Detection and Treatment of Retinoblastoma

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Pathophysiology".

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 20426

Special Issue Editors


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Guest Editor
UCL Institute of Ophthalmology, Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust; Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
Interests: adult and pediatric ocular oncology

E-Mail Website
Guest Editor
Retinoblastoma Service, Royal London Hospital, Barts Health NHS Trust; Paediatric Dept, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
Interests: Retinoblastoma

Special Issue Information

Dear Colleagues,

Rb, the most common primary intraocular malignancy of childhood is an uncommon paediatric cancer, with a constant incidence worldwide of 1:15,000–1:20,000 live births. However, its position in oncology is unique as it has served as a benchmark in terms of tumour diagnosis, classification and management. It was the first human cancer treated in the 1920s with an early attempt at brachytherapy and in the 1950s with a linear accelerator. It is initiated by a mutation in the RB1 gene, which was the first described tumour suppressor gene, in the 1970s and 1980s. It has become the first cancer for which a hereditary component was added to its AJCC TNM classification schema (i.e., TNMH).

Rb is also one of the most prominent successes among all paediatric oncology. From nearly 100% mortality a century ago, there is now over 98% survival in developed countries. It is an eye tumour that was treated just over half a century ago only by means of enucleation, but which today can be treated conservatively with retention of functional vision. Many factors have contributed to this: better understanding of the genetic basis of the disease, establishment of specialist centres, primary care infrastructure and public awareness campaigns, and in no small measure, to the dramatic evolution of Rb management and treatment options over the last century, the abandonment of external beam radiotherapy and the onset of chemotherapy and development of targeted chemotherapy into the ophthalmic artery or the vitreous cavity. Nonetheless, the burden of disease is greatest in developing countries, and challenges remain in improving outcomes for all children and their families dealing with this disease.

In this Special Issue of Cancers, we wish to curate an edition with cutting-edge knowledge and invite articles with new findings or pertinent reviews in retinoblastoma.

Prof. Mandeep S. Sagoo
Dr. Maddy Ashwin Reddy
Guest Editors

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Keywords

  • retinoblastoma
  • chemotherapy
  • intra-arterial chemotherapy
  • intravitreal chemotherapy
  • brachytherapy
  • genetics
  • surgery
  • enucleation

Published Papers (7 papers)

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11 pages, 1106 KiB  
Article
Retinoblastoma Survival Following Primary Enucleation by AJCC Staging
by Junyang Zhao, Zhaoxun Feng, Gareth Leung and Brenda L. Gallie
Cancers 2021, 13(24), 6240; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13246240 - 13 Dec 2021
Cited by 6 | Viewed by 2278
Abstract
Primary enucleation of the eye with retinoblastoma is a widely accessible, life-saving treatment for retinoblastoma. This study evaluated the survival of patients following primary enucleation based on AJCC 8th edition staging. Included were 700 consecutive patients (700 eyes) treated with primary enucleation at [...] Read more.
Primary enucleation of the eye with retinoblastoma is a widely accessible, life-saving treatment for retinoblastoma. This study evaluated the survival of patients following primary enucleation based on AJCC 8th edition staging. Included were 700 consecutive patients (700 eyes) treated with primary enucleation at 29 Chinese treatment centers between 2006 and 2015. Excluded were patients with less than one year follow-up, bilateral retinoblastoma, clinical evidence of extraocular disease at diagnosis, or prior focal or systemic therapy. The 5-year overall survival was 95.5%, and 5-year disease-specific survival (DSS) was 95.7%. Survival was better when enucleation was <26 days from diagnosis than delayed >26 days (96.1% vs. 86.9%; p = 0.017). Patients with eyes presenting with raised intraocular pressure with neovascularization and/or buphthalmos (cT3c) had worse 5-year DSS (87.1%) than those without (cT2b, 99.1%; cT3b, 98.7%; cT3d, 97.2%) (p < 0.05). The 5-year DSS based on pathological staging was pT1 (99.5%), pT2a (95.5%), pT3a (100%), pT3b (93.0%), pT3c/d (92.3%), and pT4 (40.9%). Patients with pT3 pathology who received six cycles of adjuvant chemotherapy had better 5-year DSS (97.7%) than those with no chemotherapy (88.1%; p = 0.06) and those who underwent 1–3 cycles (86.9%, p = 0.02) or 4–5 cycles (89.3%, p = 0.06). Patients with pT4 pathology who received six cycles of chemotherapy had better 5-year DSS than those with 0–5 cycles (63.6% vs. 16.7%; p = 0.02). Prompt primary enucleation yielded high long-term survival for children with retinoblastoma. The AJCC 8th edition staging is predictive of survival. Full article
(This article belongs to the Special Issue Detection and Treatment of Retinoblastoma)
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12 pages, 1017 KiB  
Article
Tylectomy Safety in Salvage of Eyes with Retinoblastoma
by Junyang Zhao, Qiyan Li, Zhao Xun Feng, Jianping Zhang, Songyi Wu, Liwen Jin and Brenda L. Gallie
Cancers 2021, 13(22), 5862; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13225862 - 22 Nov 2021
Cited by 7 | Viewed by 2449
Abstract
Intraocular surgery is tabooed in retinoblastoma management, due to the concern of lethal extraocular spread. We reviewed the outcomes of consecutive children with intraocular retinoblastoma diagnosed at 29 Chinese centers between 2012–2014. We compared the outcomes of three categories of treatment: eye salvage [...] Read more.
Intraocular surgery is tabooed in retinoblastoma management, due to the concern of lethal extraocular spread. We reviewed the outcomes of consecutive children with intraocular retinoblastoma diagnosed at 29 Chinese centers between 2012–2014. We compared the outcomes of three categories of treatment: eye salvage including tylectomy (Group I), eye salvage without tylectomy (Group II), and primary enucleation (Group III). A total of 960 patients (1243 eyes) were diagnosed: 256 in Group I, 370 in Group II, and 293 in Group III; 41 patients abandoned treatment upfront. The estimated 5-year overall survivals (OS) were, for Group I, 94%, for Group II 89%, and for Group III 95%. The estimated 5-year disease-specific survivals (DSS) were, for Group I, 96%, for Group II 90%, and for Group III 95%. Patients in Group I had a significantly higher 5-year DSS than patients in Group II (p = 0.003) and not significantly different than patients in Group III (p = 0.367). Overall survival was not compromised by the inclusion of tylectomy in eye salvage therapy compared to eye salvage without tylectomy or primary enucleation. Disease-specific survival was better when tylectomy was included in eye salvage treatments. Tylectomy as part of multimodal treatment may contribute to the care of retinoblastoma patients with chemotherapy-resistant tumor, eyes with concomitant ocular complications, or at the risk of treatment abandonment. Full article
(This article belongs to the Special Issue Detection and Treatment of Retinoblastoma)
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14 pages, 2106 KiB  
Article
Parental Origin of the RB1 Gene Mutations in Families with Low Penetrance Hereditary Retinoblastoma
by Ekaterina A. Alekseeva, Olga V. Babenko, Valentina M. Kozlova, Tatiana L. Ushakova, Tatiana P. Kazubskaya, Marina V. Nemtsova, Galina G. Chesnokova, Dmitry S. Mikhaylenko, Irina V. Bure, Alexey I. Kalinkin, Ekaterina B. Kuznetsova, Alexander S. Tanas, Sergey I. Kutsev, Dmitry V. Zaletaev and Vladimir V. Strelnikov
Cancers 2021, 13(20), 5068; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13205068 - 10 Oct 2021
Cited by 6 | Viewed by 3422
Abstract
Our aim was to identify RB1 alterations causing hereditary low penetrance retinoblastoma and to evaluate how the parental origin of an RB1 mutation affects its phenotypic expression. By NGS and MLPA, RB1 mutations were found in 191 from 332 unrelated retinoblastoma patients. Among [...] Read more.
Our aim was to identify RB1 alterations causing hereditary low penetrance retinoblastoma and to evaluate how the parental origin of an RB1 mutation affects its phenotypic expression. By NGS and MLPA, RB1 mutations were found in 191 from 332 unrelated retinoblastoma patients. Among patients with identified RB1 mutations but without clinical family history of retinoblastoma, 7% (12/175) were found to have hereditary disease with one of the parents being an asymptomatic carrier of an RB1 mutation. Additionally, in two families with retinoblastoma history, mutations were inherited by probands from unaffected parents. Overall, nine probands inherited RB1 mutations from clinically unaffected fathers and five, from mothers. Yet, we gained explanations of maternal “unaffectedness” in most cases, either as somatic mosaicism or as clinical presentation of retinomas in involution, rendering the proportion of paternal to maternal truly asymptomatic mutation carriers as 9:1 (p = 0.005). This observation supports an assumption that parental origin of an RB1 mutation influences the likelihood of developing retinoblastoma. Additionally, our study revealed a relatively high frequency of asymptomatic carriage of the RB1 mutations among the parents of retinoblastoma patients, highlighting the utmost necessity of molecular analysis among the probands’ relatives irrespective of their clinical status and family history of retinoblastoma. Full article
(This article belongs to the Special Issue Detection and Treatment of Retinoblastoma)
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11 pages, 286 KiB  
Article
The Effects of Breastfeeding on Retinoblastoma Development: Results from an International Multicenter Retinoblastoma Survey
by Jasmeen K. Randhawa, Mary E. Kim, Ashley Polski, Mark W. Reid, Kristen Mascarenhas, Brianne Brown, Ido Didi Fabian, Swathi Kaliki, Andrew W. Stacey, Elizabeth Burner, Caitlin S. Sayegh, Roy A. Poblete, Xunda Ji, Yihua Zou, Sadia Sultana, Riffat Rashid, Sadik Taju Sherief, Nathalie Cassoux, Juan Garcia, Rosdali Diaz Coronado, Arturo Manuel Zapata López, Tatiana Ushakova, Vladimir G. Polyakov, Soma Rani Roy, Alia Ahmad, M. Ashwin Reddy, Mandeep S. Sagoo, Lamis Al Harby, Nicholas John Astbury, Covadonga Bascaran, Sharon Blum, Richard Bowman, Matthew J. Burton, Nir Gomel, Naama Keren-Froim, Shiran Madgar, Marcia Zondervan and Jesse L. Berryadd Show full author list remove Hide full author list
Cancers 2021, 13(19), 4773; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13194773 - 24 Sep 2021
Cited by 2 | Viewed by 2651
Abstract
The protective effects of breastfeeding on various childhood malignancies have been established but an association has not yet been determined for retinoblastoma (RB). We aimed to further investigate the role of breastfeeding in the severity of nonhereditary RB development, assessing relationship to (1) [...] Read more.
The protective effects of breastfeeding on various childhood malignancies have been established but an association has not yet been determined for retinoblastoma (RB). We aimed to further investigate the role of breastfeeding in the severity of nonhereditary RB development, assessing relationship to (1) age at diagnosis, (2) ocular prognosis, measured by International Intraocular RB Classification (IIRC) or Intraocular Classification of RB (ICRB) group and success of eye salvage, and (3) extraocular involvement. Analyses were performed on a global dataset subgroup of 344 RB patients whose legal guardian(s) consented to answer a neonatal questionnaire. Patients with undetermined or mixed feeding history, family history of RB, or sporadic bilateral RB were excluded. There was no statistically significant difference between breastfed and formula-fed groups in (1) age at diagnosis (p = 0.20), (2) ocular prognosis measures of IIRC/ICRB group (p = 0.62) and success of eye salvage (p = 0.16), or (3) extraocular involvement shown by International Retinoblastoma Staging System (IRSS) at presentation (p = 0.74), lymph node involvement (p = 0.20), and distant metastases (p = 0.37). This study suggests that breastfeeding neither impacts the sporadic development nor is associated with a decrease in the severity of nonhereditary RB as measured by age at diagnosis, stage of disease, ocular prognosis, and extraocular spread. A further exploration into the impact of diet on children who develop RB is warranted. Full article
(This article belongs to the Special Issue Detection and Treatment of Retinoblastoma)
16 pages, 2110 KiB  
Article
Comprehensive Somatic Copy Number Analysis Using Aqueous Humor Liquid Biopsy for Retinoblastoma
by Mary E. Kim, Ashley Polski, Liya Xu, Rishvanth K. Prabakar, Chen-Ching Peng, Mark W. Reid, Rachana Shah, Peter Kuhn, David Cobrinik, James Hicks and Jesse L. Berry
Cancers 2021, 13(13), 3340; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13133340 - 3 Jul 2021
Cited by 13 | Viewed by 2691
Abstract
Aqueous humor (AH) liquid biopsy has been established as a surrogate tumor biopsy for retinoblastoma (RB). Previous AH studies have focused on highly recurrent RB somatic copy number alterations (SCNAs) including gain of 1q, 2p, 6p, and loss of 13q and 16q. In [...] Read more.
Aqueous humor (AH) liquid biopsy has been established as a surrogate tumor biopsy for retinoblastoma (RB). Previous AH studies have focused on highly recurrent RB somatic copy number alterations (SCNAs) including gain of 1q, 2p, 6p, and loss of 13q and 16q. In this retrospective study, we provide a comprehensive, whole-genome analysis of RB SCNAs and evaluate associated clinical features for 68 eyes of 64 RB patients from whom AH was obtained between December 2014 and October 2020. Shallow whole-genome sequencing of AH cell-free DNA was performed to assess for SCNAs. The prevalence of specific non-highly recurrent SCNAs, such as 20q gain and 8p loss, differed between primarily and secondarily enucleated eyes. Increases in chromosomal instability predict more advanced seeding morphology (p = 0.015); later age of diagnosis (p < 0.0001); greater odds of an endophytic tumor growth pattern (without retinal detachment; p = 0.047); tumor heights >10 mm (p = 0.09); and containing 6p gain, a biomarker of poor ocular prognosis (p = 0.004). The AH liquid biopsy platform is a high-yield method of whole-genome RB SCNA analysis, and SCNAs are associated with numerous clinical findings in RB eyes. Prospective analyses are encouraged to further elucidate the clinical relevance of specific SCNAs in RB. Full article
(This article belongs to the Special Issue Detection and Treatment of Retinoblastoma)
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19 pages, 1494 KiB  
Article
Whole-Genome Sequencing of Retinoblastoma Reveals the Diversity of Rearrangements Disrupting RB1 and Uncovers a Treatment-Related Mutational Signature
by Helen R. Davies, Kevin D. Broad, Zerrin Onadim, Elizabeth A. Price, Xueqing Zou, Ibrahim Sheriff, Esin Kotiloğlu Karaa, Irene Scheimberg, M. Ashwin Reddy, Mandeep S. Sagoo, Shin-ichi Ohnuma and Serena Nik-Zainal
Cancers 2021, 13(4), 754; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13040754 - 11 Feb 2021
Cited by 15 | Viewed by 3126
Abstract
The development of retinoblastoma is thought to require pathological genetic changes in both alleles of the RB1 gene. However, cases exist where RB1 mutations are undetectable, suggesting alternative pathways to malignancy. We used whole-genome sequencing (WGS) and transcriptomics to investigate the landscape of [...] Read more.
The development of retinoblastoma is thought to require pathological genetic changes in both alleles of the RB1 gene. However, cases exist where RB1 mutations are undetectable, suggesting alternative pathways to malignancy. We used whole-genome sequencing (WGS) and transcriptomics to investigate the landscape of sporadic retinoblastomas derived from twenty patients, sought RB1 and other driver mutations and investigated mutational signatures. At least one RB1 mutation was identified in all retinoblastomas, including new mutations in addition to those previously identified by clinical screening. Ten tumours carried structural rearrangements involving RB1 ranging from relatively simple to extremely complex rearrangement patterns, including a chromothripsis-like pattern in one tumour. Bilateral tumours obtained from one patient harboured conserved germline but divergent somatic RB1 mutations, indicating independent evolution. Mutational signature analysis showed predominance of signatures associated with cell division, an absence of ultraviolet-related DNA damage and a profound platinum-related mutational signature in a chemotherapy-exposed tumour. Most RB1 mutations are identifiable by clinical screening. However, the increased resolution and ability to detect otherwise elusive rearrangements by WGS have important repercussions on clinical management and advice on recurrence risks. Full article
(This article belongs to the Special Issue Detection and Treatment of Retinoblastoma)
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11 pages, 1025 KiB  
Brief Report
Lag Time between Onset of First Symptom and Treatment of Retinoblastoma: An International Collaborative Study of 692 Patients from 10 Countries
by Swathi Kaliki, Xunda Ji, Yihua Zou, Riffat Rashid, Sadia Sultana, Sadik Taju Sherief, Nathalie Cassoux, Rosdali Y. Diaz Coronado, Juan Luis Garcia Leon, Arturo Manuel Zapata López, Vladimir G. Polyakov, Tatiana L. Ushakova, Soma Rani Roy, Alia Ahmad, Lamis Al Harby, M. Ashwin Reddy, Mandeep S. Sagoo, Jesse L. Berry, Jonathan Kim, Ashley Polski, Nicholas J. Astbury, Covadonga Bascaran, Sharon Blum, Richard Bowman, Matthew J. Burton, Allen Foster, Nir Gomel, Naama Keren-Froim, Shiran Madgar, Andrew W. Stacey, David M. Steinberg, Ashik Mohamed, Marcia Zondervan and Ido Didi Fabianadd Show full author list remove Hide full author list
Cancers 2021, 13(8), 1956; https://doi.org/10.3390/cancers13081956 - 19 Apr 2021
Cited by 15 | Viewed by 2818
Abstract
Background: The relationship between lag time and outcomes in retinoblastoma (RB) is unclear. In this study, we aimed to study the effect of lag time between onset of symptoms and diagnosis of retinoblastoma (RB) in countries based on their national-income and analyse its [...] Read more.
Background: The relationship between lag time and outcomes in retinoblastoma (RB) is unclear. In this study, we aimed to study the effect of lag time between onset of symptoms and diagnosis of retinoblastoma (RB) in countries based on their national-income and analyse its effect on the outcomes. Methods: We performed a prospective study of 692 patients from 11 RB centres in 10 countries from 1 January 2019 to 31 December 2019. Results: The following factors were significantly different among different countries based on national-income level: age at diagnosis of RB (p = 0.001), distance from home to nearest primary healthcare centre (p = 0.03) and mean lag time between detection of first symptom to visit to RB treatment centre (p = 0.0007). After adjusting for country income, increased lag time between onset of symptoms and diagnosis of RB was associated with higher chances of an advanced tumour at presentation (p < 0.001), higher chances of high-risk histopathology features (p = 0.003), regional lymph node metastasis (p < 0.001), systemic metastasis (p < 0.001) and death (p < 0.001). Conclusions: There is a significant difference in the lag time between onset of signs and symptoms and referral to an RB treatment centre among countries based on national income resulting in significant differences in the presenting features and clinical outcomes. Full article
(This article belongs to the Special Issue Detection and Treatment of Retinoblastoma)
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