The Management of Unilateral Retinoblastoma Without Primary Enucleation

Abramson, David H.; Marks, Rosemarie Fusco; Ellsworth, Robert M.; Tretter, Patricia; Kitchin, F. David

doi:10.1001/archopht.1982.01030040227002

Cited by 53 publications

(19 citation statements)

References 8 publications

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“…It has been shown that smaller tumors diagnosed at an earlier stage of disease are more amenable to alternative treatments, which aim to avoid enucleation and preserve vision. 7 All professionals who are involved in the diagnosis and treatment of retinoblastoma must recognize that the PCP plays a vital role in the detection of retinoblastoma. With increased awareness, improved patient education, and immediate referral for ocular complaints suggestive of leukocoria, more children may have access to eye-sparing treatment modalities and avoid other, less optimal outcomes.…”

Section: Discussionmentioning

confidence: 41%

“…Shields et al 3 found an increase in eyesparing treatment modalities from 1974 to 1988; they postulated that increased awareness and earlier diagnosis of unilateral disease may result in smaller tumors that can be treated conservatively. Abramson et al 7 found no risk to life by attempting conservative management initially in all groups, although the majority of patients with Reese-Ellsworth groups IV and V eventually underwent enucleation. More important, 34 of the 39 eyes with tumors in Reese-Ellsworth groups I to III were spared with the use of radiation, plaque brachytherapy, cryotherapy, and photocoagulation as alternatives to enucleation.…”

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confidence: 47%

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Delayed Diagnosis of Retinoblastoma: Analysis of Degree, Cause, and Potential Consequences

Butros¹,

Abramson²,

Dunkel³

2002

PEDIATRICS

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ABSTRACT. Objective. To assess the degree, cause, and consequence of delays from presenting signs to diagnosis of retinoblastoma.Methods. A retrospective chart review was conducted of 64 consecutive patients who presented to the Memorial Sloan-Kettering Cancer Center with newly diagnosed retinoblastoma. Seven patients with a positive family history were excluded.Results. The median times from presenting signs to diagnosis for patients with unilateral and bilateral disease were 1.5 and 2.25 months (range: 0 -46), respectively; for those who presented with leukocoria and strabismus, median times were 1.5 (range: 0 -46) and 2.5 months (range: 0 -24). Parents noted the first signs in 75% of the cases. Seventy-seven percent delayed seeking treatment, and primary care physicians (PCPs) delayed referral in 30%. Only 3 patients were referred from PCPs solely for physical examination findings. No adverse consequence of delayed diagnosis could be established clearly, but a trend toward eye loss being associated with longer delays in patients with bilateral retinoblastoma was noted.Conclusion. Leukocoria and strabismus secondary to retinoblastoma are usually first recognized by relatives rather than PCPs. At routine visits, PCPs should inform parents about the importance of reporting eye abnormalities, and children whose parents complain of leukocoria (white, shiny, jello-like eye) should be referred promptly to an ophthalmologist regardless of whether an absent red reflex is appreciated. Pediatrics 2002;109(3). URL: http://www.pediatrics.org/cgi/content/full/109/3/e45; retinal neoplasms, newborn infant screening, strabismus, eye enucleation.ABBREVIATION. PCP, primary care physician.

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Section: Discussionmentioning

confidence: 41%

mentioning

confidence: 47%

Delayed Diagnosis of Retinoblastoma: Analysis of Degree, Cause, and Potential Consequences

Butros¹,

Abramson²,

Dunkel³

2002

PEDIATRICS

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“…Stallard later fashioned a curved disc applicator loaded with 60 Co; similar applicators (commonly called plaques) are currently used with a lower energy isotope ( 106 Ru 125 I or 103 Pd) (1-3). Brachytherapy was originally used as primary treatment of small discrete tumors (4, 5), but later its use was expanded to adjuvant and salvage therapy (6). Radioactive plaques were placed on eyes that progressed despite mainstay treatment with external beam radiation, and when this modality was replaced by systemic chemotherapy (because of concerns over radiation-induced second cancers), plaques were also used to treat these eyes.…”

Section: Introductionmentioning

confidence: 99%

Salvage/Adjuvant Brachytherapy After Ophthalmic Artery Chemosurgery for Intraocular Retinoblastoma

Francis

Barker

Wolden

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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Summary The efficacy and toxicity of brachytherapy following ophthalmic artery chemo-surgery for retinoblastoma was investigated in 15 eyes of 15 patients. This combination was effective, even in eyes with vitreous seeding, and the toxicity appeared to be no worse than reported with other radiation/chemotherapy treatments for retinoblastoma. Brachytherapy represents a potentially valuable salvage treatment for patients with recurrent retinoblastoma following ophthalmic artery chemosurgery treatment. Purpose To evaluate the efficacy and toxicity of brachytherapy after ophthalmic artery chemo-surgery (OAC) for retinoblastoma. Methods and Materials This was a single-arm, retrospective study of 15 eyes in 15 patients treated with OAC followed by brachytherapy at (blinded institution) between May 1, 2006, and December 31, 2012, with a median 19 months' follow-up from plaque insertion. Outcome measurements included patient and ocular survival, visual function, and retinal toxicity measured by electroretinogram (ERG). Results Brachytherapy was used as adjuvant treatment in 2 eyes and as salvage therapy in 13 eyes of which 12 had localized vitreous seeding. No patients developed metastasis or died of retinoblastoma. The Kaplan-Meier estimate of ocular survival was 79.4% (95% confidence interval 48.7%-92.8%) at 18 months. Three eyes were enucleated, and an additional 6 eyes developed out-of-target volume recurrences, which were controlled with additional treatments. Patients with an ocular complication had a mean interval between last OAC and plaque of 2.5 months (SD 2.3 months), which was statistically less (P= .045) than patients without ocular complication who had a mean interval between last OAC and plaque of 6.5 months (SD 4.4 months). ERG responses from pre- versus postplaque were unchanged or improved in more than half the eyes. Conclusions Brachytherapy following OAC is effective, even in the presence of vitreous seeding; the majority of eyes maintained stable or improved retinal function following treatment, as assessed by ERG.

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“…Retinoblastoma is the most common primary intraocular malignancy in children worldwide, and generally fatal when left untreated (Abramson et al. 1982; Balmer et al.…”

Section: Introductionmentioning

confidence: 99%

Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments

Venturi

Bracco

Cerase

et al. 2012

Acta Ophthalmologica

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ABSTRACT.Purpose: To report our experience in superselective ophthalmic artery infusion of melphalan (SOAIM) for intraocular retinoblastoma. Methods: From June 2008 to October 2010, 38 patients (18 women, 20 men; age range at first treatment, 7 months to 22 years) with 41 eyes with retinoblastoma were scheduled for SOAIM, for 17 newly diagnosed retinoblastomas Tumour, Node and Metastasis (TNM) 7th Edition 1a (n = 1), 1b (n = 1), 2a (n = 7), 2b (n = 4) and 3a (n = 4) and 24 retinoblastomas with partial remission ⁄ relapse TNM 7th Edition 1b (n = 13), 2a (n = 1) and 2b (n = 10). Eight patients (ten eyes) have been treated by SOAIM alone. Follow-up was 6-27 months in 28 patients (30 eyes). Results: Ophthalmic artery cannulation failed in two patients. Thirty-six patients underwent 140 treatments by internal (n = 112) or external (n = 28) carotid arteries. No major procedural complications occurred. Two patients have been lost to follow-up. Remaining 34 patients (37 eyes) had no metastatic disease. Four patients suffered permanent ocular complications: chorioretinal dystrophy (n = 2), ptosis (n = 1) and strabismus ⁄ exotropia (n = 1). Eight (22%) eyes in eight (24%) patients underwent enucleation: 7 ⁄ 16 (43%) newly diagnosed retinoblastomas and 1 ⁄ 22 (4.5%) retinoblastomas undergoing partial remission ⁄ relapse. For all treated eyes, Kaplan-Meier eye enucleation-free rates (K-M) were 85.4% (95% CI, 73.3-97.5%), 74.4% (95% CI, 57-91.8%) and still stable at 6, 12 months and 2 years, respectively. For eyes with partial remission ⁄ relapse, and eyes at presentation, K-M at 2 years were 95.5% (95% CI, 86.9-100%) and 45.6% (95% CI, 16.6-74.6%), respectively. Conclusion: Superselective ophthalmic artery infusion of melphalan was safe and powerful, especially following other therapies. Superselective ophthalmic artery infusion of melphalan should be added to focal therapies spectrum. In selected cases, melphalan should be combined with other chemotherapeutic agents.

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The Management of Unilateral Retinoblastoma Without Primary Enucleation

Cited by 53 publications

References 8 publications

Delayed Diagnosis of Retinoblastoma: Analysis of Degree, Cause, and Potential Consequences

Delayed Diagnosis of Retinoblastoma: Analysis of Degree, Cause, and Potential Consequences

Salvage/Adjuvant Brachytherapy After Ophthalmic Artery Chemosurgery for Intraocular Retinoblastoma

Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments

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