabismus and Oncology Services), University of Ilorin, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - Enrico Opocher
- Azienda Ospedaliera di Padova, Italy; Paediatric Oncology-Great Ormond Street (GOS) Hospital, London, UK
| | - M Ashwin Reddy
- Retinoblastoma Unit, Royal London Hospital, Barts Health NHS Trust; Department of Paediatrics, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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21
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Dimaras H, Corson TW. Retinoblastoma, the visible CNS tumor: A review. J Neurosci Res 2019; 97:29-44. [PMID: 29314142 PMCID: PMC6034991 DOI: 10.1002/jnr.24213] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/02/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022]
Abstract
The pediatric ocular cancer retinoblastoma is the only central nervous system (CNS) tumor readily observed without specialized equipment: it can be seen by, and in, the naked eye. This accessibility enables unique imaging modalities. Here, we review this cancer for a neuroscience audience, highlighting these clinical and research imaging options, including fundus imaging, optical coherence tomography, ultrasound, and magnetic resonance imaging. We also discuss the subtype of retinoblastoma driven by the MYCN oncogene more commonly associated with neuroblastoma, and consider trilateral retinoblastoma, in which an intracranial tumor arises along with ocular tumors in patients with germline RB1 gene mutations. Retinoblastoma research and clinical care can offer insights applicable to CNS malignancies, and also benefit from approaches developed elsewhere in the CNS.
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Affiliation(s)
- Helen Dimaras
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, ON, M5G 1X8, Canada
- Department of Human Pathology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Timothy W. Corson
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Pharmacology & Toxicology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, 46202, USA
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22
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Afshar AR, Deiner M, Allen G, Damato BE. The Patient's Experience of Ocular Melanoma in the US: A Survey of the Ocular Melanoma Foundation. Ocul Oncol Pathol 2018; 4:280-290. [PMID: 30320098 DOI: 10.1159/000485189] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/08/2017] [Indexed: 12/20/2022] Open
Abstract
Background Ocular melanomas threaten patients with early death, visual handicap, and loss of the eye. The aims of this study were to identify aspects of care that patients with ocular melanoma considered most important and to determine whether patients felt their needs had been adequately addressed. Methods A cross-sectional study including US ocular melanoma patients and their caregivers. An online survey of US ocular melanoma patients was designed and conducted by the Ocular Melanoma Foundation. Results The cohort included 180 patients with uveal melanoma and 4 with conjunctival melanoma. Median follow-up was 3 years. A third of patients reported that their uveal melanoma had initially been diagnosed as a nevus. Most uveal melanomas were treated with brachytherapy. Almost 50% of patients had no genetic tumor analysis. Screening methods reported most commonly were computed tomography and liver function tests. Metastatic disease developed in 11% of patients. Few patients (13.3%) reported an offer of psychological support. Most dissatisfaction was with lack of advice on financial aspects of care and lack of psychological counseling, with women tending to express more dissatisfaction with care. Many patients complained about the way ophthalmologists delivered bad news to them. Conclusions This patients' perspective highlights directions for research, education, and other measures to improve the care of patients with ocular melanoma in the US and elsewhere.
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Affiliation(s)
- Armin R Afshar
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Michael Deiner
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Grant Allen
- Ocular Melanoma Foundation, Washington, DC, USA
| | - Bertil E Damato
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
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23
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Hill JA, Gedleh A, Lee S, Hougham KA, Dimaras H. Knowledge, experiences and attitudes concerning genetics among retinoblastoma survivors and parents. Eur J Hum Genet 2018; 26:505-517. [PMID: 29379195 DOI: 10.1038/s41431-017-0027-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/23/2017] [Accepted: 10/10/2017] [Indexed: 01/14/2023] Open
Abstract
Clinical genetic services are increasingly providing a more nuanced understanding of genetic disease diagnostics and future risk for patients. Effectively conveying genetic information is essential for patients to make informed decisions. This is especially important for survivors of heritable cancers such as retinoblastoma (childhood eye cancer), where survivors who carry a germline mutation in the RB1 gene are at increased risk of second cancers in adulthood, and of passing on the disease risk to future offspring. We conducted focus groups with adult survivors of retinoblastoma and parents of children with retinoblastoma, to uncover their knowledge of, experiences with and attitudes about retinoblastoma genetics and related impacts of the cancer. Results revealed that participants understood that retinoblastoma was a genetic disease, but often misunderstood the implications of genetics on cancer phenotype and risk. Experiences with genetic testing and counseling were generally positive, however, participants reported challenges in accessing genetic information and psychosocial support. Participants suggested more educational resources, peer-to-peer counseling, and psychosocial support would enhance uptake of important genetic information. The results of the study will inform patient-oriented approaches to deliver comprehensive genetic healthcare.
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Affiliation(s)
- Jessica A Hill
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Amal Gedleh
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Health Promotion, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Siwon Lee
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Health Promotion, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kaitlyn A Hougham
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada. .,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada. .,Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada. .,Department of Human Pathology, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
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24
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Kamihara J, Bourdeaut F, Foulkes WD, Molenaar JJ, Mossé YP, Nakagawara A, Parareda A, Scollon SR, Schneider KW, Skalet AH, States LJ, Walsh MF, Diller LR, Brodeur GM. Retinoblastoma and Neuroblastoma Predisposition and Surveillance. Clin Cancer Res 2017; 23:e98-e106. [PMID: 28674118 PMCID: PMC7266051 DOI: 10.1158/1078-0432.ccr-17-0652] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/02/2017] [Accepted: 05/09/2017] [Indexed: 12/28/2022]
Abstract
Retinoblastoma (RB) is the most common intraocular malignancy in childhood. Approximately 40% of retinoblastomas are hereditary and due to germline mutations in the RB1 gene. Children with hereditary RB are also at risk for developing a midline intracranial tumor, most commonly pineoblastoma. We recommend intensive ocular screening for patients with germline RB1 mutations for retinoblastoma as well as neuroimaging for pineoblastoma surveillance. There is an approximately 20% risk of developing second primary cancers among individuals with hereditary RB, higher among those who received radiotherapy for their primary RB tumors. However, there is not yet a clear consensus on what, if any, screening protocol would be most appropriate and effective. Neuroblastoma (NB), an embryonal tumor of the sympathetic nervous system, accounts for 15% of pediatric cancer deaths. Prior studies suggest that about 2% of patients with NB have an underlying genetic predisposition that may have contributed to the development of NB. Germline mutations in ALK and PHOX2B account for most familial NB cases. However, other cancer predisposition syndromes, such as Li-Fraumeni syndrome, RASopathies, and others, may be associated with an increased risk for NB. No established protocols for NB surveillance currently exist. Here, we describe consensus recommendations on hereditary RB and NB from the AACR Childhood Cancer Predisposition Workshop. Clin Cancer Res; 23(13); e98-e106. ©2017 AACRSee all articles in the online-only CCR Pediatric Oncology Series.
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Affiliation(s)
- Junne Kamihara
- Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | | | - William D Foulkes
- Human Genetics, Medicine and Oncology, McGill University, Montreal, Québec, Canada
| | - Jan J Molenaar
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Yaël P Mossé
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Andreu Parareda
- Sant Joan de Deu, Barcelona Children's Hospital, Barcelona, Catalonia, Spain
| | | | | | - Alison H Skalet
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | - Lisa J States
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Lisa R Diller
- Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
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25
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Soliman SE, Eldomiaty W, Goweida MB, Dowidar A. Clinical presentation of retinoblastoma in Alexandria: A step toward earlier diagnosis. Saudi J Ophthalmol 2017; 31:80-85. [PMID: 28559718 PMCID: PMC5436382 DOI: 10.1016/j.sjopt.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 02/09/2017] [Accepted: 03/11/2017] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the clinical presentation of retinoblastoma in Alexandria, Egypt, correlate the timing of accurate diagnosis with the presence of advanced disease and identify causes of delayed presentation. Methods Retrospective noncomparative single institution study reviews demographic and clinical data of all new children with retinoblastoma presenting to Alexandria Main University ocular oncology clinic (OOC) from January 2012 to June 2014. Diagnosis time was from initial parental complaint to retinoblastoma diagnosis and referral time was from retinoblastoma diagnosis to presentation to the Alexandria OCC. Delayed Diagnosis and referral were counted if >2 weeks. Advanced presentation is defined as clinical TNMH (8th edition) staging of cT2 or cT3 (international intraocular retinoblastoma classification group D or E) in at least one eye or the presence of extra-ocular disease (cT4). Results Seventy eyes of 47 children were eligible: 52% unilateral, 7% with family history and 96% presented with leukocorea. Sixty-four percent of children had advanced intraocular disease and none had extra-ocular disease. Delayed presentation occurred in 58% of children and was significantly associated with advanced disease in both unilaterally and bilaterally affected children (p = 0.003, 0.002 respectively). The delay in diagnosis was more in unilateral cases while the delay in referral was more in bilateral cases. The main cause of delayed presentation in unilateral retinoblastoma was misdiagnosis (30%) while parental shopping for second medical opinion (30%) was the main cause in bilateral children. Conclusions Delayed diagnosis is a problem affecting retinoblastoma management. Better medical education and training, health education and earlier screening are recommended to achieve earlier diagnosis.
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Affiliation(s)
- Sameh E Soliman
- The Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.,The Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Wesam Eldomiaty
- The Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Mohamed B Goweida
- The Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Amgad Dowidar
- The Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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26
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Familial Retinoblastoma: Raised Awareness Improves Early Diagnosis and Outcome. J Ophthalmol 2017; 2017:5053961. [PMID: 28348883 PMCID: PMC5350530 DOI: 10.1155/2017/5053961] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/29/2016] [Accepted: 01/22/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose. To study the impact of awareness of retinoblastoma in the affected families on the management and outcome of familial retinoblastoma patients. Methods and Materials. This is a retrospective, clinical case series of 44 patients with familial retinoblastoma. Collected data included patient's demographics, laterality, family history, age at diagnosis, presenting signs, treatment modalities, tumor stage, eye salvage rate, metastasis, and mortality. Results. Out of 200 retinoblastoma patients in our registry, 44 (22%) patients were familial, 18 were probands, and 26 were second, third, or fourth affected family members. There were 76 affected eyes: 31 eyes of probands and 45 eyes of the other affected family members. Among probands, all patients (100%) had at least one eye enucleated: 58% (18 eyes) of the affected eyes were enucleated and 32% (10 eyes) of the affected eyes were radiated. On the other hand, among the nonprobands, only 20% had one eye enucleated, and only 4 eyes (9%) received radiation. The eye salvage rate was significantly higher in the nonprobands than in the probands in this series (p = 0.00206). Patients diagnosed by screening (38%) had excellent visual outcome, and both eyes were salvaged. Conclusion. Awareness of families of the possibility of retinoblastoma and adequate screening led to a significantly higher rate of eye salvage in patients with familial retinoblastoma.
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Abstract
Retinoblastoma is the prototypic genetic cancer. India carries the biggest burden of retinoblastoma globally, with an estimated 1500 new cases annually. Recent advances in retinoblastoma genetics are reviewed, focusing specifically on information with clinical significance to patients. The Indian literature on retinoblastoma clinical genetics is also highlighted, with a comment on challenges and future directions. The review concludes with recommendations to help clinicians implement and translate retinoblastoma genetics to their practice.
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Affiliation(s)
- Helen Dimaras
- Department of Ophthalmology and Vision Sciences, University of Toronto, Canada; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Human Pathology, University of Nairobi, Nairobi, Kenya,
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28
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Gao J, Zeng J, Guo B, He W, Chen J, Lu F, Chen D. Clinical presentation and treatment outcome of retinoblastoma in children of South Western China. Medicine (Baltimore) 2016; 95:e5204. [PMID: 27759657 PMCID: PMC5079341 DOI: 10.1097/md.0000000000005204] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 02/05/2023] Open
Abstract
To study the clinical presentation and treatment outcome among children in South Western China with retinoblastoma (RB) and to determine factors predictive of poor outcome.A retrospective review of children diagnosed with RB from 2006 to 2015 at West China Hospital was undertaken. Demographic and clinical characteristics and treatment outcomes were studied.A total of 253 patients (unilateral 80.2%, bilateral 19.8%) were studied. Twenty six patients (10.3%) were from minority ethnic groups of China. The median onset age was 21 months. Leukocoria was the most common presenting sign (71%). Tumors were intraocular in 91.3% cases, extraocular in 8.7% cases. Extraocular RB patients had a longer median lag period than intraocular patients (9 months vs 2 months, P < 0.0001). In the intraocular group, 89.5% were advanced group D or E diseases. Enucleation was the major treatment for intraocular RB. However, over 10 years, the enucleation rate decreased constantly while more patients received chemotherapy. The Kaplan-Meier survival probability was 87.8%, 81.4%, and 74.8% at 3 years, 5 years, and 10 years, respectively. On Cox regression analysis, extraocular RB (P = 0.0008) and treatment abandonment (P < 0.0001) were associated with poor outcome; bilateral RB (P = 0.0116) and advanced pathological grade pT4 (P = 0.0011) were associated with poor outcome of intraocular RB.Most RB patients from South Western China were diagnosed at advanced clinical stage. Delayed presentation is related to extraocular RB which is a risk factor for poor outcome. Chemotherapy increased the eye salvage but had no effects to overall survival. Education for parents and general physicians for the early signs of RB (such as leukocoria), therapeutic strategy and treatment outcomes of RB may promote early diagnosis, improve the compliance, and outcome.
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Affiliation(s)
| | | | | | | | | | | | - Danian Chen
- Ophthalmic Laboratory, Torsten-Wiesel Research Institute of World Eye Organization, State Key Laboratory of Biotherapy, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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29
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Racher H, Soliman S, Argiropoulos B, Chan HSL, Gallie BL, Perrier R, Matevski D, Rushlow D, Piovesan B, Shaikh F, MacDonald H, Corson TW. Molecular analysis distinguishes metastatic disease from second cancers in patients with retinoblastoma. Cancer Genet 2016; 209:359-63. [PMID: 27318443 DOI: 10.1016/j.cancergen.2016.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/25/2016] [Accepted: 06/02/2016] [Indexed: 12/17/2022]
Abstract
The pediatric ocular tumor retinoblastoma readily metastasizes, but these lesions can masquerade as histologically similar pediatric small round blue cell tumors. Since 98% of retinoblastomas have RB1 mutations and a characteristic genomic copy number "signature", genetic analysis is an appealing adjunct to histopathology to distinguish retinoblastoma metastasis from second primary cancer in retinoblastoma patients. Here, we describe such an approach in two retinoblastoma cases. In patient one, allele-specific (AS)-PCR for a somatic nonsense mutation confirmed that a temple mass was metastatic retinoblastoma. In a second patient, a rib mass shared somatic copy number gains and losses with the primary tumor. For definitive diagnosis, however, an RB1 mutation was needed, but heterozygous promoter→exon 11 deletion was the only RB1 mutation detected in the primary tumor. We used a novel application of inverse PCR to identify the deletion breakpoint. Subsequently, AS-PCR designed for the breakpoint confirmed that the rib mass was metastatic retinoblastoma. These cases demonstrate that personalized molecular testing can confirm retinoblastoma metastases and rule out a second primary cancer, thereby helping to direct the clinical management.
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Affiliation(s)
- Hilary Racher
- Impact Genetics, Bowmanville, Ontario L1C 3K5, Canada
| | - Sameh Soliman
- Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada; Ophthalmology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Bob Argiropoulos
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Helen S L Chan
- Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Brenda L Gallie
- Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Renée Perrier
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | | | - Diane Rushlow
- Impact Genetics, Bowmanville, Ontario L1C 3K5, Canada
| | | | - Furqan Shaikh
- Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | | | - Timothy W Corson
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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30
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Kim JY, Park Y. Treatment of Retinoblastoma: The Role of External Beam Radiotherapy. Yonsei Med J 2015; 56:1478-91. [PMID: 26446627 PMCID: PMC4630033 DOI: 10.3349/ymj.2015.56.6.1478] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/18/2015] [Accepted: 05/27/2015] [Indexed: 12/26/2022] Open
Abstract
The risk of radiotherapy-related secondary cancers in children with constitutional retinoblastoma 1 (RB1) mutations has led to reduced use of external beam radiotherapy (EBRT) for RB. Presently, tumor reduction with chemotherapy with or without focal surgery (chemosurgery) is most commonly undertaken; EBRT is avoided as much as possible and is considered only as the last treatment option prior to enucleation. Nevertheless, approximately 80% of patients are diagnosed at a locally advanced stage, and only 20-25% of early stage RB patients can be cured with a chemosurgery strategy. As a whole, chemotherapy fails in more than two-thirds of eyes with advanced stage disease, requiring EBRT or enucleation. Radiotherapy is still considered necessary for patients with large tumor(s) who are not candidates for chemosurgery but who have visual potential. When radiation therapy is indicated, the lowest possible radiation dose combined with systemic or local chemotherapy and focal surgery may yield the best clinical outcomes in terms of local control and treatment-related toxicity. Proton beam therapy is one EBRT method that can be used for treatment of RB and reduces the radiation dose delivered to the adjacent orbital bone while maintaining an adequate dose to the tumor. To maximize the therapeutic success of treatment of advanced RB, the possibility of integrating radiotherapy at early stages of treatment may need to be discussed by a multidisciplinary team, rather than considering EBRT as only a last treatment option.
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Affiliation(s)
- Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang, Korea.
| | - Younghee Park
- Proton Therapy Center, National Cancer Center, Goyang, Korea
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Dimaras H, Corson TW, Cobrinik D, White A, Zhao J, Munier FL, Abramson DH, Shields CL, Chantada GL, Njuguna F, Gallie BL. Retinoblastoma. Nat Rev Dis Primers 2015; 1:15021. [PMID: 27189421 PMCID: PMC5744255 DOI: 10.1038/nrdp.2015.21] [Citation(s) in RCA: 339] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Retinoblastoma is a rare cancer of the infant retina that is diagnosed in approximately 8,000 children each year worldwide. It forms when both retinoblastoma gene (RB1) alleles are mutated in a susceptible retinal cell, probably a cone photoreceptor precursor. Loss of the tumour-suppressive functions of the retinoblastoma protein (pRB) leads to uncontrolled cell division and recurrent genomic changes during tumour progression. Although pRB is expressed in almost all tissues, cone precursors have biochemical and molecular features that may sensitize them to RB1 loss and enable tumorigenesis. Patient survival is >95% in high-income countries but <30% globally. However, outcomes are improving owing to increased disease awareness for earlier diagnosis, application of new guidelines and sharing of expertise. Intra-arterial and intravitreal chemotherapy have emerged as promising methods to salvage eyes that with conventional treatment might have been lost. Ongoing international collaborations will replace the multiple different classifications of eye involvement with standardized definitions to consistently assess the eligibility, efficacy and safety of treatment options. Life-long follow-up is warranted, as survivors of heritable retinoblastoma are at risk for developing second cancers. Defining the molecular consequences of RB1 loss in diverse tissues may open new avenues for treatment and prevention of retinoblastoma, as well as second cancers, in patients with germline RB1 mutations.
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Affiliation(s)
- Helen Dimaras
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, Toronto, Canada
| | - Timothy W. Corson
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David Cobrinik
- The Vision Center, Children’s Hospital Los Angeles & USC Eye Institute, University of Southern California, Los Angeles, CA USA
| | | | - Junyang Zhao
- Department of Ophthalmology, Beijing Children’s Hospital, Capital Medial University, Beijing, China
| | - Francis L. Munier
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - David H. Abramson
- Department of Ophthalmology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | | | - Festus Njuguna
- Department of Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Brenda L. Gallie
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, 555 University Ave, Toronto, Ontario M5G1X8, Canada
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Nyamori JM, Kimani K, Njuguna MW, Dimaras H. Retinoblastoma referral pattern in Kenya. Middle East Afr J Ophthalmol 2015; 21:321-7. [PMID: 25371638 PMCID: PMC4219224 DOI: 10.4103/0974-9233.142270] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose: Kenya is a large country with a widely dispersed population. As retinoblastoma requires specialized treatment, we determined the referral pattern for patients with retinoblastoma in Kenya to facilitate the formulation of a national policy. Materials and Methods: A retrospective study was performed for retinoblastoma patients who presented from January 1, 2006 to December 31, 2007. Data were collected on the referral process from presenting health facility to the hospital where patient was treated. Data were also collected on the time interval when the first symptoms were noticed to the time of presentation at a health facility (lag time). For cases that could be traced to a referral hospital, the time delay due to referral (referral lag time) was recorded. Results: There were 206 patients diagnosed with retinoblastoma in 51 Kenyan and 2 foreign healthcare facilities, and they received final treatment at a Kenyan hospital. Mean lag time was 6.8 months (±6.45). Of all patients, 18% (38/206) were treated at the hospital where they first presented and 82% (168/206) were referred elsewhere. Of those referred, 35% (58/168) were lost to follow-up. The mean referral lag time was 1.7 months (±2.5). Conclusions: A significant proportion of cases presented late, and either delayed seeking further treatment or were lost after initial referral. We recommend the implementation of a national strategy that emphasizes early detection, documentation and follow up of retinoblastoma patients.
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Affiliation(s)
| | - Kahaki Kimani
- The Department of Ophthalmology, University of Nairobi, Kenya
| | | | - Helen Dimaras
- The Department of Ophthalmology and Vision Sciences, University of Toronto, Canada ; Division of Vision Science, Toronto Western Research Institute, Canada ; Sick Kids Research Institute, The Hospital for Sick Children, Toronto, Canada
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Liu Y, Zhong X, Wan S, Zhang W, Lin J, Zhang P, Li Y. p16(INK4a) expression in retinoblastoma: a marker of differentiation grade. Diagn Pathol 2014; 9:180. [PMID: 25499675 PMCID: PMC4300043 DOI: 10.1186/s13000-014-0180-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 09/07/2014] [Indexed: 08/30/2023] Open
Abstract
Background The tumor suppressor protein p16INK4a has been extensively studied in many tumors with very different results, ranging from its loss to its clear overexpression, which may be associated with degree of tumor differentiation and prognosis. However, its expression remains unclear in human retinoblastoma (RB), a common malignant tumor of retina in childhood. The aim of this study was to explore the expression pattern of p16INK4a in RB, and the correlation between p16INK4a expression and histopathological features of RB. Methods Sixty-five cases of RB were retrospectively analyzed. Paraffin-embedded blocks were retrieved from the archives of ocular pathology department at Zhongshan Ophthalmic Center of Sun Yat-sen University, China. Serial sections were cut and subjected to hematoxylin and eosin staining. Immunohistochemical staining was further done with antibodies p16INK4a, CRX and Ki67. The correlation of p16 INK4a expression with CRX and Ki67 and clinicopathological features of RB were analyzed. Results RB tumor histologically consists of various differentiation components including undifferentiated (UD) cells, Homer-Wright rosettes (HWR) or Flexner-Winterstein rosettes (FWR) and fleurettes characteristic of photoreceptor differentiation or Retinocytoma (RC). p16INK4a expression was negative in both fleurette region and the residual retinal tissue adjacent to the tumor, weakly to moderately positive in FWR, strongly positive in both HWR and UD region. However, CRX had the reverse expression patterns in comparison with p16INK4a. It was strongly positive in photoreceptor cells within the residual retina and fleurettes, but weakly to moderately positive in UD area. Together with Ki67 staining, high p16INK4a expression was associated with poor histological differentiation of RB tumors, which had higher risk features with the optic nerve invasion and uveal invasion. Conclusions p16INK4a expression increased with the decreasing level of cell differentiation of RBs. RB tumors extensively expressing p16INK4a tended to have higher risk features with poor prognosis. This study suggested that p16INK4a would be a valuable molecular marker of RB to distinguish its histological phenotypes and to serve as a predictor of its prognosis. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_180
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Affiliation(s)
- Yue Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 S Xianlie Rd, Guangzhou, 510060, China.
| | - Xiufeng Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 S Xianlie Rd, Guangzhou, 510060, China.
| | - Shangtao Wan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 S Xianlie Rd, Guangzhou, 510060, China.
| | - Wenxin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 S Xianlie Rd, Guangzhou, 510060, China.
| | - Jianxian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 S Xianlie Rd, Guangzhou, 510060, China.
| | - Ping Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 S Xianlie Rd, Guangzhou, 510060, China.
| | - Yongping Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 S Xianlie Rd, Guangzhou, 510060, China.
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Zhang L, Jia R, Zhao J, Fan J, Zhou Y, Han B, Song X, Wu L, Zhang H, Song H, Ge S, Fan X. Novel mutations in the RB1 gene from Chinese families with a history of retinoblastoma. Tumour Biol 2014; 36:2409-20. [PMID: 25424699 DOI: 10.1007/s13277-014-2851-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/13/2014] [Indexed: 12/28/2022] Open
Abstract
Retinoblastoma is an aggressive eye cancer that develops during infancy and is divided into two clinical types, sporadic and heritable. RB1 has been identified as the only pathological gene responsible for heritable retinoblastoma. Here, we identified 11 RB1 germline mutations in the Han pedigrees of 17 bilateral retinoblastoma patients from China. Four mutations were nonsense mutations, five were splice site mutations, and two resulted in a frame shift due to an insertion or a deletion. Three of the mutations had not been previously reported, and the p.Q344L mutation occurred in two generations of retinoblastoma patients. We investigated phenotypic-genotypic relationships for the novel mutations and showed that these mutations affected the expression, location, and function of the retinoblastoma protein. Abnormal protein localization was observed after transfection of the mutant genes. In addition, changes in the cell cycle distribution and apoptosis rates were observed when the Saos-2 cell line was transfected with plasmids encoding the mutant RB1 genes. Our findings expand the spectrum of known RB1 mutations and will benefit the investigation of RB1 mutation hotspots. Genetic counseling can be offered to families with heritable RB1 mutations.
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Affiliation(s)
- Leilei Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Road, Shanghai, 200011, People's Republic of China
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Samuel N, Villani A, Fernandez CV, Malkin D. Management of familial cancer: sequencing, surveillance and society. Nat Rev Clin Oncol 2014; 11:723-31. [PMID: 25311347 DOI: 10.1038/nrclinonc.2014.169] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The clinical management of familial cancer begins with recognition of patterns of cancer occurrence suggestive of genetic susceptibility in a proband or pedigree, to enable subsequent investigation of the underlying DNA mutations. In this regard, next-generation sequencing of DNA continues to transform cancer diagnostics, by enabling screening for cancer-susceptibility genes in the context of known and emerging familial cancer syndromes. Increasingly, not only are candidate cancer genes sequenced, but also entire 'healthy' genomes are mapped in children with cancer and their family members. Although large-scale genomic analysis is considered intrinsic to the success of cancer research and discovery, a number of accompanying ethical and technical issues must be addressed before this approach can be adopted widely in personalized therapy. In this Perspectives article, we describe our views on how the emergence of new sequencing technologies and cancer surveillance strategies is altering the framework for the clinical management of hereditary cancer. Genetic counselling and disclosure issues are discussed, and strategies for approaching ethical dilemmas are proposed.
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Affiliation(s)
- Nardin Samuel
- Department of Medical Biophysics, University of Toronto, Division of Hematology/Oncology and Genetics &Genome Biology Program, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Anita Villani
- Department of Pediatrics and Institute of Medical Science, University of Toronto, Division of Hematology/Oncology and Genetics &Genome Biology Program, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Conrad V Fernandez
- Department of Pediatrics, Division of Hematology/Oncology, IWK Health Centre, 5850-5980 University Avenue, Halifax, NS B3K 6R8, Canada
| | - David Malkin
- 1] Department of Medical Biophysics, University of Toronto, Division of Hematology/Oncology and Genetics &Genome Biology Program, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada. [2] Department of Pediatrics and Institute of Medical Science, University of Toronto, Division of Hematology/Oncology and Genetics &Genome Biology Program, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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He LQ, Njambi L, Nyamori JM, Nyenze EM, Kimani K, Matende I, Rono H, Njom V, Bett J, Mukuria M, Gachago M, Roberts H, Dimaras H. Developing clinical cancer genetics services in resource-limited countries: the case of retinoblastoma in Kenya. Public Health Genomics 2014; 17:221-7. [PMID: 25059247 DOI: 10.1159/000363645] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/16/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS Clinical cancer genetics is an integral part of cancer control and management, yet its development as an essential medical service has been hindered in many low-and-middle-income countries. We report our experiences in developing a clinical cancer genetics service for retinoblastoma in Kenya. METHODS A genetics task force was created from within the membership of the existing Kenyan National Retinoblastoma Strategy group. The task force engaged in multiple in-person and telephone discussions, delineating experiences, opinions and suggestions for an evidence-based, culturally sensitive retinoblastoma genetics service. Discussions were recorded and thematically categorized to develop a strategy for the design and implementation of a national retinoblastoma clinical genetics service. RESULTS Discussion among the retinoblastoma genetics task force supported the development of a comprehensive genetics service that rests on 3 pillars: (1) patient and family counseling, (2) community involvement, and (3) medical education. CONCLUSIONS A coordinated national retinoblastoma genetics task force led to the creation of a unique and relevant approach to delivering comprehensive and accurate genetic care to Kenyan retinoblastoma patients. The task force aims to stimulate innovative approaches in cancer genetics research, education and knowledge translation, taking advantage of unique opportunities offered in the African context.
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Affiliation(s)
- Li Qun He
- Human Biology Program, University of Toronto, Toronto, Ont., Canada
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Luo C, Deng YP. Retinoblastoma: concerning its initiation and treatment. Int J Ophthalmol 2013; 6:397-401. [PMID: 23826540 DOI: 10.3980/j.issn.2222-3959.2013.03.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/22/2013] [Indexed: 02/05/2023] Open
Abstract
Retinoblastoma (RB) is the most common intraocular cancer of infancy and childhood. This cancer is initiated by mutation on RB1, the tumor suppressor gene that is responsible for the regulation of both cell cycle and gnome stability in retinal cells. Patients with a constitutional mutation on RB1 can be inherited. RB occurs approximately 1 in every 15 000-20 000 live births. The worldwide mortality for this cancer is about 5%-11%. However, this rate rises to about 40%-70% in developing countries due to a delay in diagnosis. A wide variety of options are available for the treatment, but often a combination of therapies is adopted to optimize individualized care.
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Affiliation(s)
- Chang Luo
- Department of Ophthalmology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu 610041, Sichuan Province, China
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