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Extraocular Spread (extraocular + spread)

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Medical Sciences	100%

Selected Abstracts

Uveal melanoma: management and outcome of patients with extraocular spread

ACTA OPHTHALMOLOGICA, Issue 2009
N CASSOUX
Purpose Extraocular spread is thought to be a negative prognostic factor on survival of the patient with uveal melanoma. Depending on the size of the tumor and the type of extraocular extension conservative treatments can be employed. Methods 2256 patients were treated between 2000 and 2007 at the Institut Curie, Paris, France for an uveal melanoma. 67 patients (3.0%) presented an extraocular extension. A retrospective study was performed to evaluate the patients outcome with regard to tumour recurrence and their survival. Results Results: Eye-conserving treatment was employed in 38 (52.8%) patients. An enucleation was performed in 29 (47.2%) patients. The median follow-up was 38 (range 7 - 79) months with an overall survival rate at 5-years of 40.4% in enucleated patients and 79.3% in the eye- conserving treatment group (protons n=19, iodine-125 plaque n = 19) (p = 0.01; Kaplan- Meier analysis). No tumor recurrence was observed in any group. Degree of extraocular spread as well as the clinical characteristics tumor location, retinal detachment, ciliary body involvement (p < 0.01; Chi-square test) and tumor thickness (p = 0.04; Chi-square test) influenced the choice of treatment. Age, tumor diameter, involving optic nerve, vitreous hemorrhage, achromic lesion was without any influence. Conclusion Conclusion: No tumor recurrence and no lower survival rate were observed in patients receiving an eye-conserving treatment. They may represent thus a therapeutic option in selected patients with extraocular spread. [source]

Impact of an education program on late diagnosis of retinoblastoma in Honduras

PEDIATRIC BLOOD & CANCER, Issue 6 2007
Christopher Leander MD
Abstract Background In developed countries, more than 90% of children with retinoblastoma present with limited-stage disease and are cured; however, in countries with limited resources, like Honduras, most patients present with advanced disease and cure rates are less than 50%. Early diagnosis is necessary to improve the survival of children with retinoblastoma in these countries. Procedure We describe the preliminary results of a retinoblastoma education program linked to a national vaccination campaign in Honduras. Posters and flyers were designed to be accessible to poorly educated readers, to convey the severity of retinoblastoma, and to provide contact information. Charts and an electronic database were reviewed to determine age at diagnosis, presenting signs and symptoms, date of diagnosis, and outcome. Results During the eight previous years (July 1995,June 2003), 73% of the 59 diagnosed cases of retinoblastoma were extraocular; in contrast, during the post-campaign period (June 2003,January 2005), only 35% of the 23 diagnosed cases showed extraocular spread (P,=,0.002). More than one-third of patients in both time periods either refused therapy or abandoned treatment. Conclusion This inexpensive approach is an effective first step toward improving survival of childhood retinoblastoma. Abandonment and refusal of therapy are continuing obstacles. Pediatr Blood Cancer 2007;49:817,819. © 2006 Wiley-Liss, Inc. [source]

Uveal melanoma: management and outcome of patients with extraocular spread

Revisiting the value of assessing the mitotic rate of choroidal melanoma

ACTA OPHTHALMOLOGICA, Issue 2009
SE COUPLAND
Purpose To re-evaluate mitotic rate (MR) as an indicator of malignancy grade in uveal melanoma (UM) and as a predictor for UM-related mortality. Methods UM patients treated 1993-2006 by local resection or enucleation were included. Data on largest basal diameter (LBD), ciliary body involvement, extraocular extension, cell type, closed loops, MR per 40/HPF, cytogenetics were collected. Mortality data were obtained from NHS Cancer Registry. Results 918 patients (520 M; 398 F) had median age of 64.6 yrs with a median follow-up of 3.46 yrs (range 0.02-13). The UM had mean diameter of 14.9 mm with ciliary body involvement in 43.0%, epithelioid cells in 63.3%, closed loops in 41.2%, extraocular spread in 11.3%. Cytogenetics in 337 patients showed disomy 3 and 8 in 27%, monosomy 3 in 10.7%, chromosome 8 gains in 24.0%, both these abnormalities in 38.3%. The median MR was 3(range 0-61, SD 6). High MR correlated with ciliary body involvement (p = 0.001), epithelioid cells(p = 0.009), closed loops(p<0.0001), extraocular spread(p=0.027) & monosomy 3(p<0.0001;Mann-Whitney). MR also correlated with LBD(p=0.0001; t-test). Metastatic death occurred in 243 patients (26.7%). Kaplan-Meier analysis showed MR >4/40 HPF to be associated with increased 10-year metastatic mortality from 32.5 (95% confidence intervals [CI] 25.7-39.3) to 65.5 (95% CI 55-7-75.4; log rank statistic 53.28, p<0.0001). Cox multivariate analysis showed MR to be an independent predictive factor for metastatic death (p<0.0001). MR was predictive of metastatic death also in patients without detectable monosomy 3 (Log rank statistic 10.38, p = 0.002). Conclusion MR correlates with other known risk factors for metastatic death and independently predicts mortality even when cytogenetics show disomy 3. [source]

Ocular conservation in patients with uveal melanoma by a multimodality approach to treatment

ACTA OPHTHALMOLOGICA, Issue 2007
C GARCIA-ALVAREZ
Purpose: To analyse eye survival in patients with uveal melanoma with a multimodality approach to treatment Methods: 273 patients with uveal melanoma diagnosed at Ocular Oncology Unit of the University Hospital of Valladolid from 1997 September to 2007 April. Pearson's Chi-square test was used to identify between variables and primary enucleation. Logistic regression was used to identify independent variables predicting primary enucleation. Cox's univariate proportional hazards model was used to identify associations between variables and time to secondary enucleation.Kaplan-Meier estimates were used to draw survival curves for time to secondary enucleation Results: 273 patients were included in the study. Primary enucleation was performed in 80 patients. Secondary enucleation in 12. Gender (p=0,032), basal tumour diameter >15mm (p<0,001), tumour weight >10mm (p<0,001), anterior tumour margin (p<0,001) and extraocular spread (p<0,001) were associated with primary enucleation. Predictive factors for primary enucleation were largest basal tumor diameter (odds ratio [OR], 3,8; 95% confidence interval [IC], 1,5-9,1) and tumour weight (OR, 2,7; IC, 1-7,5). Ocular conservation probability 5 years after conservative treatment was 88%. Largest basal tumor diameter, anterior tumour margin and extraocular spread had influence in ocular survival after conservative treatment. Only largest basal tumor diameter was a predictive factor of secondary enucleation Conclusions: In the present series 69,9% of patiens had a conservative treatment and 88% of them conserved treated eye 5 years [source]