RESUMEN
PURPOSE: To determine the impact of subtle differences (most notably in their classification of group E eyes) in two published versions of the ICRB (Philadelphia and the Children's Hospital Los Angeles). METHODS: Analysis of a series of 96 eyes with intra-ocular retinoblastoma. RESULTS: The disparate criteria of the 2 published ICRB schemas affected group assignment of 5.2% of the eyes (25% of the group E eyes). CONCLUSION: Discrepancies need to be reconciled to ensure accurate and uniform application of the ICRB.
Asunto(s)
Clasificación Internacional de Enfermedades/normas , Neoplasias de la Retina/clasificación , Retinoblastoma/clasificación , Antineoplásicos/uso terapéutico , Carboplatino/uso terapéutico , Preescolar , Humanos , Lactante , Publicaciones/normas , Neoplasias de la Retina/tratamiento farmacológico , Neoplasias de la Retina/mortalidad , Retinoblastoma/tratamiento farmacológico , Retinoblastoma/mortalidad , Tasa de SupervivenciaRESUMEN
BACKGROUND: Retinoblastoma patients with RB1 germline mutations are at risk of developing second malignancies and external beam radiation therapy increases the risk. Carboplatin-containing chemotherapy regimens in conjunction with local therapies have been investigated for intraocular retinoblastoma, but the lack of data regarding the efficacy of single agent intravenous carboplatin prompted this phase II study. PROCEDURE: Twenty-five patients (43 eyes) were treated with intravenous carboplatin (18.7 mg/kg for patients < 12 kg, 560 mg/m(2) for patients >/= 12 kg). Patients received a median of two cycles of carboplatin (range one to five cycles) beginning at a median age of 5 months (range 14 days to 22 months). RESULTS: All patients were extraocular disease free during the follow-up period (median 76.3 months). Responses were noted in 33 of 36 evaluable eyes (92%). The 5-year overall ocular and ocular event-free survivals were 93.3% (95% CI, 84.4-100%) and 43.5% (95% CI, 25.8-61.3%) for eyes treated for Reese-Ellsworth (RE) group 1-3 disease and 25.0% (95% CI, 1.0-50.0%) and 8.3% (95% CI, 0-24.0%) for RE group 4-5 disease, respectively. No non-hematopoietic serious or permanent toxicities related to the chemotherapy were observed. CONCLUSION: When used as a neoadjuvant agent, carboplatin usually leads to objective responses of intraocular retinoblastoma. The 5-year ocular event-free survival appears inferior to other protocols using more extensive chemotherapy, but with greater radiation therapy usage, overall ocular survival rate for RE group 1-3 eyes was excellent.
Asunto(s)
Carboplatino/administración & dosificación , Retinoblastoma/tratamiento farmacológico , Antineoplásicos , Carboplatino/toxicidad , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Terapia Neoadyuvante , Inducción de Remisión , Retinoblastoma/mortalidad , Retinoblastoma/radioterapia , Análisis de SupervivenciaRESUMEN
PURPOSE: To determine the frequency and timing of new intraocular tumor formation in children with hereditary retinoblastoma initially treated with systemic carboplatin. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: This study included 34 children (57 eyes) with hereditary bilateral retinoblastoma initially treated with systemic carboplatin at the Robert M. Ellsworth Ophthalmic Oncology Center at NewYork-Presbyterian Hospital from 1994 through 2000. MAIN OUTCOME MEASURES: New tumor formation after initial treatment with systemic carboplatin. RESULTS: There were a total of 165 tumors in 57 eyes. There were 63 new tumors in 27 eyes (47%) after administration of systemic carboplatin, for a mean of 1.1 new tumors per eye. The mean patient age at time of new tumor presentation was 9 months, with 57% of new tumors developing within 4 months of carboplatin treatment. Kaplan-Meier analysis showed that children who were treated when younger than 6 months of age were more likely to have new tumors (60%) compared with those treated after 6 months of age (31%; P = 0.0182). CONCLUSIONS: New intraocular tumors continue to develop after systemic carboplatin; most new tumors appeared within 4 months of treatment.
Asunto(s)
Antineoplásicos/uso terapéutico , Carboplatino/uso terapéutico , Neoplasias Primarias Secundarias/etiología , Neoplasias de la Retina/etiología , Retinoblastoma/etiología , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Neoplasias de la Retina/tratamiento farmacológico , Retinoblastoma/tratamiento farmacológico , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
With recent advances in the management of cancer, the clinical course of patients with metastatic bone disease is more likely to be prolonged and accompanied by morbidity, including severe pain, hypercalcemia, pathologic fracture, and spinal cord and/or nerve root compression. The early identification of patients at higher risk for developing bone metastases enables practitioners to be proactive in their diagnosis and treatment. A multidisciplinary approach that integrates the diagnosis and treatment of the cancer, symptom management, and rehabilitation ensures optimal care. Bisphosphonates can reduce the number of skeletal-related complications, delay the onset of progressive disease in bone, and relieve metastatic bone pain caused by a variety of solid tumors with a resulting enhanced quality of life. The complexity of the clinical problem and the need to involve an array of health-care providers present a logistical and clinical challenge. A strong argument is made for a thematically integrated bone metastases program as part of the primary care of patients with cancer.