A Study of Pathologic Risk Factors in Postchemoreduced, Enucleated Specimens of Advanced Retinoblastomas in a Developing Country

Suryawanshi, Pallavi; Ramadwar, Mukta; Dikshit, Rajesh; Kane, Shubhada; Kurkure, Purna; Banavali, Shripad; Viswanathan, Seethalakshmi

doi:10.5858/2010-0311-oar2

Cited by 21 publications

(18 citation statements)

References 34 publications

(37 reference statements)

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“…The chemoreduction protocol could have been responsible for pathological downstaging of tumor as suggested by Zhao et al [32]. Overall, HRF in postchemotherapy-reduced eyes were found in 10.1% (27/228) in our study, which is much lower than 51.9% reported by Suryawanshi et al [33]. This gross difference is due to the inclusion of vitreous seeds in 44.2% as HRF and consideration of even extraocular cases for the study of HRF.…”

Section: Discussioncontrasting

confidence: 53%

Retinoblastoma: A Sixteen-Year Review of the Presentation, Treatment, and Outcome from a Tertiary Care Institute in Northern India

Singh¹,

Katoch²,

Kaur³

et al. 2017

Ocul Oncol Pathol

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Purpose: To study epidemiology, demographic profile, clinical characteristics, and outcome in pediatric patients with retinoblastoma. Methods: This was a retrospective review of retinoblastoma patients of a tertiary institute from January 1st 1998 to December 31st 2014. Results: The study included 467 patients (618 eyes) with a mean age of 34.7 ± 24.6 months (median = 30; 15 days to 144 months). Retinoblastoma was bilateral in 151 (32.3%) and there were 61.7% males. Intraocular disease was seen in 301 patients (451 eyes [72.9%]) and extraocular in 166 patients (167 eyes; 27.0%). Out of the 347 (74.3%) who received treatment, primary treatment was chemoreduction in 228 (65.7%) and enucleation in 117 (33.7%), while 25.6% of patients refused treatment and 151 (43.5%) defaulted therapy. Local recurrence was seen in 20 (4.3%), metastasis in 2 (0.4%), and deaths in 13 (2.8%) (average follow-up 28.5 ± 44.4 months). Histopathological high risk features were significantly less in the eyes that received chemoreduction (5.0%) versus primary enucleation (20.8%) (p < 0.0004), but there was no difference in the rate of metastasis, recurrence, and death between the two. Conclusions: The majority of retinoblastoma patients in our study had advanced disease, and nearly a third had extraocular extension. There were a significant number of therapy refusals and dropouts. Chemoreduction led to a significant decrease in the histopathological risk factors without affecting the outcomes.

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Section: Discussioncontrasting

confidence: 53%

Retinoblastoma: A Sixteen-Year Review of the Presentation, Treatment, and Outcome from a Tertiary Care Institute in Northern India

Singh¹,

Katoch²,

Kaur³

et al. 2017

Ocul Oncol Pathol

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“…Previous reports have described HRH after enucleation, 13,18 but ours is the largest cohort of primary and secondary enucleation from a single institution. In this study we reviewed 207 enucleated eyes of 202 patients with retinoblastoma; 59 eyes (29%) were considered to have HRH: 46 primarily enucleated eyes and 13 secondarily enucleated eyes.…”

Section: Discussionmentioning

confidence: 79%

“…Our incidence of HRH is comparable with previous reports. 7,11,14 One report of a higher incidence of HRH 18 was due to more advanced (pT4) disease at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…If HRH features are discovered at the time of enucleation, subsequent adjuvant chemotherapy and/or external beam radiation therapy (EBRT) may be prescribed. 11,14-18 In some cases of advanced intraocular disease, pathology may be down-staged after neo-adjuvant therapy, increasing the risk of metastasis and death due to reduced surveillance and inappropriate management of unrecognized high-risk disease. 19 …”

Section: Introductionmentioning

confidence: 99%

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Comparison of high-risk histopathological features in eyes with primary or secondary enucleation for retinoblastoma

et al. 2015

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Aims To compare high-risk histopathology of eyes with primary vs. secondary enucleation from patients with retinoblastoma. Patients and Methods A retrospective histopathology review identified 207 eyes enucleated from 202 patients between March 1997 and August 2013. Our review considered high-risk histopathologic features to include extraocular disease or invasion of the anterior chamber, iris, ciliary body, choroid (massive), postlaminar optic nerve, or sclera. Results Most eyes (144, 70%) were primarily enucleated; 63 (30%) were secondarily enucleated after neoadjuvant therapy. The primary enucleation group had more advanced disease (Reese-Ellsworth Group V: 95% vs. 59%; International Classification Group D/E: 97% vs. 59%; p<0.001). The incidence of high-risk histopathology features was similar between groups (32% vs. 21%, n=59; p=0.132). The type of prior therapy was not associated with high-risk histopathology features. Time to enucleation was longer for secondarily enucleated eyes with high-risk features. Choroid and postlaminar optic nerve invasion were more frequent in eyes primarily enucleated (p<0.001). Forty-six of the 59 (78%) patients with high-risk features received adjuvant chemotherapy and/or external beam radiation therapy. Three patients who received primary enucleation and adjuvant therapy died of metastatic recurrence. Conclusion Despite the more favorable classification of eyes treated with neoadjuvant therapy, the risk of high-risk histopathology features at enucleation was comparable to eyes undergoing primary enucleation. Delayed enucleation was associated with these features, and the majority of patients required further adjuvant therapy. Caution must be exercised in treating recalcitrant intraocular retinoblastoma to promptly pursue definitive enucleation in an effort to minimize further treatment exposures and metastases.

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“…Aqueous seeding (see 6.2.4.1) with or without concomitant anterior uveal involvement was until recently considered an intractable form of retinoblastoma. The prognostic value of aqueous seeding and/or anterior uveal invasion such as iris or corpus ciliaris is controversial, but is no longer considered to be high risk for metastasis and, consequently, does not represent an automatic indication for adjuvant chemotherapy (Baroni et al, 2014;Sreelakshmi et al, 2017;Suryawanshi et al, 2011).…”

Section: Intracameral Chemotherapymentioning

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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A Study of Pathologic Risk Factors in Postchemoreduced, Enucleated Specimens of Advanced Retinoblastomas in a Developing Country

Cited by 21 publications

References 34 publications

Retinoblastoma: A Sixteen-Year Review of the Presentation, Treatment, and Outcome from a Tertiary Care Institute in Northern India

Retinoblastoma: A Sixteen-Year Review of the Presentation, Treatment, and Outcome from a Tertiary Care Institute in Northern India

Comparison of high-risk histopathological features in eyes with primary or secondary enucleation for retinoblastoma

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

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