Loss of fundus view as an indication for secondary enucleation in retinoblastoma

Berry, Jesse L.; Kogachi, Kaitlin; Jubran, Rima; Kim, Jonathan W.

doi:10.1002/pbc.26908

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…The risk of tumor spread in eyes with active retinoblastoma undergoing cataract surgery has since long been recognized (Brooks et al, 1990;Honavar et al, 2001) and requires specific security guidelines. A minimum of 6-12 months disease-free interval before surgery is recommended (Brooks et al, 1990;Honavar et al, 2001;Miller et al, 2005;Osman et al, 2011), whereas eyes where fundus view is lost sooner are usually treated with enucleation (Berry et al, 2018a;Brennan et al, 2015). Providing that specific additional precautions are followed, however, such eyes, in selected cases, can still be managed conservatively.…”

Section: Amblyopiamentioning

confidence: 99%

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Munier

Beck‐Popovic

Chantada

et al. 2019

Progress in Retinal and Eye Research

160

157

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Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.

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Section: Amblyopiamentioning

confidence: 99%

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Munier

Beck‐Popovic

Chantada

et al. 2019

Progress in Retinal and Eye Research

160

157

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“…Since the beginning of conservative retinoblastoma management, the main reason to stop eye-preserving therapies has always been, and still is related, independently of the treatment modalities used, to uncontrolled tumor activity (80–90% of SE) [ 2 , 4 , 5 , 6 , 7 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 29 , 30 , 31 , 32 , 34 , 35 , 37 , 38 , 40 , 41 , 53 , 54 , 55 , 56 ], while the occurrence of intraocular complications, especially those obscuring the fundus view, explains the remaining cases (10–20% of SE) [ 2 , 5 , 10 , 11 , 13 , 16 , 17 , 18 , 21 , 23 , 28 , 29 , 34 , 39 , 40 , 41 …”

Section: Resultsmentioning

confidence: 99%

“…In two studies comparing histopathology in eyes treated with first line enucleation versus SE, others demonstrated, however, that prolonged times to enucleation were associated with the presence of high-risk features but not to the development of metastasis nor mortality [ 21 , 24 ], suggesting that prompt recognition of refractory disease followed by timely enucleation and adjuvant therapy for high risk factors can efficiently prevent metastatic dissemination [ 21 ]. Interestingly, in a study including 24 eyes enucleated after chemoreduction at an average time of five months after loss of fundus view, 22 (92%) had viable tumor cells on histopathology, but none of them showed high-risk features [ 55 ]. Finally, in two other studies comparing advanced retinoblastoma group D/E treated with either first line systemic chemotherapy or first line intra-arterial chemotherapy versus primary enucleation, conservative treatment was not found to increase the risk of orbital recurrences, metastatic disease or death [ 22 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

Current Indications of Secondary Enucleation in Retinoblastoma Management: A Position Paper on Behalf of the European Retinoblastoma Group (EURbG)

Stathopoulos

Rouic

Moll

et al. 2021

Cancers

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Secondary enucleation (SE) puts an irreversible end to eye-preserving therapies, whenever their prolongation is expected to violate the presumed state of metastatic grace. At present, it must be acknowledged that clear criteria for SE are missing, leading to empiric and subjective indications commonly related to disease progression or relapse, disease persistence masking the optic nerve head or treatment-related complications obscuring the fundus view. This absence of evidence-based consensus regarding SE is explained by the continuously moving frontiers of the conservative management as a result of diagnostic and therapeutic advances, as well as by the lack of studies sufficiently powered to accurately stratify the risk of metastasis in conservatively treated patients. In this position paper of the European Retinoblastoma Group (EURbG), we give an overview of the progressive shift in the indications for SE over the past decades and propose guidelines to assist decision-making with respect to when SE becomes imperative or recommended, with corresponding absolute and relative SE indications. Further studies and validation of biologic markers correlated with the risk of metastasis are expected to set more precisely the frontiers of conservative management and thus consensual criteria for SE in the future.

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“…The intravitreal chemotherapy injection procedure for vitreous seeding in retinoblastoma eyes at CHLA closely follows the protocol initially described by Munier et al [4] and previously published by our center [14, 21, 22]. …”

Section: Methodsmentioning

confidence: 99%

Posterior Vitreous Detachment and the Associated Risk of Retinal Toxicity with Intravitreal Melphalan Treatment for Retinoblastoma

et al. 2018

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Background/Aims: The presence of a posterior vitreous detachment (PVD) may play a role in the development of severe retinal toxicity following intravitreal melphalan (IVM) injection for vitreous seeding. We aimed to evaluate the incidence of PVD in retinoblastoma eyes and its association with retinal toxicity after IVM. Methods: We reviewed 112 eyes of 81 retinoblastoma patients with B-scan images available for review from 2010 to 2017. A cohort with vitreous seeding treated with IVM was compared to a cohort that did not undergo injection. The primary outcome measure was the presence of PVD at diagnosis and after treatment. Secondary measures included IVM-associated retinal toxicity and other ocular complications. Results: The incidence of PVD was 20% at diagnosis, and in eyes with B-scans available both at diagnosis and after treatment 18% of eyes developed a PVD over the course of therapy, more frequently after IVM (p = 0.05). Of 34 eyes receiving IVM treatment, the incidences of posterior segment toxicity and globe salvage were similar between eyes with and without PVD (p = 0.4015 and 0.52, respectively). Conclusion: In this cohort of patients, there did not appear to be an association with the presence of PVD during IVM and the development of retinal toxicity.

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Loss of fundus view as an indication for secondary enucleation in retinoblastoma

Cited by 6 publications

References 9 publications

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Current Indications of Secondary Enucleation in Retinoblastoma Management: A Position Paper on Behalf of the European Retinoblastoma Group (EURbG)

Posterior Vitreous Detachment and the Associated Risk of Retinal Toxicity with Intravitreal Melphalan Treatment for Retinoblastoma

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