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Pareek A, Kumar D, Pareek A, Gupta MM, Jeandet P, Ratan Y, Jain V, Kamal MA, Saboor M, Ashraf GM, Chuturgoon A. Retinoblastoma: An update on genetic origin, classification, conventional to next-generation treatment strategies. Heliyon 2024; 10:e32844. [PMID: 38975183 PMCID: PMC11226919 DOI: 10.1016/j.heliyon.2024.e32844] [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: 10/09/2023] [Revised: 05/23/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
The most prevalent paediatric vision-threatening medical condition, retinoblastoma (RB), has been a global concern for a long time. Several conventional therapies, such as systemic chemotherapy and focal therapy, have been used for curative purposes; however, the search for tumour eradication with the least impact on surrounding tissues is still ongoing. This review focuses on the genetic origin, classification, conventional treatment modalities, and their combination with nano-scale delivery systems for active tumour targeting. In addition, the review also delves into ongoing clinical trials and patents, as well as emerging therapies such as gene therapy and immunotherapy for the treatment of RB. Understanding the role of genetics in the development of RB has refined its treatment strategy according to the genetic type. New approaches such as nanostructured drug delivery systems, galenic preparations, nutlin-3a, histone deacetylase inhibitors, N-MYC inhibitors, pentoxifylline, immunotherapy, gene therapy, etc. discussed in this review, have the potential to circumvent the limitations of conventional therapies and improve treatment outcomes for RB. In summary, this review highlights the importance and need for novel approaches as alternative therapies that would ultimately displace the shortcomings associated with conventional therapies and reduce the enucleation rate, thereby preserving global vision in the affected paediatric population.
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Affiliation(s)
- Ashutosh Pareek
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, 304022, Rajasthan, India
| | - Deepanjali Kumar
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, 304022, Rajasthan, India
| | - Aaushi Pareek
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, 304022, Rajasthan, India
| | - Madan Mohan Gupta
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine 3303, Trinidad and Tobago
| | - Philippe Jeandet
- Research Unit Induced Resistance and Plant Bioprotection - USC INRAe 1488, University of Reims, PO Box 1039, 51687, Reims, France
| | - Yashumati Ratan
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, 304022, Rajasthan, India
| | - Vivek Jain
- Department of Pharmaceutical Sciences, Mohan Lal Sukhadia University, Udaipur, 313001, India
| | - Mohammad Amjad Kamal
- Joint Laboratory of Artificial Intelligence for Critical Care Medicine, Department of Critical Care Medicine and Institutes for Systems Genetics, West China School of Nursing, Frontiers Science Centre for Disease-related Molecular Network, West China Hospital, Sichuan University, China
- King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, 1207, Bangladesh
- Enzymoics, Novel Global Community Educational Foundation, 7 Peterlee Place, Hebersham, NSW, 2770, Australia
| | - Muhammad Saboor
- Department of Medical Laboratory Science, College of Health Sciences, and Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates
| | - Ghulam Md Ashraf
- Department of Medical Laboratory Science, College of Health Sciences, and Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates
| | - Anil Chuturgoon
- Discipline of Medical Biochemistry, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, 4041, South Africa
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Nag A, Khetan V. Retinoblastoma - A comprehensive review, update and recent advances. Indian J Ophthalmol 2024; 72:778-788. [PMID: 38804799 PMCID: PMC11232864 DOI: 10.4103/ijo.ijo_2414_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 05/29/2024] Open
Abstract
Retinoblastoma is the most common pediatric ocular malignancy. It is triggered by a biallelic mutation in the RB1 gene or MYCN oncogene amplification. Retinoblastomas can be unilateral (60%-70%) or bilateral (30%-40%); bilateral tumors are always heritable and present at an earlier age as compared to unilateral ones (18-24 months vs. 36 months in India). High prevalence rates, delayed presentation, and inaccessibility to healthcare lead to worse outcomes in developing countries. The past few decades have seen a paradigm change in the treatment of retinoblastomas, shifting from enucleation and external beam radiotherapy to less aggressive modalities for eye salvage. Multimodality treatment is now the standard of care and includes intraarterial or intravenous chemotherapy along with focal consolidation therapies such as transpupillary thermotherapy, cryotherapy, and laser photocoagulation. Intravitreal and intracameral chemotherapy can help in controlling intraocular seeds. Advanced extraocular or metastatic tumors still have a poor prognosis. Genetic testing, counseling, and screening of at-risk family members must be incorporated as essential parts of management. A better understanding of the genetics and molecular basis of retinoblastoma has opened up the path for potential targeted therapy in the future. Novel recent advances such as liquid biopsy, prenatal diagnosis, prognostic biomarkers, tylectomy, and chemoplaque point to promising future directions.
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Affiliation(s)
- Adwaita Nag
- Ocular Oncology Service, Department of Ophthalmology and Vision Sciences, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Vikas Khetan
- Formerly at Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
- Professor, Department of Ophthalmology, Flaum Eye Institute, Rochester, NY, USA
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3
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Wu KY, Wang XC, Anderson M, Tran SD. Advancements in Nanosystems for Ocular Drug Delivery: A Focus on Pediatric Retinoblastoma. Molecules 2024; 29:2263. [PMID: 38792122 PMCID: PMC11123804 DOI: 10.3390/molecules29102263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
The eye's complex anatomical structures present formidable barriers to effective drug delivery across a range of ocular diseases, from anterior to posterior segment pathologies. Emerging as a promising solution to these challenges, nanotechnology-based platforms-including but not limited to liposomes, dendrimers, and micelles-have shown the potential to revolutionize ophthalmic therapeutics. These nanocarriers enhance drug bioavailability, increase residence time in targeted ocular tissues, and offer precise, localized delivery, minimizing systemic side effects. Focusing on pediatric ophthalmology, particularly on retinoblastoma, this review delves into the recent advancements in functionalized nanosystems for drug delivery. Covering the literature from 2017 to 2023, it comprehensively examines these nanocarriers' potential impact on transforming the treatment landscape for retinoblastoma. The review highlights the critical role of these platforms in overcoming the unique pediatric eye barriers, thus enhancing treatment efficacy. It underscores the necessity for ongoing research to realize the full clinical potential of these innovative drug delivery systems in pediatric ophthalmology.
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Affiliation(s)
- Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Xingao C. Wang
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3T 1J4, Canada
| | - Maude Anderson
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; (K.Y.W.)
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Mohammad M, Mehyar M, Halalsheh H, Shehada R, Al Adawi O, Khzouz J, Jaradat I, Al-Hussaini M, Sultan I, Alnawaiseh I, Yousef YA. The Impact of Tumor Laterality (Unilateral vs. Bilateral) on Presentation and Management Outcome in Patients with Retinoblastoma. J Clin Med 2024; 13:2146. [PMID: 38610910 PMCID: PMC11012679 DOI: 10.3390/jcm13072146] [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: 02/18/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This study compares the outcomes of managing retinoblastoma between patients with unilateral and bilateral presentations. Methods: The study, conducted at the King Hussein Cancer Center in Amman, Jordan, retrospectively analyzed cases of retinoblastoma treated between March 2003 and December 2019. Evaluation criteria included clinical features, disease stage, treatment methods, and overall management outcomes. Results: The study comprised 697 eyes from 478 patients with retinoblastoma, with 52% being males. Bilateral disease was observed in 70% of patients, and a family history of retinoblastoma was more prevalent in cases with bilateral disease (20%) compared to those with unilateral disease (4%). Unilateral cases had a median age at diagnosis of 28 months, whereas bilateral cases were diagnosed at a median age of 6 months. Extra-ocular retinoblastoma was detected in 1% of eyes. According to the International Intraocular Retinoblastoma Classification (IIRC), 88% of unilateral cases presented with advanced disease (IIRC group D/E), compared to 46% in bilateral cases. Primary enucleation was performed in 29% of unilateral cases and 16% of bilateral cases (p-value 0.0007). Eye salvage rates were 31% in unilateral cases and 68% in bilateral cases (p-value < 0.0001). At 120 months of follow-up, 5% of patients died from secondary neoplasms or metastases, 81% were alive, and 14% were lost to follow-up. There was no significant difference in metastasis, secondary neoplasms, or mortality between patients with unilateral and bilateral retinoblastoma. Conclusions: This study highlights the nuanced differences in clinical characteristics and outcomes between unilateral and bilateral retinoblastoma, emphasizing the necessity of customized management and early detection strategies. It demonstrates that while bilateral retinoblastoma benefits from earlier detection and has a higher rate of eye salvage, there is no significant difference in metastasis or mortality rates when compared to unilateral cases. The critical roles of primary enucleation in advanced cases, along with effective communication and patient education, are also underscored to improve treatment adherence. Overall, these findings point to the importance of tailored approaches in optimizing outcomes for the diverse patient population affected by retinoblastoma.
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Affiliation(s)
- Mona Mohammad
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
| | - Mustafa Mehyar
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
| | - Hadeel Halalsheh
- Pediatric Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (H.H.); (I.S.)
- Pediatric Department, University of Jordan, Amman 11941, Jordan
| | - Reham Shehada
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
| | - Omar Al Adawi
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
| | - Jakub Khzouz
- Pathology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (J.K.); (M.A.-H.)
| | - Imad Jaradat
- Radiation Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan;
| | - Maysa Al-Hussaini
- Pathology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (J.K.); (M.A.-H.)
| | - Iyad Sultan
- Pediatric Oncology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (H.H.); (I.S.)
| | - Ibrahim Alnawaiseh
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
| | - Yacoub A. Yousef
- Departments of Ophthalmology, King Hussein Cancer Centre (KHCC), Amman 11941, Jordan; (M.M.); (R.S.); (I.A.)
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5
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Kolyvas P, Mir A, Stirrat T, Brookner B, Pilar N, Monroe E, Ahuja R. Advanced Interventional Treatments in Retinoblastoma Management: A Comprehensive Review. Cardiovasc Intervent Radiol 2024; 47:407-415. [PMID: 38509339 DOI: 10.1007/s00270-024-03692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024]
Abstract
Retinoblastoma is the most common eye malignancy in children that if left untreated can invade intraocular structures, metastasize, and rarely lead to death. Traditionally treated with systemic chemotherapy, Intra-arterial chemotherapy is gaining popularity as it allows for the direct administration of chemotherapy through the ophthalmic artery, thus reducing systemic side effects. Intra-arterial chemotherapy procedures have evolved, with refinements to reduce risks and radiation exposure. Intra-arterial chemotherapy boasts an impressive technical success rate and one year ocular survival even amongst advanced cases. This review offers a thorough examination of the technique, indications, contraindications, outcomes, and alternative options for Intra-arterial chemotherapy.
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Affiliation(s)
- Peter Kolyvas
- Department of Radiology, Georgetown University School of Medicine, Washington, USA.
| | - Aazrin Mir
- Department of Radiology, Georgetown University School of Medicine, Washington, USA
| | - Thomas Stirrat
- Department of Radiology, Georgetown University School of Medicine, Washington, USA
| | - Brittany Brookner
- Department of Radiology, Georgetown University School of Medicine, Washington, USA
| | - Nathanael Pilar
- Department of Radiology, Georgetown University School of Medicine, Washington, USA
| | - Eric Monroe
- Department of Radiology, University of Wisconsin, Madison, USA
| | - Rakesh Ahuja
- McGovern Medical School, Diagnostic and Interventional Radiology, The University of Texas Health Science Center Houston, Houston, USA
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Croley CR, Pumarol J, Delgadillo BE, Cook AC, Day F, Kaceli T, Ward CC, Husain I, Husain A, Banerjee S, Bishayee A. Signaling pathways driving ocular malignancies and their targeting by bioactive phytochemicals. Pharmacol Ther 2023:108479. [PMID: 37330112 DOI: 10.1016/j.pharmthera.2023.108479] [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: 04/21/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
Ocular cancers represent a rare pathology. The American Cancer Society estimates that 3,360 cases of ocular cancer occur annually in the United States. The major types of cancers of the eye include ocular melanoma (also known as uveal melanoma), ocular lymphoma, retinoblastoma, and squamous cell carcinoma. While uveal melanoma is one of the primary intraocular cancers with the highest occurrence in adults, retinoblastoma remains the most common primary intraocular cancer in children, and squamous cell carcinoma presents as the most common conjunctival cancer. The pathophysiology of these diseases involves specific cell signaling pathways. Oncogene mutations, tumor suppressor mutations, chromosome deletions/translocations and altered proteins are all described as causal events in developing ocular cancer. Without proper identification and treatment of these cancers, vision loss, cancer spread, and even death can occur. The current treatments for these cancers involve enucleation, radiation, excision, laser treatment, cryotherapy, immunotherapy, and chemotherapy. These treatments present a significant burden to the patient that includes a possible loss of vision and a myriad of side effects. Therefore, alternatives to traditional therapy are urgently needed. Intercepting the signaling pathways for these cancers with the use of naturally occurring phytochemicals could be a way to relieve both cancer burden and perhaps even prevent cancer occurrence. This research aims to present a comprehensive review of the signaling pathways involved in various ocular cancers, discuss current therapeutic options, and examine the potential of bioactive phytocompounds in the prevention and targeted treatment of ocular neoplasms. The current limitations, challenges, pitfalls, and future research directions are also discussed.
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Affiliation(s)
- Courtney R Croley
- Healthcare Corporation of America, Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Hudson, FL 34667, USA
| | - Joshua Pumarol
- Ross University School of Medicine, Miramar, FL 33027, USA
| | - Blake E Delgadillo
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Andrew C Cook
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Faith Day
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Tea Kaceli
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Caroline C Ward
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Imran Husain
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Ali Husain
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Sabyasachi Banerjee
- Department of Pharmaceutical Chemistry, Gupta College of Technological Sciences, Asansol 713 301, India
| | - Anupam Bishayee
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA.
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7
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Yarovoy AA, Golanov AV, Yarovaya VA, Kostjuchenko VV, Volodin DP. Stereotactic Gamma Knife® Radiosurgery of Intraocular Retinoblastoma: Six-Year Experience. Cureus 2022; 14:e28751. [PMID: 36211113 PMCID: PMC9529235 DOI: 10.7759/cureus.28751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background External beam radiotherapy for resistant retinoblastoma is now seen as a last resort to saving the eye because of the risk of severe side effects: secondary cancers and cosmetic problems of orbital bone growth retardation. To reduce such complications, treatment modalities have shifted towards new radiation therapy techniques. No information on single fraction Gamma Knife® radiosurgery (GKRS) for intraocular retinoblastoma exists. Materials and methods Eighteen children (19 eyes) with retinoblastoma were treated with GKRS. The mean age at the time of treatment was 35 months (from 12 to 114 months). Before GKRS, all routes of chemotherapy delivery were held in all cases. The eligibility criteria for GKRS were retinoblastomas not amenable either to systemic or local chemotherapy and local ophthalmological treatment, retinoblastomas too large for conventional local methods, and inability to perform intraarterial chemotherapy. Conventional external beam radiotherapy was excluded in the presented cases, given the possible complications mentioned above. In every case, eye removal was suggested to the child's parents, but they flatly refused. GKRS was proposed as the last chance to save the eye (in four cases, it was performed on the only eye). The median prescribed dose was 22 Gy (interquartile range [IQR]: 18-35 Gy), and the median prescribed isodose was 50% (IQR: 36-90%). Results Local control was achieved in 79% of cases (complete tumor regression in 69%, incomplete regression in 10%). Two eyes (10.5%) could not be preserved and had to be enucleated due to the tumor recurrence. Two eyes (10.5%) developed secondary complications (total vitreous hemorrhage, retinal detachment, and iris neovascularization), making adequate tumor control nearly impossible. Overall, 15 eyes (79%) were preserved, and four eyes (21%) were enucleated after GKRS with no signs of tumor recurrence and metastasis in the mean follow-up of 41 months. No acute radiation side effects occurred in any patient after GKRS. Ten children (10 eyes, 53%) were diagnosed with vitreous hemorrhage from mild to severe. Three eyes presented with optic neuropathy one year after GKRS, and four eyes developed retinopathy. Radiation-induced cataract occurred in two eyes. There were no cases of secondary glaucoma or keratopathy in our study. All patients and eyes treated by GKRS were stable within 41 months (from seven to 74 months). Conclusions Single fraction Gamma Knife® radiosurgery may be a reasonable salvage treatment for resistant and recurrent retinoblastoma as an alternative approach to enucleation in selected cases. GKRS should be considered in retinoblastoma management.
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Kruger M, van Elsland SL, Afungchwi GM, Bardin R, Njodzeka B, Kouya F, Nfor P, Nana P, Wharin P, Hesseling PB. Outcome of retinoblastoma treatment protocol in Cameroon as per SIOP-PODC recommendation for a low-income setting. Pediatr Blood Cancer 2022; 69:e29642. [PMID: 35403812 DOI: 10.1002/pbc.29642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The International Society of Paediatric Oncology-Paediatric Oncology in Developing Countries (SIOP-PODC) group recommended graduated-intensity retinoblastoma treatment for children in low- and middle-income countries with limited local resources. AIM The aim was to improve outcome of children with retinoblastoma by means of a treatment protocol for low-income settings as recommended by the SIOP-PODC recommendation in Cameroon. METHODS Children diagnosed with retinoblastoma between 2012 and 2016 were treated in two Baptist Mission hospitals in Cameroon, staging according to the International Retinoblastoma Staging System. Treatment included local therapy and combination chemotherapy (vincristine, cyclophosphamide, and doxorubicin) with or without surgery as per SIOP-PODC guidelines for low-income countries. Endpoint was survival at 24 months. Kaplan-Meier curves with log-rank (Mantel-Cox) chi-square (χ2 ) with respective p-values were prepared. RESULTS Eighty-two children were included, of whom 79.3% had unilateral disease. The majority were males (61.0%) with median age 24 months (range 1-112 months; standard deviation [SD] 19). Limited disease was diagnosed in 58.5%, metastatic disease in 35.4%, and unknown stage in 6.1%. Overall survival (OS) was 50.0% at 24 months post diagnosis, but 68.8% for limited disease. Estimated cumulative survival at 24 months was 0.528 (standard error [SE] 0.056). Causes of death included disease progression/relapses (60.5%), neutropenic sepsis (15.9%), unknown causes (18.4%), unrelated infection (2.6%), and death post surgery (2.6%). Stage was significantly associated with OS (p < .001). CONCLUSION Stage was the most significant factor for good OS and demonstrated the efficacy and feasibility of the SIOP-PODC-proposed management guidelines for retinoblastoma in a lower middle-income setting.
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Affiliation(s)
- Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sabine L van Elsland
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Glenn M Afungchwi
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.,Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Richard Bardin
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Bernard Njodzeka
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Francine Kouya
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Patience Nfor
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Philippa Nana
- Cameroon Baptist Convention Health Services, Mbingo Baptist Hospital and Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Paul Wharin
- Beryl Thyer Memorial Africa Trust, Warkton, UK
| | - Peter B Hesseling
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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9
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Analysis of Cause-Specific Mortality in Patients with Retinoblastoma. J Ophthalmol 2022; 2022:2470890. [PMID: 35282141 PMCID: PMC8916902 DOI: 10.1155/2022/2470890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Retinoblastoma (RB) is a rare pediatric tumor with a relatively favorable prognosis. However, RB is associated with cause-specific mortality, some of that should be of great importance to clinicians. In this study, we summarize the characteristics of cause-specific mortality from nontumor disease in patients with RB. Methods. This retrospective case series study identified and analyzed cause-specific mortality in patients with RB. The information of cause-specific mortality of RB patients, including detailed clinical characteristics, diagnosis, treatment process, cause-specific mortality classification, and lag time, was assessed. Results. A total of 12 eligible patients were selected from 264 patients who died among 3780 patients diagnosed with RB. The cause-specific mortality rate was 4.5% for all patients with RB who died and 0.3% for all patients with RB. The main nontumor cause-specific mortalities were diseases of the nervous, circulatory, and respiratory systems, which specifically included intracranial infection, cerebral hemorrhage, paraplegia, and respiratory failure. The longest lag time was 42 days from the last chemoradiotherapy or surgery. Conclusion. Nontumor cause-specific mortality is an essential outcome of RB. Thus, intensive care and differentiation during management need to be taken seriously.
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10
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Elbanna M, Chowdhury NN, Rhome R, Fishel ML. Clinical and Preclinical Outcomes of Combining Targeted Therapy With Radiotherapy. Front Oncol 2021; 11:749496. [PMID: 34733787 PMCID: PMC8558533 DOI: 10.3389/fonc.2021.749496] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/30/2021] [Indexed: 12/12/2022] Open
Abstract
In the era of precision medicine, radiation medicine is currently focused on the precise delivery of highly conformal radiation treatments. However, the tremendous developments in targeted therapy are yet to fulfill their full promise and arguably have the potential to dramatically enhance the radiation therapeutic ratio. The increased ability to molecularly profile tumors both at diagnosis and at relapse and the co-incident progress in the field of radiogenomics could potentially pave the way for a more personalized approach to radiation treatment in contrast to the current ‘‘one size fits all’’ paradigm. Few clinical trials to date have shown an improved clinical outcome when combining targeted agents with radiation therapy, however, most have failed to show benefit, which is arguably due to limited preclinical data. Several key molecular pathways could theoretically enhance therapeutic effect of radiation when rationally targeted either by directly enhancing tumor cell kill or indirectly through the abscopal effect of radiation when combined with novel immunotherapies. The timing of combining molecular targeted therapy with radiation is also important to determine and could greatly affect the outcome depending on which pathway is being inhibited.
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Affiliation(s)
- May Elbanna
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, United States.,Indiana University Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Nayela N Chowdhury
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ryan Rhome
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, United States.,Indiana University Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Melissa L Fishel
- Indiana University Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States.,Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States.,Department of Pediatrics and Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, United States
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11
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Lal P. Role of radiotherapy in retinoblastoma. Indian J Ophthalmol 2021; 69:2912-2913. [PMID: 34571692 PMCID: PMC8597497 DOI: 10.4103/ijo.ijo_1284_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Punita Lal
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
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12
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Zhao J, Feng Z, Gallie BL. Natural History of Untreated Retinoblastoma. Cancers (Basel) 2021; 13:3646. [PMID: 34359552 PMCID: PMC8344972 DOI: 10.3390/cancers13153646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Treatment abandonment is a leading cause of death in children with retinoblastoma worldwide. We studied children who abandoned treatment upfront at diagnosis to delineate the natural history of untreated retinoblastoma. Studied were children who received no treatment, diagnosed between 2007 and 2017 at 29 Chinese centers. Data were retrospectively collected from medical chart reviews and interviews with each patient's family. During the study period, 44 children received no treatment after diagnosis of retinoblastoma. Clinical or radiologic evidence of orbital extension was available for 25 children, and radiologic evidence of systemic metastasis was available for 12 children. Median times from diagnosis of intraocular tumor to orbital disease was 13.7 months, orbital disease to metastasis was 2.6 months, and metastasis to death was 2.0 months. Children with brain metastasis had shorter survival than those with metastasis to other sites (median 1.0 vs. 3.1 months; p = 0.015). Overall, 36% of patients died within 12 months of diagnosis, 77% within 24 months, 95% within 36 months and 100% within 48 months. While multiple factors influence refusal of treatment, insights into the natural history of retinoblastoma derived from real-world evidence can inform clinicians and parents that retinoblastoma is life-threatening and encourage urgent treatment at diagnosis.
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Affiliation(s)
- Junyang Zhao
- Department of Ophthalmology, Chongqing Aier Children’s Eye Hospital, Chongqing 400020, China;
| | - Zhaoxun Feng
- Department of Ophthalmology, University of Ottawa, Ottawa, ON K1H 8M2, Canada;
| | - Brenda L. Gallie
- Department of Ophthalmology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Krembil Research Institute, Toronto, ON M5T 0S8, Canada
- Techna Institute, Toronto, ON M5G 1L5, Canada
- Department of Ophthalmology, Medical Biophysics, Molecular Genetics, University of Toronto, Toronto, ON M5T 3A9, Canada
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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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14
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Nowak MS, Romanowska-Dixon B, Grabska-Liberek I, Żurek M. Incidence and Characteristics of Retinoblastoma in Poland: The First Nationwide Study 2010-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6539. [PMID: 34204493 PMCID: PMC8296438 DOI: 10.3390/ijerph18126539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022]
Abstract
Background: The present study aimed to investigate the incidence and characteristics of retinoblastoma in the overall population of Poland. Methods: The retrospective survey of both National Health Fund (NHF) and National Cancer Registry (NCR) databases were performed to identify all retinoblastoma cases in Poland in the years 2010-2017. Results: During 2010-2017, the mean age-standardised incidence of retinoblastoma (the unit of incidence is per 1,000,000 person-years) was 10.15 (95% CI 7.23-13.08) among children aged 0 to 4 years and 5.39 (95% CI 4.18-6.60) in those aged 0 to 9 years. During 2010-2014 (to allow 5 years of follow-up), the mean incidence of retinoblastoma by birth cohort analysis in Poland was 4.89 (95% CI 4.04-5.74) per 100,000 live births, corresponding to an incidence of 1 per 20,561 (95% CI 15,855-25,267) live births. In Poland, 14.6% of children with retinoblastoma had enucleation of the eye globe, 76.8% received different types of chemotherapy combined with focal treatment, 5.9% were treated with external beam radiotherapy, and 2.7% were treated with focal treatments only. Conclusions: The incidence of retinoblastoma and the pattern of medical management of retinoblastoma in Poland was similar to that reported in developed countries in Western Europe, Asia, and North America.
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Affiliation(s)
- Michał S. Nowak
- Provisus Eye Clinic, 112 Redzinska str., 42-209 Czestochowa, Poland
- Saint Family Hospital Medical Center, 19 Wigury Str., 90-302 Lodz, Poland
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology and Ophthalmic Oncology, Jagiellonian University Collegium Medicum, 31-501 Cracow, Poland;
| | - Iwona Grabska-Liberek
- Department of Ophthalmology, Centre of Postgraduate Medical Education, 01-416 Warsaw, Poland;
| | - Michał Żurek
- Department of Analyses and Strategies, Ministry of Health, 00-952 Warsaw, Poland;
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
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15
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Dittner-Moormann S, Reschke M, Abbink FCH, Aerts I, Atalay HT, Fedorovna Bobrova N, Biewald E, Brecht IB, Caspi S, Cassoux N, Castela G, Diarra Y, Duncan C, Ebinger M, Garcia Aldana D, Hadjistilianou D, Kepák T, Klett A, Kiratli H, Maka E, Opocher E, Pawinska-Wasikowska K, Rascon J, Russo I, Rutynowska-Pronicka O, Sábado Álvarez C, Pacheco SSR, Svojgr K, Timmermann B, Vishnevskia-Dai V, Eggert A, Ritter-Sovinz P, Bechrakis NE, Jenkinson H, Moll A, Munier FL, Popovic MB, Chantada G, Doz F, Ketteler P. Adjuvant therapy of histopathological risk factors of retinoblastoma in Europe: A survey by the European Retinoblastoma Group (EURbG). Pediatr Blood Cancer 2021; 68:e28963. [PMID: 33720495 DOI: 10.1002/pbc.28963] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/17/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Advanced intraocular retinoblastoma can be cured by enucleation, but spread of retinoblastoma cells beyond the natural limits of the eye is related to a high mortality. Adjuvant therapy after enucleation has been shown to prevent metastasis in children with risk factors for extraocular retinoblastoma. However, histological criteria and adjuvant treatment regimens vary and there is no unifying consensus on the optimal choice of treatment. METHOD Data on guidelines for adjuvant treatment in European retinoblastoma referral centres were collected in an online survey among all members of the European Retinoblastoma Group (EURbG) network. Extended information was gathered via personal email communication. RESULTS Data were collected from 26 centres in 17 countries. Guidelines for adjuvant treatment were in place at 92.3% of retinoblastoma centres. There was a consensus on indication for and intensity of adjuvant treatment among more than 80% of all centres. The majority of centres use no adjuvant treatment for isolated focal choroidal invasion or prelaminar optic nerve invasion. Patients with massive choroidal invasion or postlaminar optic nerve invasion receive adjuvant chemotherapy, while microscopic invasion of the resection margin of the optic nerve or extension through the sclera are treated with combined chemo- and radiotherapy. CONCLUSION Indications and adjuvant treatment regimens in European retinoblastoma referral centres are similar but not uniform. Further biomarkers in addition to histopathological risk factors could improve treatment stratification. The high consensus in European centres is an excellent foundation for a common European study with prospective validation of new biomarkers.
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Affiliation(s)
- Sabine Dittner-Moormann
- Department of Pediatric Hematology and Oncology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Madlen Reschke
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Floor C H Abbink
- Amsterdam UMC, Location VU University Medical Centre, Amsterdam, The Netherlands
| | - Isabelle Aerts
- Institut Curie, PSL Research University and University of Paris, Paris, France
| | | | | | - Eva Biewald
- Department of Ophthalmology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Ines B Brecht
- Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Shani Caspi
- Pediatric Oncology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Nathalie Cassoux
- Institut Curie, PSL Research University and University of Paris, Paris, France
| | - Guilherme Castela
- Centro Hospitalar e Universitário de Coimbra, University of Coimbra, Coimbra, Portugal
| | - Yelena Diarra
- Department of Pediatric Hematology and Oncology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Catriona Duncan
- Royal London Hospital and Great Ormond Street Hospital, London, England
| | - Martin Ebinger
- Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | | | | | - Tomáš Kepák
- University Hospital Brno and St. Anna University Hospital/ICRC, Masaryk University, Brno, Czech Republic
| | - Artur Klett
- East-Tallinn Central Hospital, Tallinn, Estonia
| | | | - Erika Maka
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Enrico Opocher
- Royal London Hospital and Great Ormond Street Hospital, London, England.,Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy
| | | | - Jelena Rascon
- Centre for Pediatric Oncology and Hematology, Vilnius University, Vilnius, Lithuania
| | - Ida Russo
- Department of Pediatric Hematology/Oncology, IRCCS, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | | | | | - Karel Svojgr
- Charles University in Prague, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany.,German Consortium for Translational Cancer Research (DKTK), Essen, Germany German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Angelika Eggert
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Ritter-Sovinz
- Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria
| | - Nikolaos E Bechrakis
- Department of Ophthalmology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | | | - Annette Moll
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Maja Beck Popovic
- Department of Pediatric Hematology and Oncology, University Hospital CHUV, University of Lausanne, Lausanne, Switzerland
| | | | - François Doz
- Institut Curie, PSL Research University and University of Paris, Paris, France
| | - Petra Ketteler
- Department of Pediatric Hematology and Oncology, University Duisburg-Essen, University Hospital Essen, Essen, Germany.,German Consortium for Translational Cancer Research (DKTK), Essen, Germany German Cancer Research Center (DKFZ), Heidelberg, Germany
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16
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Clinical audit of retinoblastoma management: a retrospective single-institution study. Can J Ophthalmol 2021; 57:257-269. [PMID: 34077747 DOI: 10.1016/j.jcjo.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The primary aim of this study was to identify the frequency of death, metastasis, enucleation, and use of external beam radiation therapy (EBRT) among retinoblastoma patients. The secondary aim was to determine whether any events were associated with suboptimal clinical management to identify areas for clinical care improvement. METHODS Patients diagnosed with retinoblastoma between January 1, 2000, and December 31, 2015, at The Hospital for Sick Children were included. Medical records of eligible patients underwent a comprehensive 2-part review. First, a chart review collected diagnostic details, treatment course, and occurrence of 4 events: death, metastasis, use of EBRT, and enucleation. Next, events were reviewed in detail, and a multidisciplinary committee reached consensus on cases managed suboptimally. RESULTS The study included 209 patients (292 eyes). There were 8 deaths, 11 metastases, 177 enucleations (143 primary, 34 secondary), and 8 uses of EBRT. Thirteen patients were reviewed by the multidisciplinary committee, which confirmed that 5 of these patients had events associated with suboptimal clinical management. Three patients developed metastases leading to death (misdiagnosis and mismanagement of trilateral retinoblastoma [1], parental refusal of enucleation [1], and inaccurate histopathology after primary enucleation [1]). One patient developed extraocular extension related to scleral invasion following aggressive focal therapy. One patient underwent secondary enucleation for a Group B eye related to mismanagement of a treatment complication. DISCUSSION Deaths, metastases, and enucleations with documented instances of suboptimal care highlighted a need to enhance medical team and patient communication, histopathology interpretation, laser treatment guidelines, and trilateral retinoblastoma management. Routine clinical audit of retinoblastoma management can identify areas for clinical practice change.
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Feasibility of Proton Beam Therapy as a Rescue Therapy in Heavily Pre-Treated Retinoblastoma Eyes. Cancers (Basel) 2021; 13:cancers13081862. [PMID: 33924716 PMCID: PMC8069965 DOI: 10.3390/cancers13081862] [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: 02/28/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary A variety of therapies are available for the treatment of retinoblastomas. Nevertheless, despite exhaustion of all therapeutic methods, refractory or recurrent courses of the disease occur. In eyes with a function worthy of preservation radiation therapy may become unavoidable. Proton beam therapy, compared to conventional photon-based radiotherapy, is a highly conformal form of radiation therapy with a high biological effectiveness with a simultaneously reduced probability of radiation-related side-effects and induction of secondary primary malignancies. The aim of our retrospective study was to evaluate the efficacy of proton beam therapy as rescue therapy in 15 heavily pretreated retinoblastoma eyes. In our retrospective series of a highly negatively selected patient population, we were able to preserve 60% of the eyes with a manageable side effect profile. A cataract, as the most common long-term complication, was evident in 44.4% of the preserved eyes. There was no in-field second tumor manifestation during follow-up, therefore the preliminary data of this study and series published by others suggest that the risk is significantly lower after proton beam therapy compared to conventional external beam radiation therapy using photons. Abstract Despite the increased risk of subsequent primary tumors (SPTs) external beam radiation (EBRT) may be the only therapeutic option to preserve a retinoblastoma eye. Due to their physical properties, proton beam therapy (PBT) offers the possibility to use the effectiveness of EBRT in tumor treatment and to decisively reduce the treatment-related morbidity. We report our experiences of PBT as rescue therapy in a retrospectively studied cohort of 15 advanced retinoblastoma eyes as final option for eye-preserving therapy. The average age at the initiation of PBT was 35 (14–97) months, mean follow-up was 22 (2–46) months. Prior to PBT, all eyes were treated with systemic chemotherapy and a mean number of 7.1 additional treatments. Indication for PBT was non-feasibility of intra-arterial chemotherapy (IAC) in 10 eyes, tumor recurrence after IAC in another 3 eyes and diffuse infiltrating retinoblastoma in 2 eyes. Six eyes (40%) were enucleated after a mean time interval of 4.8 (1–8) months. Cataract formation was the most common complication affecting 44.4% of the preserved eyes, yet 77.8% achieved a visual acuity of >20/200. Two of the 15 children treated developed metastatic disease during follow-up, resulting in a 13.3% metastasis rate. PBT is a useful treatment modality as a rescue therapy in retinoblastoma eyes with an eye-preserving rate of 60%. As patients are at lifetime risk of SPTs consistent monitoring is mandatory.
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The role for intra-arterial chemotherapy for refractory retinoblastoma: a systematic review. Clin Transl Oncol 2021; 23:2066-2077. [PMID: 33826082 DOI: 10.1007/s12094-021-02610-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intra-arterial chemotherapy is a new retinoblastoma treatment associated with high rates of globe salvage that has been widely adopted for primary treatment of retinoblastoma but is less frequently used as secondary treatment for refractory retinoblastoma. This systematic review aims to summarize the reported outcomes of intra-arterial chemotherapy for refractory retinoblastoma. METHODS We conducted a systematic review of studies published on PubMed, Medline, and Embase from 2011 to 2021 reporting globe salvage rates following intra-arterial chemotherapy for secondary treatment of refractory retinoblastoma. RESULTS Our search yielded 316 studies, and 24 met inclusion criteria. The 24 included studies were comprised of 1366 patients and 1757 eyes. Among these, 1184 (67%) eyes received secondary indication treatment, and globe salvage was achieved for 776 of these 1184 eyes (64%). Sixteen studies reported cannulation success rates from 71.8 to 100%. Pooled analysis of subjects revealed 21 patients (2.6%) with metastatic disease and 26 deaths (3%) during study follow-up periods (7-74 months). The most common ocular complications were vitreous hemorrhage (13.2%), loss of eyelashes (12.7%), and periocular edema (10.5%). The most common systemic complications were nausea/vomiting (20.5%), neutropenia (14.1%), fever (8.2%), and bronchospasm (6.2%). CONCLUSIONS Intra-arterial chemotherapy is associated with high rates of globe salvage and low rates of serious complications in patients with refractory retinoblastoma. Unfortunately, current literature is predominantly comprised of retrospective case studies, and further high-quality evidence is necessary to inform clinical practice.
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Silvera VM, Guerin JB, Brinjikji W, Dalvin LA. Retinoblastoma: What the Neuroradiologist Needs to Know. AJNR Am J Neuroradiol 2021; 42:618-626. [PMID: 33509920 DOI: 10.3174/ajnr.a6949] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
Retinoblastoma is the most common primary intraocular tumor of childhood. Accurate diagnosis at an early stage is important to maximize patient survival, globe salvage, and visual acuity. Management of retinoblastoma is individualized based on the presenting clinical and imaging features of the tumor, and a multidisciplinary team is required to optimize patient outcomes. The neuroradiologist is a key member of the retinoblastoma care team and should be familiar with characteristic diagnostic and prognostic imaging features of this disease. Furthermore, with the adoption of intra-arterial chemotherapy as a standard of care option for globe salvage therapy in many centers, the interventional neuroradiologist may play an active role in retinoblastoma treatment. In this review, we discuss the clinical presentation of retinoblastoma, ophthalmic imaging modalities, neuroradiology imaging features, and current treatment options.
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Affiliation(s)
- V M Silvera
- From the Departments of Neuroradiology (V.M.S., J.B.G., W.B.)
| | - J B Guerin
- From the Departments of Neuroradiology (V.M.S., J.B.G., W.B.)
| | - W Brinjikji
- From the Departments of Neuroradiology (V.M.S., J.B.G., W.B.).,Neurosurgery (W.B.)
| | - L A Dalvin
- Ophthalmology (L.A.D.), Mayo Clinic, Rochester, Minnesota
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Applications of iodine-125 plaque radiotherapy for residual or recurrent retinoblastoma. Can J Ophthalmol 2021; 56:317-324. [PMID: 33493457 DOI: 10.1016/j.jcjo.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the role of iodine-125 plaque radiotherapy (IPR) as a secondary treatment for localized (solitary or multiple) residual (partially regressed) or recurrent (regrowth after ≥6 months stability) retinoblastoma in the era of systemic and/or regional chemotherapy. DESIGN A single-institute retrospective, noncomparative, interventional case series managed between July 2014 and June 2019. PARTICIPANTS Thirteen consecutive eyes of 12 patients with 14 residual or recurrent retinoblastoma tumors treated with IPR. Patients who had to follow up <1 year post-IPR were excluded except for those who had enucleation. METHODS Data collected included pre-IPR treatments, tumor characteristics at IPR, and post-IPR anatomical outcome (local tumor control and globe salvage) and functional outcome (radiation complications). RESULTS Local tumor control was achievable in 12 of 14 tumors. Local recurrences were observed in 2 of 5 tumors that exhibited fish-flesh regression after IPR (p = 0.04). Globe salvage was possible in 11 eyes (12 tumors). Only 2 eyes were legally blind and the remaining 9 eyes had vision >20/125. Radiation-induced complications included radiation retinopathy (4/11), radiation papillopathy (1/11), diffuse vitreous hemorrhage (4/11). Eyes with fish-flesh-regressed tumours tended to show more complications, but were statistically insignificant (p = 0.09, Fisher exact test). There was no association of time to IPR (early <6 months vs late >6 months) with occurrence of tumor recurrence or complications (p > 0.05). CONCLUSION IPR offers satisfactory local tumor control and globe salvage in localized recurrent/residual retinoblastoma. Fish-flesh tumor regression after IPR should be closely monitored for further recurrences.
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21
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Dosimetric comparison of different radiotherapy techniques for the treatment of Retinoblastoma. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim:
This study aims to compare the dosimetric parameters among four different external beam radiotherapy techniques used for the treatment of retinoblastoma.
Materials and methods:
Computed tomography (CT) sets of five retinoblastoma patients who required radiotherapy to one globe were included. Four different plans were generated for each patient using three dimensional conformal radiotherapy (3DCRT), intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and VMAT using flattening filter free (VMAT-FFF) beam techniques. Plans were compared for target coverage and organs at risk (OARs) sparing.
Results:
The target coverage of planning target volume (PTV) for all the four modalities were clinically acceptable with a V95 of 95 ± 0%, 97·6 ± 1·87%, 99·3 ± 0·5% and 99·17 ± 0·45% for 3DCRT, IMRT, VMAT and VMAT-FFF respectively. The VMAT and IMRT plans had better target coverage than the 3DCRT plans (p = 0·001 and p = 0·07 respectively). IMRT and VMAT plans were also found superior to 3DCRT plans in terms of OAR sparing like brainstem, optic chiasm, brain (p < 0·05). VMAT delivered significantly lower dose to the brainstem and contralateral optic nerve in comparison to IMRT. Use of VMAT-FFF beams did not show any benefit over VMAT in target coverage and OAR sparing.
Conclusion:
VMAT should be preferred over 3DCRT and IMRT for treatment of retinoblastoma owing to better target coverage and less dose to most of the OARs. However, IMRT and VMAT should be used with caution because of the increased low dose volumes to the OARs like contralateral lens and eyeball.
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Ancona-Lezama D, Dalvin LA, Shields CL. Modern treatment of retinoblastoma: A 2020 review. Indian J Ophthalmol 2020; 68:2356-2365. [PMID: 33120616 PMCID: PMC7774148 DOI: 10.4103/ijo.ijo_721_20] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/23/2020] [Accepted: 07/07/2020] [Indexed: 12/23/2022] Open
Abstract
Retinoblastoma management remains complex, requiring individualized treatment based on International Classification of Retinoblastoma (ICRB) staging, germline mutation status, family psychosocial factors and cultural beliefs, and available institutional resources. For this 2020 retinoblastoma review, PubMed was searched for articles dated as early as 1931, with an emphasis on articles from 1990 to the present day, using keywords of retinoblastoma, chemotherapy, intravenous chemotherapy, chemoreduction, intra-arterial chemotherapy, ophthalmic artery chemosurgery, intravitreal chemotherapy, intracameral chemotherapy, cryotherapy, transpupillary thermotherapy, laser, radiation, external beam radiotherapy, plaque radiotherapy, brachytherapy, and enucleation. We discuss current treatment modalities as used in the year 2020, including intravenous chemotherapy (IVC), intra-arterial chemotherapy (IAC), intravitreal chemotherapy (IvitC), intracameral chemotherapy (IcamC), consolidation therapies (cryotherapy and transpupillary thermotherapy [TTT]), radiation-based therapies (external beam radiotherapy [EBRT] and plaque radiotherapy), and enucleation. Additionally, we present a consensus treatment algorithm based on the agreement of three North American retinoblastoma treatment centers, and encourage further collaboration amongst the world's most expert retinoblastoma treatment centers in order to develop consensus management plans and continue advancement in the identification and treatment of this childhood cancer.
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Affiliation(s)
- David Ancona-Lezama
- Ocular Oncology Service, Institute of Ophthalmology and Visual Sciences, Tecnologico de Monterrey, Mexico
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Carol L Shields
- Ocular Oncology Service Wills Eye Hospital, Philadelphia, PA, USA
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MiR-486-3p inhibits the proliferation, migration and invasion of retinoblastoma cells by targeting ECM1. Biosci Rep 2020; 40:224127. [PMID: 32401301 PMCID: PMC7273916 DOI: 10.1042/bsr20200392] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022] Open
Abstract
It has been reported that miR-486-3p expression is decreased in retinoblastoma (RB) tumor tissues, however, its function in RB has been less reported. The present study aimed to explore the regulatory effects of miR-486-3p on RB cells. The expression of miR-486-3p in RB tissues and cells was detected by quantitative real-time polymerase chain reaction (qRT-PCR). Cell viability, proliferation, apoptosis, migration and invasion ability were determined by cell counting kit-8 (CCK-8) kit, clone formation assay, flow cytometry, scratch assay and transwell, respectively. Targetscan 7.2 and dual-luciferase reporter were used to verify target genes for miR-486-3p. The expressions of apoptosis-related proteins and ECM1 were detected by Western blot. The miR-486-3p expression was decreased in RB tissues and cells. In RB cells, overexpression of miR-486-3p inhibited cell proliferation, migration and invasion, while promoted apoptosis. Moreover, overexpression of miR-486-3p decreased Bcl-2 expression, while increased the expressions of Bax and Cleaved Caspase-3 (C caspase-3). ECM1 was the target gene of miR-486-3p, and miR-486-3p inhibited the expression of ECM1. Furthermore, ECM1 partially reversed the inhibitory effect of miR-486-3p on the proliferation, migration and invasion of RB cells. MiR-486-3p inhibited the proliferation, migration and invasion of RB by down-regulating ECM1.
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Zhu X, Yu M, Wang K, Zou W, Zhu L. FoxM1 affects adhesive, migratory, and invasive abilities of human retinoblastoma Y-79 cells by targeting matrix metalloproteinase 2. Acta Biochim Biophys Sin (Shanghai) 2020; 52:294-301. [PMID: 32152631 DOI: 10.1093/abbs/gmz160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/01/2019] [Accepted: 11/06/2019] [Indexed: 12/22/2022] Open
Abstract
Forkhead box protein M1 (FoxM1) is an important transcription factor involved in various pathological processes including tumor metastasis. The changes of adhesive, migratory, and invasive abilities are considered as crucial events in tumor metastasis progression. In this study, we aimed to investigate the correlation between FoxM1 and retinoblastoma (Rb) metastasis and to explore the detailed mechanism. Wound healing, cell adhesion, and invasion assays showed that FoxM1 overexpression induced epithelial-mesenchymal transition in Y-79 cells and inhibited adhesion and subsequently promoted metastasis of Y-79 cells, while FoxM1 knockdown showed the opposite effects. A luciferase reporter assay and chromatin immunoprecipitation assay provided evidence that FoxM1 promoted matrix metalloproteinase 2 (MMP2) transcription by directly binding to and promoting MMP2 promoter. MMP2 knockdown by siRNA transfection attenuated cell metastasis of Y-79 cells induced by FoxM1 overexpression. Furthermore, the FoxM1-binding site mapped between -1167 and -1161 bp of the MMP2 promoter was identified. Our results suggested that the FoxM1-MMP2 axis plays an important role in Rb metastasis, which may be a novel target for designing therapeutic regimen to control Rb metastasis.
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Affiliation(s)
- Xue Zhu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi 214063, China
| | - Mengxi Yu
- Department of Ophthalmology, The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi 214002, Jiangsu, China
| | - Ke Wang
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi 214063, China
| | - Wenjun Zou
- Department of Ophthalmology, The Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University, Wuxi 214002, Jiangsu, China
| | - Ling Zhu
- Save Sight Institute, University of Sydney, Sydney, New South Wales 2000, Australia
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Khademi R, Razminia A. Selective nano-thermal therapy of human retinoblastoma in retinal laser surgery. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 24:102102. [PMID: 31678179 DOI: 10.1016/j.nano.2019.102102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
Abstract
In this research, an experimental validated predictive finite element model of a cancerous human eye is developed to investigate how the tumor cells in retinoblastoma can be selectively damaged in the course of laser irradiation. In the computational modeling, the tumor is assumed to be in the initial growth stages and located in the macular zone. The statistical calculations testify that an 8.5% improvement in our estimation of the experimental temperature inside the normal human eye compared to those provided by the previous model has been achieved. Under the surgical conditions, the at-risk regions are determined, and the thermal responses of the tissue to various intrinsic and operating factors are obtained and discussed. Our findings indicate that, in the same amount of exposure time, introducing biodegradable nanoparticles in a concentration of 0.2 into the tumor tissue can increase the lethal zone area by 51 percent, and could plays an effective role in surviving of corneal injury.
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Affiliation(s)
- Ramin Khademi
- Chemical Engineering Department, University of Sistan and Baluchestan, Zahedan, Iran.
| | - Abolhassan Razminia
- Dynamical Systems & Control (DSC) Research Lab., Department of Electrical Engineering, School of Engineering, Persian Gulf University, 75169, Bushehr, Iran.
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Abstract
Proton beam therapy is a highly conformal form of radiation therapy, which currently represents an important therapeutic component in multidisciplinary management in paediatric oncology. The precise adjustability of protons results in a reduction of radiation-related long-term side-effects and secondary malignancy induction, which is of particular importance for the quality of life. Proton irradiation has been shown to offer significant advantages over conventional photon-based radiotherapy, although the biological effectiveness of both irradiation modalities is comparable. This review evaluates current data from clinical and dosimetric studies on the treatment of tumours of the central nervous system, soft tissue and bone sarcomas of the head and neck region, paraspinal or pelvic region, and retinoblastoma. To date, the clinical results of irradiating childhood tumours with high-precision proton therapy are promising both with regard to tumour cure and the reduction of adverse events. Modern proton therapy techniques such as pencil beam scanning and intensity modulation are increasingly established modern facilities. However, further investigations with larger patient cohorts and longer follow-up periods are required, in order to be able to have clear evidence on clinical benefits.
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Affiliation(s)
- Heike Thomas
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), West German, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), West German, Germany.,German Cancer Consortium (DKTK), Essen, Germany
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27
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Rong X, Sun C, Zhang F, Zheng J. Effect of dexmedetomidine anesthesia on respiratory function in pediatric patients undergoing retinoblastoma resection. Oncol Lett 2019; 17:2721-2728. [PMID: 30867730 PMCID: PMC6365899 DOI: 10.3892/ol.2019.9893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to investigate the effect of dexmedetomidine (Dex) on the respiratory function during anesthesia induction in pediatric patients undergoing retinoblastoma (RB) resection. A total of 87 pediatric patients who underwent RB resection in Yidu Central Hospital of Weifang were recruited into this study. General anesthesia was first induced for all patients, of which 45 were randomly assigned to the experimental group and received Dex through an intravenous infusion pump to maintain general anesthesia. The remaining 42 patients were assigned to the control group and received saline through an intravenous infusion pump. Respiratory function and hemodynamic indexes at five time-points, i.e., before anesthesia induction (T0), 5 min after injection of anesthetic agents (T1), before intubation (T2), 15 min after intubation (T3), and 30 min after extubation (T4), were recorded and compared. Incidence of perioperative cardiac and respiratory adverse events was counted in both groups, and post-anesthesia resuscitation was evaluated and compared. Compared with T0, the respiratory rate (R) of the experimental group was lower at T1-T4, but there was no statistical difference (P<0.05). Compared with T0, the control group had a higher R at T2, lower R at T3 and T4 (P<0.05), and there was no significant difference in R between T0 and T1 (P>0.05). At the same time-point, compared with the experimental group, the R was higher at T2, and lower at T3 and T4 in the control group (P<0.05), and no significant difference was found at T1. Blood oxygen saturation (SpO2) of the experimental group was slightly lower than that of T0 at T1-T4 (P>0.05). In the control group, the levels of SpO2 were significantly lower at T1-T4 than those at T0 (P<0.05). Compared with the experimental group at the same time-point, SpO2 of the control group at T1-T4 decreased significantly (P<0.05). The heart rate (HR) of the experimental and control groups was lower at T1-T4 than that at T0 (P<0.05). The HR of the experimental group was higher than that of the control group at T1-T4 (P<0.05). Mean arterial pressure (MAP) of the experimental and control groups was lower at T1-T4 than that at T0 (P<0.05). MAP of the control group was higher than that of the experimental group at T2 but lower than that at T0 of the control group. MAP of the control group was lower than that of the experimental group at T1-T4. There was no significant difference in incidence of tachycardia, bradycardia, vomiting, hypoxia and laryngism between the two groups (P>0.05). There was no difference in resuscitation and extubation time between the two groups (P>0.05). Finally, agitation of the control group was more severe than that of the experimental group (P<0.05). Therefore, Dex can improve the respiratory function and hemodynamic stability during anesthesia induction in children with RB resection.
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Affiliation(s)
- Xi Rong
- School of Pharmacy of Qingdao University, Qingdao, Shandong 266021, P.R. China.,Department of Pharmacy, Yidu Central Hospital of Weifang, Weifang, Shandong 262500, P.R. China
| | - Chunlei Sun
- Department of Pediatric Internal Medicine, Yidu Central Hospital of Weifang, Weifang, Shandong 262500, P.R. China
| | - Feng Zhang
- Department of Pharmacy, Yidu Central Hospital of Weifang, Weifang, Shandong 262500, P.R. China
| | - Jie Zheng
- School of Pharmacy of Qingdao University, Qingdao, Shandong 266021, P.R. China
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Abstract
Vitreous seeds are the most challenging aspect in the management of retinoblastoma. We report the outcomes of treatment with proton beam radiation therapy (PBRT) for retinoblastoma with vitreous seeds in naive or previously treated eyes. In this retrospective case series, we analyzed data of 4 retinoblastoma patients with vitreous seeds who received PBRT at the Proton Therapy Center, National Cancer Center in Korea between June 2007 and August 2017. All 4 eyes treated by PBRT were classified as group D according to the International Classification of Retinoblastoma (ICRB) criteria, and the vitreous seeds, as class 3 (clouds). The tumor and vitreous seeds regressed in 2 eyes, and globe salvage was achieved in these 2 eyes (50%). The post-PBRT ophthalmologic follow-up time of these 2 preserved eyes was 12 and 50 months, respectively. Visual acuity measurements of the successfully treated patients were 20/40 and 20/600. No radiation-associated malignancies were noted. In conclusion, PBRT successfully treated vitreous seeds classified as clouds in half of the cases, and successfully treated patients who retained useful vision. Therefore, PBRT might be a viable treatment option for vitreous seeds in patients with retinoblastoma.
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Klinger F, Maione L, Vinci V, Lisa A, Barbera F, Balia L, Caviggioli F, Di Maria A. Autologous fat graft in irradiated orbit postenucleation for retinoblastoma. Orbit 2018; 37:344-347. [PMID: 29303387 DOI: 10.1080/01676830.2017.1423358] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/29/2017] [Indexed: 06/07/2023]
Abstract
Autologous fat grafting has been extensively and successfully adopted in a number of pathologic conditions in regenerative surgery especially on irradiated fields in order to improve pain symptoms and tissue trophism promoting scar release. In the present study, we report our experience with autologous fat grafting for the treatment of postirradiation fibrosis and pain on three consecutive patients undergoing orbital enucleation for locally advanced retinoblastoma (RB) and subsequent radiotherapy. We selected three consecutive patients who underwent orbital enucleation for locally advanced RB and subsequent local radiotherapy showing severe reduction in orbital volume and eyelid length and retraction due to fibrosis, spontaneous local pain exacerbated after digital pressure with no possibility to place an ocular implant. They underwent autologous fat grafting in the orbital cavity and results were evaluated by clinical examination at 5 and 14 days, and 1, 3, 6 months, and 1 year after surgery. A significant release of scar retraction, reduction of fibrosis and orbital rim contraction together with an important improvement of pain symptoms was observed in all patients. The local changes observed enabled an ease placement of an ocular prosthetic implant (implant). No local or systemic complication occurred. Fat grafting is a promising treatment for patients showing radiotherapy related complication in the orbital area and it should be adopted by all oculoplastic surgeon in order to improve pain syndrome creating the ideal local conditions for the placement of an ocular prosthetic implant.
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Affiliation(s)
- Francesco Klinger
- a Reconstructive and Aesthetic Plastic Surgery School-MultiMedica Holding S.p.A.- Plastic Surgery Unit-Sesto San Giovanni , University of Milan , Milan , Italy
| | - Luca Maione
- b Department of Medical Biotechnology and Translational Medicine BIOMETRA-Plastic Surgery Unit, Humanitas Research Hospital , University of Milan, Reconstructive and Aesthetic Plastic Surgery School , Milan , Rozzano , Italy
| | - Valeriano Vinci
- b Department of Medical Biotechnology and Translational Medicine BIOMETRA-Plastic Surgery Unit, Humanitas Research Hospital , University of Milan, Reconstructive and Aesthetic Plastic Surgery School , Milan , Rozzano , Italy
| | - Andrea Lisa
- b Department of Medical Biotechnology and Translational Medicine BIOMETRA-Plastic Surgery Unit, Humanitas Research Hospital , University of Milan, Reconstructive and Aesthetic Plastic Surgery School , Milan , Rozzano , Italy
| | - Federico Barbera
- b Department of Medical Biotechnology and Translational Medicine BIOMETRA-Plastic Surgery Unit, Humanitas Research Hospital , University of Milan, Reconstructive and Aesthetic Plastic Surgery School , Milan , Rozzano , Italy
| | - Laura Balia
- c Ophthalmology Unit , Humanitas Research Hospital , Milan , Rozzano , Italy
| | - Fabio Caviggioli
- a Reconstructive and Aesthetic Plastic Surgery School-MultiMedica Holding S.p.A.- Plastic Surgery Unit-Sesto San Giovanni , University of Milan , Milan , Italy
| | - Alessandra Di Maria
- c Ophthalmology Unit , Humanitas Research Hospital , Milan , Rozzano , Italy
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Galangin inhibits the cell progression and induces cell apoptosis through activating PTEN and Caspase-3 pathways in retinoblastoma. Biomed Pharmacother 2018; 97:851-863. [DOI: 10.1016/j.biopha.2017.09.144] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/11/2017] [Accepted: 09/26/2017] [Indexed: 12/17/2022] Open
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31
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Pant G, Verma N, Kumar A, Pooniya V, Gupta SK. Outcome of extraocular retinoblastoma in a resource limited center from low middle income country. Pediatr Hematol Oncol 2017; 34:419-424. [PMID: 29337595 DOI: 10.1080/08880018.2017.1422060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Retinoblastoma (RB) is the most common ocular malignancy in children, and is managed by multimodal treatment. There is a paucity of data regarding the clinical profile and outcome of children with extraocular retinoblastoma from Low Middle Income Countries (LMIC) including India. Case records of children with newly diagnosed extraocular RB from January 2013 to August 2016 treated at our unit were analysed for clinical profile, treatment, and outcome. Over the 44 month study period, 91 children were diagnosed with RB, out of which 41 had extraocular disease. While 26 children had extraocular spread limited to orbit (IRSS stage III), 15 had a distant spread to brain (IRSS stage IV). Median lag period for diagnosis was eight months. Treatment abandonment rates were 38.5% and 46.6% in International Retinoblastoma Staging System (IRSS) stage III and IV respectively. With a median follow up of 31.5 months, the projected overall survival for IRSS III at one, two, and three years was 87.5%, 55.6%, and 39.7%. All patients with stage IV disease died after a median follow up duration of three months. High treatment abandonment rates and limited availability of resources lead to suboptimal survival in children with extraocular RB from LMIC. Initiatives aimed at improving early diagnosis, so that the disease is detected in the intraocular stage, are critical to improve the survival in children with RB.
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Affiliation(s)
- Gitika Pant
- a Pediatric Hematology-Oncology Unit, Department of Pediatrics , King George's Medical University , Lucknow , Uttar Pradesh , India
| | - Nishant Verma
- a Pediatric Hematology-Oncology Unit, Department of Pediatrics , King George's Medical University , Lucknow , Uttar Pradesh , India
| | - Archana Kumar
- a Pediatric Hematology-Oncology Unit, Department of Pediatrics , King George's Medical University , Lucknow , Uttar Pradesh , India
| | - Vishal Pooniya
- a Pediatric Hematology-Oncology Unit, Department of Pediatrics , King George's Medical University , Lucknow , Uttar Pradesh , India
| | - Sanjiv Kumar Gupta
- b Department of Ophthalmology , King George's Medical University , Lucknow , Uttar Pradesh , India
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32
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Zhu X, Wang K, Yao Y, Zhang K, Zhou F, Zhu L. Triggering p53 activation is essential in ziyuglycoside I-induced human retinoblastoma WERI-Rb-1 cell apoptosis. J Biochem Mol Toxicol 2017; 32. [DOI: 10.1002/jbt.22001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Xue Zhu
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine; Jiangsu Institute of Nuclear Medicine; Wuxi 214063 Jiangsu Province People's Republic of China
| | - Ke Wang
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine; Jiangsu Institute of Nuclear Medicine; Wuxi 214063 Jiangsu Province People's Republic of China
| | - Yong Yao
- Department of Ophthalmology; Wuxi People's Hospital Affiliated to Nanjing Medical University; Wuxi 214023 Jiangsu Province People's Republic of China
| | - Kai Zhang
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine; Jiangsu Institute of Nuclear Medicine; Wuxi 214063 Jiangsu Province People's Republic of China
| | - Fanfan Zhou
- Faculty of Pharmacy; University of Sydney; Sydney NSW 2006 Australia
| | - Ling Zhu
- Save Sight Institute; University of Sydney; Sydney NSW 2000 Australia
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Tschulakow AV, Dittmann K, Huber SM, Klumpp D, Stegen B, Schraermeyer U, Rodemann HP, Julien-Schraermeyer S. The radioprotector ortho-phospho-L-tyrosine (pTyr) attenuates the side effects of fractionated irradiation in retinoblastoma mouse models but also decreases the local tumour control. Radiother Oncol 2017; 124:462-467. [PMID: 28711224 DOI: 10.1016/j.radonc.2017.06.023] [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: 07/06/2016] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radiotherapy (RT) is used to treat retinoblastoma (Rb), the most frequent ocular tumour in children. Besides eradicating the tumour, RT can cause severe side effects including secondary malignancies. This study aimed to define whether the radioprotector ortho-phospho-L-tyrosine (pTyr) prevents RT-induced side effects and affects local tumour control in a xenograft and a genetic orthotopic Rb mouse model. METHODS B6;129-Rb1tm3Tyj/J (Rb+/-) and Y79-Rb cell-xenografted nude mice were fractionated external beam irradiated (15 fractions of 5Gy 6MV photons during 3weeks) with or without pTyr pre-treatment (100mg/kg BW, 16h prior to each irradiation). One, three, six and nine months after RT, tumour control and RT toxicity were evaluated using in vivo imaging and histology. We also analysed pTyr dependant post irradiation cell survival and p53 activity in vitro. RESULTS In vitro pTyr pre-treatment showed no radioprotection on Y79 cells, but led to p53 stabilisation in unirradiated Y79 cells and to a facilitation of radiation-induced p21 up-regulation, confirming a modulation of p53 activity by pTyr. In both mouse models, secondary tumours were undetectable. In Rb+/- mice, pTyr significantly lowered RT-induced greying of the fur, retinal thickness reduction and photoreceptor loss. However, in the xenografted Rb model, pTyr considerably decreased RT-mediated tumour control, which was observed in 16 out of 22 control eyes but in none of the 24 pTyr treated eyes. CONCLUSIONS In Rb+/- mice pTyr significantly prevents RT-induced greying of the fur as well as retinal degeneration. However, since non-irradiated control mice were not used in our study, a formal possibility exists that the effect shown in the retina of Rb+/- mice may be due to ageing of the animals and/or actions of pTyr alone. Unfortunately, as tested in a xenograft model, pTyr treatment reduced the control of Rb tumours.
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Affiliation(s)
- Alexander V Tschulakow
- Division of Experimental Vitreoretinal Surgery, Centre for Ophthalmology, University of Tuebingen, Germany
| | - Klaus Dittmann
- Division of Radiobiology & Molecular Environmental Research, Department of Radiation Oncology, University of Tuebingen, Germany
| | - Stephan M Huber
- Department of Radiation Oncology, University of Tuebingen, Germany
| | - Dominik Klumpp
- Department of Radiation Oncology, University of Tuebingen, Germany
| | - Benjamin Stegen
- Department of Radiation Oncology, University of Tuebingen, Germany
| | - Ulrich Schraermeyer
- Division of Experimental Vitreoretinal Surgery, Centre for Ophthalmology, University of Tuebingen, Germany
| | - H Peter Rodemann
- Division of Radiobiology & Molecular Environmental Research, Department of Radiation Oncology, University of Tuebingen, Germany
| | - Sylvie Julien-Schraermeyer
- Division of Experimental Vitreoretinal Surgery, Centre for Ophthalmology, University of Tuebingen, Germany.
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