The Classification of Vitreous Seeds in Retinoblastoma and Response to Intravitreal Melphalan

Francis, Jasmine H.; Abramson, David H.; Gaillard, Marie-Claire; Marr, Brian P.; Beck‐Popovic, Maja; Munier, Francis L.

doi:10.1016/j.ophtha.2015.01.017

Cited by 118 publications

(131 citation statements)

References 11 publications

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“…Comparisons to the larger previously published cohort, which included 28 eyes receiving systemic chemotherapy and IVM [5], are displayed in Table 2 by seed class [7, 14]. In this group of 28 eyes, 6 eyes demonstrated persistent seeding during systemic chemotherapy.…”

Section: Resultsmentioning

confidence: 99%

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Integrated Treatment during the Intravitreal Melphalan Era: Concurrent Intravitreal Melphalan and Systemic Chemoreduction

et al. 2018

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Background: Intravitreal injection of melphalan (IVM) is safe and effective for the treatment of seeding in retinoblastoma. Current protocols require weekly injections during examination under anesthesia (EUA). To avoid additional anesthesia exposure for these children, IVM was initiated at the EUA concurrent with the 4th cycle of systemic chemoreduction in a series of 6 patients with persistent seeding. Methods: A retrospective review was completed to assess treatment response compared to all patients at our center treated with IVM and systemic chemotherapy. Overall, 6 eyes of 6 patients were included; salvage therapy included systemic chemoreduction with vincristine, etoposide, and carboplatin and IVM for persistent seeding. Results: IVM was initiated in all eyes at cycle 4 of their chemotherapy. Success in eradicating vitreous seeds was 100%; overall salvage rate was 67%. Anterior toxicity was observed in 2 out of 6 eyes and posterior toxicity in 4 out of 6 eyes. Conclusion: The concurrent chemoreduction and IVM protocol demonstrated a similar efficacy of globe salvage while sparing children additional EUAs. However, the increased rates of observed melphalan-related toxicities for concurrent therapy are concerning. Further clinical experience is necessary to define the best initiation time and dosing schedule for IVM.

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Section: Resultsmentioning

confidence: 99%

“…Eyes were classified according to the International Intraocular Retinoblastoma Classification (IIRC) System outlined by Linn Murphree [17] and the seeding classification outlined by Munier [14] and Francis et al [7, 18]. …”

Section: Methodsmentioning

confidence: 99%

Integrated Treatment during the Intravitreal Melphalan Era: Concurrent Intravitreal Melphalan and Systemic Chemoreduction

et al. 2018

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“…Regressing tumors were categorized as fish flesh (type 2) if calcifications within the tumor were minimal and nonconfluent. Vitreous seeds were subcategorized as dust (D), spheres (S), and clouds (C) [4]. Their activity was categorized as new (N), larger (L), persistent (P), diminished (D), inactive (I), and uncertain (U).…”

Section: Methodsmentioning

confidence: 99%

The University of California, San Francisco Documentation System for Retinoblastoma: Preparing to Improve Staging Methods for This Disease

et al. 2018

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Background/Aims: Current retinoblastoma staging systems do not adequately describe the disease, especially in eyes with multiple tumors. The aims of this study were to develop methods for documenting individual tumors and to score disease burden over time. Methods: A coding system was devised to describe each tumor according to affected eye, meridian, anteroposterior location, activity, growth pattern, type of seed, and treatment. A scoring system for quantifying disease burden was developed, taking account of tumor number, size, spread, and secondary effects on the eye. Results: Our coding system allowed contemporaneous tumor documentation, producing datasets that enabled generation of fundus diagrams, Kaplan-Meier curves, and tables summarizing disease progression in individual tumors and eyes. Our data showed disparities between ocular and tumor documentation, e.g., indicating earlier tumor development in the left eye but younger age at presentation if disease was worse in the right eye. Actuarial rates of local treatment failure were lower when individual tumors were analyzed than when data were reported in terms of whole eyes. Conclusion: Our methods for documenting individual retinoblastomas have facilitated the review of patients’ progress in our routine practice and may provide data that could be used to refine retinoblastoma classifications in the future.

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“…25 The vitreous seed classification can be predictive in regard to time to regression and number of intravitreal melphalan injections required: median time to regression was 0.6, 1.7, and 7.7 months for dust, spheres, and clouds, respectively, and median number of injections required to reach regression was 3, 5, and 8 injections, respectively. 26 In terms of tumour spread, Smith and Smith performed a systematic review in which they included 14 studies and more than 1,300 intravitreal injections, and concluded it is a rare occurrence.…”

Section: Novel Treatments For Intraocular Retinoblastomamentioning

confidence: 99%

Ocular oncology: advances in retinoblastoma, uveal melanoma and conjunctival melanoma

Vasalaki

Fabian

Reddy

et al. 2017

British Medical Bulletin

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The Classification of Vitreous Seeds in Retinoblastoma and Response to Intravitreal Melphalan

Cited by 118 publications

References 11 publications

Integrated Treatment during the Intravitreal Melphalan Era: Concurrent Intravitreal Melphalan and Systemic Chemoreduction

Integrated Treatment during the Intravitreal Melphalan Era: Concurrent Intravitreal Melphalan and Systemic Chemoreduction

The University of California, San Francisco Documentation System for Retinoblastoma: Preparing to Improve Staging Methods for This Disease

Ocular oncology: advances in retinoblastoma, uveal melanoma and conjunctival melanoma

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