Intra-arterial chemotherapy for retinoblastoma in 341 consecutive eyes (1,292 infusions): comparative analysis of outcomes based on patient age, race, and sex

Shields, Carol L.; Dockery, Philip W.; Yaghy, Antonio; Duffner, Emily R.; Levin, Hannah; Taylor, Olivia; Sajjadi, Zaynab; Lally, Sara E.; Shields, Jerry A.; Rosenwasser, Robert H.; Tjoumakaris, Stavropoula; Jabbour, Pascal

doi:10.1016/j.jaapos.2020.12.006

Cited by 25 publications

(13 citation statements)

References 28 publications

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“…Women were less likely to undergo certain ophthalmic surgical procedures. 55,56 In contrast, 11 studies found no association between sex and/or gender and ophthalmic conditions, 30,34,[57][58][59][60] follow-up adherence, 23,[27][28][29] or access to eye care. 37 Further findings can be found in the eTable in the Supplement.…”

Section: Sex And/or Gendermentioning

confidence: 99%

Inequities and Research Gaps in Ophthalmology

et al. 2023

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ImportanceDeficient ophthalmologic care is costly to patients, making the identification of groups not receiving adequate care of vital importance. The current landscape of equity in ophthalmic care has yet to be thoroughly investigated and is important to ensure inclusivity and patient-centered care.ObjectiveTo perform a scoping review of the literature pertaining to health care inequities in the field of ophthalmology.Evidence ReviewA comprehensive database search using MEDLINE (via PubMed) and Ovid Embase was done in July 2022. English-language articles published from 2016 to 2021 were included and encompassed all article types except commentaries or correspondence. The search modeled the National Institutes of Health list of designated US health inequity populations, which includes income, education level, occupational status, rural and underresourced area, sex and gender, lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity, and race and ethnicity. A total of 8170 abstracts and titles were screened by 2 independent investigators, and 189 studies were assessed in full text for eligibility. For inclusion, articles needed to be an ophthalmic study discussing health inequities. In a masked, duplicate fashion, 2 independent investigators screened 75 full-text studies for data extraction using a pilot-tested form. Data extraction included general publication characteristics and health inequity data based on the National Institutes of Health’s defined inequity groups.FindingsA total of 75 publications were included. Notable inequities were found among Black and Hispanic patients associated with negative ophthalmic outcomes and mixed associations regarding sex or gender. Overall, lower-income patients were more likely to have vision impairment, use eye care services less, and have lower adherence to eye examinations. No articles within our sample examined LGBTQ inequities among ophthalmology patients since the 2016 National Institutes of Health classification of sexual and gender minority populations. Substantial research gaps were observed within the ophthalmic literature pertaining to the LGBTQ community, race and ethnicity, and rural and underresourced areas.Conclusions and RelevanceThis scoping review found substantial findings associated with the LGBTQ community, race and ethnicity, and the role of telemedicine in rural and underresourced areas. Because of the importance of ophthalmic care in overall patient health, it is vital to understand the various inequities present and strive to improve the current gaps in the literature. Future studies should (1) examine barriers to clinical study and medical trainee recruitment as well as patient values and preference studies and (2) investigate the implementation of telemedicine in underresourced areas.

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Section: Sex And/or Gendermentioning

confidence: 99%

Inequities and Research Gaps in Ophthalmology

et al. 2023

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“…Furthermore, we did not include results of IAC used in intraocular tumors from Group E, which has already been described in the literature as an effective option in some cases. 11 , 18 Shields et al reported a global 5-year globe salvage of 76% for primary therapy with IAC, however with values of 100% for Groups B and C, 86% for group D, and only 55% for group E. 11 They concluded that intra-arterial chemotherapy is now most often used for unilateral retinoblastoma, for eyes in Groups B, C, and D, and occasionally E. Furthermore, we emphasize that there is great variability in the different classifications of intraocular retinoblastoma and there are different Group E patients, including from tumors that involve more than 50% of the vitreous cavity to patients with anterior chamber invasion and neovascular glaucoma. So, although in our sample we did not include Group E patients, we think that in some less advanced Group E patients IAC would be a reasonable possibility.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Intra-Arterial Chemotherapy for the Treatment of Intraocular Retinoblastoma: Relevance of a Multidisciplinary Setting

Castela¹,

Providência²,

Monteiro³

et al. 2023

OPTH

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Purpose We aim to report about effectiveness and safety in the context of our centers’ setting in the management of retinoblastoma with intra-arterial chemotherapy (IAC) in a 5-year retrospective analysis of the Portuguese population. Patients and Methods Retrospective analysis of consecutive cases of retinoblastoma selected to initiate IAC between 2015 and 2020, at the Portuguese National Reference Center. All included patients underwent complete ophthalmological evaluation under anesthesia with fundus photography. Diagnosis and classification of retinoblastoma was made according to the International Classification of Intraocular Retinoblastoma (ICRB). The patients were further divided into two groups: Group I for primary IAC and Group II for secondary IAC. Tumor recurrence or relapses, systemic metastasis and deaths were documented. Main efficacy outcome included ocular salvage and recurrence-free survival rates estimated using the Kaplan–Meier method. Results Twenty-eight eyes (19 eyes included in Group I and 9 eyes included in Group II) were eligible and a total of 130 IAC procedures were performed, with a median number of sessions of 4 (range 1–8) for each treated eye, during a median follow-up of 21 months (range 4–64). Of the included eyes, 22 (78.6%) were preserved. An overall survival of 100% was achieved. Considering the preserved eyes, the overall median decimal visual acuity achieved at the last visit was 0.15 (range 0.02–0.8). Three patients had permanent adverse events related to IAC (cataract, vitreous hemorrhage and choroidal ischemia). Considering the survival analysis of recurrence, the mean survival without recurrence was 84.2% for Group I and 66.7% for Group II, and the mean survival without enucleation was 78.6% (no events in Group II). Conclusion IAC has been shown to be an effective and safe treatment for children with intraocular retinoblastoma. This study demonstrates that IAC is effective even in moderate sample sizes, when a multidisciplinary approach is available.

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“…Also, other factors such as the location of SRS away from the primary tumor and the inability of chemotherapeutic drugs to achieve tumoricidal concentration within the subretinal space can be attributed to the poor therapeutic response to systemic IVC. More recently, the advent of IAC appears to have significantly improved the prognosis for eye preservation (70-80%) of Group D eyes [4,[22][23][24]. Abramson et al [4] have reported 2-year success rates of IAC at 83% in RB eyes that were treatment-naive and 50% in eyes that had been previously treated.…”

Section: Discussionmentioning

confidence: 99%

Primary Subretinal Seeding in Retinoblastoma: Clinical Presentation and Treatment Outcomes

et al. 2023

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Purpose: To describe the clinical features and treatment outcomes of primary subretinal seeds (SRS) in patients with intraocular retinoblastoma (RB). Methods: Descriptive analysis of primary SRS in 47 patients (50 eyes) with RB. Results: Mean age was 19 months (range, 2–72 months) and 55% (n=26) of the subjects were male. At presentation, the SRS involved two or more quadrants in 88% of eyes. Most seeds appeared yellowish-grey (66%) and round to oval in shape (48%). Two-thirds of SRS were seen posterior to the equator and within 5 mm from the main tumor. Associated features included subretinal fluid in 50 eyes (100%), total retinal detachment in 28 eyes (56%) and vitreous seeds in 20 eyes (40%). Treatment included intravenous chemotherapy (IVC) (n=47; 94%), enucleation (n=2; 4%), and intra-arterial chemotherapy (n=1; 2%). SRS treatment included adjunct use of focal transpupillary thermotherapy and/or cryotherapy (n=20, 40%). Retinal tumor control was achieved in 36 eyes (76%) with 32 eyes (78%) showing a type 3 regression pattern, while SRS completely regressed in 24 (48%) eyes, partially in 15 (30%) and worsened in 2 (4%) eyes. Over a mean follow-up of 30 months (range, 3–68 months), SRS recurrence was noted in 12 eyes (29%), globe salvage was achieved in 39 eyes (78%), and one (4%) patient died of presumed metastasis. Conclusion: Primary SRS poses a therapeutic challenge during RB treatment. SRS responds moderately to systemic IVC, with one-third cases showing SRS recurrence and one-fifth ultimately requiring enucleation.

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Intra-arterial chemotherapy for retinoblastoma in 341 consecutive eyes (1,292 infusions): comparative analysis of outcomes based on patient age, race, and sex

Cited by 25 publications

References 28 publications

Inequities and Research Gaps in Ophthalmology

Inequities and Research Gaps in Ophthalmology

Effectiveness of Intra-Arterial Chemotherapy for the Treatment of Intraocular Retinoblastoma: Relevance of a Multidisciplinary Setting

Primary Subretinal Seeding in Retinoblastoma: Clinical Presentation and Treatment Outcomes

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