Long‐term outcomes of Group D eyes in bilateral retinoblastoma patients treated with chemoreduction and low‐dose IMRT salvage

Berry, Jesse L.; Jubran, Rima; Kim, Jonathan W.; Wong, Kenneth; Bababeygy, Simon R.; Almarzouki, Hashem; Lee, Thomas C.; Murphree, A. Linn

doi:10.1002/pbc.24303

Cited by 100 publications

(98 citation statements)

References 40 publications

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“…Globe salvaging treatment for Group E retinoblastoma is done only if the patient has bilateral disease wherein the contralateral eye will also require systemic therapy for salvage. The treatment paradigms at our center have been described previously [9,10,11]. …”

Section: Methodsmentioning

confidence: 99%

Optic Nerve Obscuration in Retinoblastoma: A Risk Factor for Optic Nerve Invasion

et al. 2017

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Background: The objective of this study is to evaluate the risk of optic nerve invasion associated with optic nerve obscuration at diagnosis or persisting during treatment. Methods: Retrospective review from 2011-2016 of patients with advanced retinoblastoma (Group D/E) with complete obscuration of the nerve at diagnosis and a second group of patients with persistent, complete obscuration throughout treatment. Results: Advanced retinoblastoma was diagnosed in 102 eyes of 86 patients. The optic nerve was obscured in 69 eyes (68%) at diagnosis. Of these, 30 (43%) underwent salvage therapy and 39 (57%) primary enucleation. Histopathologic analysis of primarily enucleated eyes showed 41% prelaminar and 15% postlaminar invasion. Four eyes in the salvage group demonstrated persistent nerve obscuration; 2 were subsequently enucleated without evidence of nerve invasion. Average follow-up was 23.5 months (range 1-62 months). Conclusions and Relevance: Optic nerve obscuration at diagnosis may be associated with postlaminar optic nerve invasion. While persistent, complete obscuration of the optic nerve by retinoblastoma during treatment is a poor prognostic sign for both globe salvage and vision, it does not appear, in this small cohort, to increase the risk of optic nerve invasion. With appropriate control of the intraocular tumor, these eyes can be salvaged.

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Section: Methodsmentioning

confidence: 99%

Optic Nerve Obscuration in Retinoblastoma: A Risk Factor for Optic Nerve Invasion

et al. 2017

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“…With our protocol we maintained a 93% (68/73) salvage rate for eyes with Group A-C disease, a 55% (6/11) salvage rate for treated eyes with Group D disease, and a 25% (4/16) salvage rate for eyes with Group E disease. All of these success rates are comparable to standard dose CRD in older age groups [17,18], suggesting that concerns regarding tumor drug resistance with lower dose chemotherapy regimens may be unfounded in this younger group of patients. …”

Section: Discussionmentioning

confidence: 55%

“…One patient developed severe hearing loss that required hearing aids. Another patient developed non-etoposide-associated AML 12 months after the completion of CRD, and this case has been described previously [17]. All patients were alive and no other secondary malignancies have been identified at a median follow-up of 52.9 months (range 1-148).…”

Section: Resultsmentioning

confidence: 87%

“…We also demonstrated that a reduced-dose, 2- to 3-drug CRD regimen has acceptable and tolerable systemic drug toxicity even in very young infants. When comparing the rates of systemic toxicity between this reduced-dose approach in young infants versus all children with Group D disease treated with CRD, the rates of grade III toxicity, hospital admissions, hearing loss, and long-term side effects were similar [17]. No patient was admitted for chemotherapy-related toxicity during the follow-up period, and only 1 patient developed detectable hearing loss.…”

Section: Discussionmentioning

confidence: 99%

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Low-Dose Chemoreduction for Infants Diagnosed with Retinoblastoma before 6 Months of Age

Berry¹,

Jubran

Lee³

et al. 2015

Ocul Oncol Pathol

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Aim: The purpose of this study was to evaluate the outcomes of infants diagnosed with retinoblastoma before 6 months of age, including the need for chemoreduction (CRD). In this age group, dosage of CRD was reduced due to its potential for toxicity. Methods: This is a retrospective review from 2000 to 2009 that includes 126 eyes of 72 infants (18 unilateral, 54 bilateral). Systemic CRD was administered when local modalities failed or were considered inadequate. Primary outcome measures were the need for CRD and globe salvage. Results: Of the 72 infants diagnosed before 6 months of age, 48 (67%) ultimately required CRD for globe salvage, 40 (56%) patients before 6 months of age. Globe salvage was achieved in 62% (78/126) of eyes overall and in 93% (68/73) of eyes with Group A-C disease. No patient was hospitalized for CRD-related illness; survival was 100%. The mean follow-up was 52.9 months (range 1-148 months). Conclusion: Utilizing a combination of focal modalities and reduced-dose CRD, children diagnosed with retinoblastoma before 6 months of age attain globe salvage rates comparable to those of older age groups. Two thirds of the infants ultimately required CRD for globe salvage. Bilateral disease as well as Group D and E classification in at least one eye at presentation increased the chance of requiring CRD (p < 0.0001 and p < 0.016, respectively).

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“…It was reported that the cure rate reached up to 75% after 6 courses of chemotherapy (carboplatin, etoposide, vincristine and cyclophosphamide as )combined with laser, thermotherapy and other topical therapies (Künkele et al, 2013). The research of Berry et al showed that the cure rate of binoculus RB treated by chemoreduction was 47%, with the survival time of 82% of the patients was more than 12 months and 68% more than 60 months (Berry et al, 2013). The application of chemoreduction significantly increase the retention rate of RB patients, but new RB still occur in 24% of patients during or after the treatment, most of which are in infancy or have a family history of the disease (Shields et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy and Prognostic Factors of Chemoreduction Combined with Topical Treatment for Advanced Intraocular Retinoblastoma

Liu

Xi²,

Liu³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Long‐term outcomes of Group D eyes in bilateral retinoblastoma patients treated with chemoreduction and low‐dose IMRT salvage

Cited by 100 publications

References 40 publications

Optic Nerve Obscuration in Retinoblastoma: A Risk Factor for Optic Nerve Invasion

Optic Nerve Obscuration in Retinoblastoma: A Risk Factor for Optic Nerve Invasion

Low-Dose Chemoreduction for Infants Diagnosed with Retinoblastoma before 6 Months of Age

Clinical Efficacy and Prognostic Factors of Chemoreduction Combined with Topical Treatment for Advanced Intraocular Retinoblastoma

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