The Eye Cancer Foundation Hosts Successful Retinoblastoma Workshop in China

Last fall, The Eye Cancer Foundation hosted a retinoblastoma workshop in Guangzhou, China.

The primary goal was to deliver systematic training in retinoblastoma management based on the general principles of the origin and development of the disease. But the workshop went beyond practical training. It served to build strong relationships among all of the participants.

Eleven faculty members interacted enthusiastically with 19 students. The students included practicing ophthalmologists, oncologists, pathologists, and radiologists. These medical professionals already cared for retinoblastoma patients in their daily work, but they generally lacked the opportunity to discuss the science and rationale behind the treatment with others.

You can watch videos of the workshop sessions here.

The extensive effort the faculty put into their presentations was evident in the discussions, which included topics ranging from core treatment modalities, to fundamental molecular mechanisms in retinoblastoma, to social and life issues facing patients’ families. Eager students engaged in active dialogue, which even extended into breaks. The students left the workshop possessing greater depth of knowledge and new ideas for treating retinoblastoma in China.

The workshop also kicked off a long-term project. Students left with homework: all of the students filled out a table outlining their opinions of care options for a child presenting with IIRC1 Group D eye. This homework is first step in a study of informed consent for retinoblastoma families, and all participants of the workshop will be co-authors.

The Eye Cancer Foundation has a video library of the workshop talks that will be posted on the organization’s website to benefit students worldwide.

The long-term impact of the workshop is still being measured. All participating students filled out pre-workshop and post-workshop assessments to gage their knowledge of retinoblastoma. Once the videos are available in China, and students have an opportunity to review them, we will conduct additional questionnaires.

Comments from the students reveal just how valuable the workshop was.

“..these lectures in Guangzhou touched me deeply.”

“…such a wonderful workshop…very comprehensive training of retinoblastoma, covered overall content of RB from epidemiology, genetic, pathology to clinical treatment. The excellent talks and heated discussion refreshed my knowledge and will help me to improve my clinical treatment of RB.”

“So glad to have this opportunity…We learned much more updated knowledge about RB.”

“I benefited a lot from this training”

“Deeply indebted …for the comprehensive lessons in RB Workshop”

“After the training, I have a deep understanding about retinoblastoma.”

“The most important thing I learn is cooperate. We can’t fight the disease alone.”

“I learned much in this meeting and workshop. Lack of experience in diagnosis and treatment, I did not exchange with experts, but I have the chance to consult some domestic counterparts.”

ick here to watch the workshop videos.

1. Murphree AL. Intraocular retinoblastoma: the case for a new group classification. Ophthalmology clinics of North America. 2005;18:41-53.

 2. Mallipatna AC, Gallie BL, Chevez-Barrios P, Lumbroso-Le Rouic L, Chantada GL, Doz F, Brisse HJ, Munier FL, Albert DM, Catala-Mora J, Desjardins L, Suzuki S, Carroll WL, Coupland SE, Finger PT. Chapter 68: Retinoblastoma Ophthalmic Sites: Part XV  The AJCC Cancer Staging Manual, 8th edition. Editor in Chief, Mahul B. Amin, Ed. Board: Edge, SB, Byrd, DR, Compton, CC, Fritz, AG, Greene, FL, Trotti A.   New York, Springer 2017, pp. 819-831.


The Eye Cancer Foundation Retinoblastoma Workshop

GuangZhou, China November 28- 30, 2016

Purpose

  • Systematic retinoblastoma management training
  • Understand general principles of pathogenesis of retinoblastoma

Duration: 3.5 days

Trainees: 12-15 doctors

Trainers:

Dr. Junyang Zhao, Beijing Children’s Hospital, China;

Dr. Xiaoli Ma, Pediatric Oncology, Beijing Children’s Hospital, China

Dr. Bin Li, Beijing Tongren Hospital, China

Dr. Jing Zhang, Guangzhou Women and Children Medical Center, China

Dr. Brenda Gallie, Director Retinoblastoma Program, SickKids Hospital, Professor University of Toronto, Canada;

Dr. Tero Kivelä, Helsinki University Central Hospital,        University of Helsinki, Faculty of Medicine, Helsinki, Finland;

Professor David Mackey, Perth, Australia;

Professor Sandra E. Staffieri, Centre for Eye Research Australia

Dr. Francis Munier, Head, Ocular-oncology Unit, Jules Gonin Eye Hospital, Professor, Faculté de biologie et de medicine de l’UNIL, Lausanne, Switzerland;

Dr. Bhavna Chawla, Ocular Oncology Service, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India;

Dr. Vikas Khetan, Ocular Oncology Service, Senkara Nethralaya, Chennai, India;

Dr. Wantanee Dangboon, Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand;

Dr. Pamela Astudillo, Medical Specialist III, Jose B Lingad Memorial Regional Hospital, Consultant, Angeles University Foundation Medical Center, The Philippines;

Ms. Sandra E. Staffieri, PhD Candidate, Clinical and Research Orthoptist,Centre for Eye Research and Retinoblastoma Care Co-ordinator, Department of Ophthalmology, The Royal Children’s Hospital, Melbourne, Australia.

Schedule

Day 1: Monday, November 28, 2016:

8:20-9:50           Geographic and world perspective

Dr. Junyang Zhao, Dr. Brenda Gallie, Dr. Tero Kivelä

  • (10 min) Workshop strategy and Questionnaires #1/3
  • (30 min) History of global retinoblastoma treatments: enucleation, radiotherapy, chemotherapy, focal chemotherapy modalities, etc. (Brenda Gallie)
  • (30 min) World epidemiological trends of retinoblastoma, especially in Asia-Pacific. (Tero Kivelä)
  • (20 min) History of retinoblastoma in China (Junyang Zhao)

9:50-10:10         Tea Break

10:10-11:40       2016 collaborative care and innovations

Drs. Junyang Zhao, Brenda Gallie

  • (20 min) Chinese retinoblastoma collaboration. (Junyang Zhao)
  • (30 min) 1RBW map & meeting, classification/staging. (Brenda Gallie)
  • (40 min) eCancerCareretinoblastoma (eCCrb) for patient care and research. (Brenda Gallie)

11:40-13:20       Lunch

13:20-14:50   Systemic chemotherapy

Drs. Xiaoli Ma, Dr. Bhavna Chawla

  • (30 min) Systemic chemotherapy and management. (Xiaoli Ma)
    • Mechanism of drugs, dosage, side effects.
    • (20 min) Multi-modal therapy for extra-ocular retinoblastoma. (Xiaoli Ma)
      • High-dose chemotherapy and stem cell rescue
      • Adjuvant chemo for high risk pathology
      • (20 min) Systemic chemotherapy for intra-ocular retinoblastoma. (Bhavna Chawla)
      • (20 min) Neo-adjuvant chemo for extra-ocular retinoblastoma. (Bhavna Chawla)

14:50-15:10       Tea Break

15:10-16:40 Genetic testing and counseling

Drs. David Mackie, Sandra E. Staffieri, Wantanee Dangboon,

  • (30 min) Principles of genetic knowledge and counseling. (David Mackey)
  • (20 min) Genomic forefront for the future. (David Mackey)
  • (20 min) Low vs full penetrance RB1 mutations and mosicism (Brenda Gallie)
  • (20 min) Genetic testing for retinoblastoma – the changing paradigm for clinical care. (Sandra Staffieri)
  • (20 min) Life-long surveillance for retinoblastoma and second cancers. (Wantanee Dangboon)

16:40-17:00       Tea Break

17:00-17:40       Day review and free discussion

Day 2: Tuesday, November 29, 2016:

8:20-9:50           Pathology

Drs. Xialin Xi, Brenda Gallie

  • (30 min) Pathogenesis of retinoblastoma. (Brenda Gallie)
  • (30 min) pTNM and pathology report. (Brenda Gallie)
  • (15 min) Critical observations, communication, actions. (Xialin Xi)
  • (15 min) High-risk eye pathology features & indication for adjuvant chemotherapy. (Brenda Gallie)

9:50-10:10         Tea Break

10:10-11:40       Examination staging and screening

Drs. Vikas Khetan, Tero Kivelä

  • (30 min) Presentation and diagnosis. (Vikas Khetan)
  • (30 min) 2017 TNMH vs 2005 IIRC (Vikas Khetan)
  • (15 min) Neonatal retinoblastoma. (Tero Kivelä)
  • (15 min) Trilateral retinoblastoma. (Tero Kivelä)

11:40-13:20       Lunch

13:20-14:50       Focal therapies

Drs. Francis Munier, Jing Zhang, Jungyang Zhao, Pamela Astudillo

  • (15 min) Intravitreal and Intra-arterial chemotherapy for retinoblastoma. (Francis Munier)
  • (15 min) Laser/cryo, plaque. (Francis Munier)
  • (20 min) Technique, dos and don’ts of selective intra-artery chemo. (Jing Zhang, presented by Drummond Xia)
  • (20 min) Enucleation, Myoconjunctival technique, Prosthetic conformers and eyes. (Pamela Astudillo)
  • (20 min) Intraocular tumor resection. (Junyang Zhao)

14:50-15:10       Tea Break

15:10-16:40       Clinic and Basic Research Opportunities

Dr. Tero Kivelä

  • (30 min) World surveys and analysis of outcomes (Tero Kivelä)
  • (30 min) Standardization of care (Tero Kivelä)
  • (30 min) Basic statistical principles for clinical reports (Tero Kivelä)
  • (15 min) Role of eCCRB (Brenda Gallie)

16:40-17:00       Tea Break

17:00-17:40       Day review and free discussion

Day 3: Wednesday, November 30, 2016:

8:20-9:50         Collaboration

Drs. Junyang Zhao, Jing Zhang, Xiaolin Xia, Francis Munier, Tero Kivelä, Brenda Gallie, Vikas Khetan, Bhavna Chawla, David Mackie

  • National China
  • National India
  • EuRBG
  • 1RBW

9:50-10:10         Tea Break

10:10-10:30 Genetic consultant and explanation of Impact/Geenseq reports. (Marc Zhao)

10:30-11:30     Knowledge Summary and Review

All participants

  • Questionaire #2/3

12:00                 Check-out

 

Six months after the Workshop, we request all participants to fill out Questionnaire #3/3, on line.


Don’t Forget Sunglasses: Think of them as Sunblock for Your Eyes

Memorial Day weekend is right around the corner. The holiday traditionally kicks off the summer season. That means boating out on the lake, lazy days at the beach, yard work, and long road trips.

As you get ready for all of your summer activities, you’ll probably run by the store and pick up some sunscreen and slather it on before you head out. While you’re at it, don’t forget to get some sunglasses. After all, you should “think of sunglasses as sunblock for your eyes.” tm

Wearing sunglasses isn’t just about making a fashion statement, or even comfort. They may actually serve as an important line of defense against eye cancer.

Sun can damage tissues in your eyes just like it does the skin. Of course, you can’t rub sunscreen on your eyes. That’s why you need to have (and wear) ultraviolet blocking sunglasses.

And ultraviolet blocking is key.

To protect your eyes, you need quality sunglasses that provide 100% UV protection. You want to wear sunglasses that block all UVA, UVB, and UVC rays. Many optical shops have a machine called a photometer that measures UV transmission through glasses. You want to make sure your sunglasses filter out all UV radiation or light under 400 nm in wavelength.

Ocular melanoma is the most common primary eye tumor in adults. Doctors diagnose around 2,000 new cases every year. These tumors are closely related to skin cancer. Since exposure to the sun is a known risk factor for skin, eyelids and conjunctival cancers, it follows that UV rays from the sun may also increase the risk of developing this form of eye cancer. There is circumstantial evidence linking exposure to sunlight and ocular melanoma. This form of eye cancer is more common in patients with blue eyes, arc-welders and those who work in outdoor occupations.

So don’t take a chance. Make sure you have sunblock for your eyes – a quality pair of sunglasses.


What to Expect: Eye Plaque Radiation Therapy (Video)

Radiation plaque therapy is the most common treatment for melanoma inside the eye.

This eye and vision sparing treatment utilizes a metallic plaque, sometime called a “radiation implant” or “radioactive source.” The doctor surgically implants the plaque on the wall of the eye, covering the base of the intraocular tumor. The implant remains in place for five to seven days, delivering a highly concentrated radiation dose to the tumor. The plaque’s location on the eye means surrounding healthy tissues get relatively less radiation exposure.

Once the plaque is in place, The New York Eye Cancer Center patient spends the rest of the treatment period at home or at a hotel. After the prescribed amount of time, the patient returns to the hospital to have the plaque safely removed.

The following video explains the procedure, what to expect, and the safety measures that must be followed during the course of treatment.


New Study Highlights Promising Treatment for Patients with Iris Melanoma

A new study by Dr. Sonal Chaugule and Dr. Paul Finger has identified a promising treatment for patients diagnosed with iris melanoma. This is a first study describing regression characteristics in published literature.

Uveal melanoma is the most common primary intraocular malignancy in adults. Iris melanoma is the rarest cancer in this family, making up only 2% to 3% of cases. However, recent studies have found that biopsy-proven iris melanomas can spread outside the eye in up to 11% of cases. These findingsIris melanoma support the treatment of iris melanomas.

In the past, most patients with melanoma of the iris were treated by removal of the tumor along with the surrounding iris. Though the tumor is removed, the surgical procedure usually leaves a giant pupil with a non-functional iris sphincter and symptoms of glare.

“After part of the iris is removed, it is like having one pupil constantly dilated, even in the sun,” Dr. Finger said.

In their new study Chaugule and Dr. Finger describe patterns of tumor regression and side effects after iris-sparing treatment for iris melanoma using palladium-103 (103Pd) plaque brachytherapy. At the New York Eye Cancer Center, plaque brachytherapy has been found to be a conservative treatment modality with low local recurrence rate. Treatment with plaque radiation to sterilize the melanoma eliminates the need to open the eye, remove the tumor and make the pupil abnormally large.

Dr. Chaugule sought to examine and document the patterns of change after plaque radiation therapy for iris melanoma. The study included 50 patients with iris melanoma who underwent 103Pd plaque brachytherapy with at least 6 months of follow-up. Pre-treatment and post-treatment tumor morphology, gonioscopy and high frequency ultrasound imaging was studied and analysed.

In this study, palladium (103Pd) plaque brachytherapy of iris melanomas showed dissappearance of blood vessels within the tumor,, darkening of tumor surface, and decreased tumor thickness. With 100% local and systemic control at a mean duration of 5.2 years, the study shows this to be a safe and effective pupil sparing treatment.

You can click here to download and read the full study.


Patient Stories

"Very well treated by Dr. Finger. He explained everything I needed to know about my issue with detail and attention, putting me at ease and giving me confidence to handle this problem for the rest of my life.”
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