Postenucleation Adjuvant Therapy in High-Risk Retinoblastoma

Honavar, Santosh G; Singh, Arun D.; Shields, Carol L.; Meadows, Anna T.; Demirci, Hakan; Cater, Jacqueline; Shields, Jerry A.

doi:10.1001/archopht.120.7.923

Cited by 242 publications

(191 citation statements)

References 33 publications

Supporting

Mentioning

186

Contrasting

Unclassified

Order By: Relevance

“…Those at greatest risk for metastasis show features of retinoblastoma invasion beyond the lamina cribrosa in the optic nerve, in the choroid (>2 mm dimension), sclera, orbit, or anterior chamber. 13 Eyes with invasion of the optic nerve or choroid generally demonstrate large retinoblastoma over 15 mm greatest dimension along with elevated intraocular pressure and total retinal detachment. 14,15 Patients with evidence of invasive retinoblastoma should be treated with chemotherapy for 4 to 6 months to prevent metastases; however, criteria for regarding the need for adjuvant chemotherapy remain unclear.…”

Section: At Risk For Metastasismentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Management of Retinoblastoma

2004

View full text Add to dashboard Cite

show abstract

Section: At Risk For Metastasismentioning

confidence: 99%

“…In an analysis from our department, metastases were reduced from 24% in those without preventive chemotherapy to 4% in those with chemotherapy. 13 …”

Section: At Risk For Metastasismentioning

confidence: 99%

Diagnosis and Management of Retinoblastoma

2004

View full text Add to dashboard Cite

show abstract

“…The significance of isolated anterior segment involvement remains debatable, but we have previously witnessed metastasis in such cases, so this was included as a factor. 10 Some authors 5,13 have suggested that anterior segment involvement and isolated choroidal invasion are not risk factors for metastasis. The other major source of variation is related to the definition of massive choroidal invasion.…”

Section: Discussionmentioning

confidence: 99%

“…Uusitalo and associates 31 studied 129 patients using variable regimens and concluded that chemoprophylaxis was beneficial in patients with tumor extending beyond the lamina cribrosa. Honavar and colleagues 10 conducted a retrospective, nonrandomized comparative study of 80 patients with high-risk RB, in which 58% of patients received adjuvant therapy and 42% did not receive adjuvant therapy for various reasons. A significant difference was found in the rate of metastasis between the group that had received adjuvant therapy (4%) and the group that had not (24%).…”

Section: Discussionmentioning

confidence: 99%

Postenucleation Adjuvant Chemotherapy With Vincristine, Etoposide, and Carboplatin for the Treatment of High-Risk Retinoblastoma

Kaliki

Shields²,

Shah³

et al. 2011

Arch Ophthalmol

116

View full text Add to dashboard Cite

Background: Analysis of 52 eyes with high-risk retinoblastoma managed with postenucleation adjuvant chemotherapy using vincristine sulfate, etoposide phosphate, and carboplatin showed no evidence of systemic metastasis in any case during a mean (range) follow-up of 66 (12-202) months.Purpose: To determine the efficacy of postenucleation adjuvant chemotherapy with vincristine, etoposide, and carboplatin in the prevention of metastasis for patients with high-risk retinoblastoma.Methods: Retrospective, nonrandomized, interventional case series of 52 eyes in 51 patients with high-risk retinoblastoma consisting of tumor invasion into the anterior segment, posterior uvea 3 mm or greater, postlaminar optic nerve, or any combination of posterior uvea and optic nerve involvement.Results: Of 51 consecutive patients with high-risk retinoblastoma, there were 30 males (59%) and 21 females (41%), with a median age of 28 months at diagnosis. All 52 eyes were classified as group E. The main histopathologic risk factors included anterior segment invasion ( 7[13%]), isolated massive posterior uveal invasion of 3 mm or greater (6 [12%]), isolated postlaminar optic nerve invasion (15 [29%]), or any posterior uveal invasion with any optic nerve involvement (24 [46%]). There was additional invasion into the sclera (3 [6%]) and extrascleral structures, including the orbit (1 [2%]). A single histopathologic high-risk factor was present in 32 eyes (62%), whereas 20 eyes (38%) manifested 2 or more highrisk characteristics. Based on previously published series, untreated high-risk retinoblastoma carries at least a 24% risk for metastatic disease. In the present series, using vincristine, etoposide, and carboplatin in all cases, there was no metastasis during a mean follow-up of 66 months (median [range], 55 months).Conclusions: Retinoblastoma with invasion into the postlaminar optic nerve and/or posterior uvea is at high risk for metastasis and death. In this study, postenucleation chemotherapy using vincristine, etoposide, and carboplatin was effective in preventing metastasis in every case (100%).

show abstract

“…38,[43][44][45] High-risk retinoblastoma leads to metastasis in 24% of patients if not treated with systemic chemotherapy compared with 4% of those that receive IVC. 44 The International Classification of Retinoblastoma can predict those eyes with high-risk retinoblastoma. It is presumed that groups A, B, and C rarely show high-risk features, but they rarely come to enucleation for histopathological inspection.…”

Section: Prevention Of Systemic Metastasis In High-risk Retinoblastomamentioning

confidence: 99%

Erratum: Retinoblastoma frontiers with intravenous, intra-arterial, periocular, and intravitreal chemotherapy

Shields¹,

Fulco²,

Arias³

et al. 2012

Eye

View full text Add to dashboard Cite

In this report, we explore retinoblastoma diagnostic accuracy and review chemotherapy alternatives for retinoblastoma using intravenous, intra-arterial, periocular, and intravitreal routes. A review of 2775 patients referred for management of retinoblastoma, disclosed 78% with confirmed retinoblastoma and 22% with simulating lesions, termed pseudoretinoblastomas. Children r2 years old showed leading pseudoretinoblastomas of persistent fetal vasculature, Coats disease, and vitreous haemorrhage, whereas those 45 years showed simulators of Coats, toxocariasis, and familial exudative vitreoretinopathy. The diagnosis of retinoblastoma should be established before planning therapeutic strategy. Chemotherapy strategy depends on tumour laterality and stage of disease. If bilateral retinoblastoma, intravenous chemotherapy (IVC) is important as first-line therapy for control of intraocular disease, prevention of metastasis, and reduction in prevalence of pinealoblastoma and long-term second malignant neoplasms. Bilateral groups D and E retinoblastoma receive additional subtenon's carboplatin boost for improved local control. If unilateral disease is present, then intra-arterial chemotherapy (IAC) is often considered. IAC can be salvage therapy following chemoreduction failure. Unilateral retinoblastoma of groups D and E are managed with enucleation or globeconserving IVC and/or IAC. Intravitreal chemotherapy is cautiously reserved for recurrent vitreous seeds following other therapies. In conclusion, the strategy for retinoblastoma management with chemotherapy depends on tumour laterality and stage of disease. Bilateral retinoblastoma is most often managed with IVC and unilateral retinoblastoma with IAC, but if advanced stage, combination IVC plus IAC or enucleation.

show abstract

Postenucleation Adjuvant Therapy in High-Risk Retinoblastoma

Cited by 242 publications

References 33 publications

Diagnosis and Management of Retinoblastoma

Diagnosis and Management of Retinoblastoma

Postenucleation Adjuvant Chemotherapy With Vincristine, Etoposide, and Carboplatin for the Treatment of High-Risk Retinoblastoma

Erratum: Retinoblastoma frontiers with intravenous, intra-arterial, periocular, and intravitreal chemotherapy

Contact Info

Product

Resources

About