AJCC Celebrates 60th Anniversary

This year, 2019, is the 60th anniversary of the founding of the American Joint Committee on Cancer, the AJCC. This committee was founded in 1959 by leaders of the American College of Surgeons in order to support patients by creating a staging system for cancer. The founders had the foresight as well as the influence to develop a cancer classification system based on the tumor, nodal status, and metastatic findings (TNM). What is interesting is that these features were first used by a French surgeon in the 1940s to classify breast cancer! They later became the standard international language for the staging system locked in place today by the AJCC for the needs of US physicians and hospitals. 

As the decades went by, the AJCC collaborated with the Union for International Cancer Control (UICC) to create a standardized cancer language for the world. Through the hard work of numerous physicians dedicated to improving cancer mortality, a worldwide TNM system was achieved in 1987. Since 1997, AJCC has published periodic improvements to the TNM system. 

In 2005, our very own Dr. Finger was selected to join the American Joint Committee on Cancer: Section on Ophthalmic Oncology! Then, 4 years later he was elected Chair, for Ophthalmic Oncology. Dr. Finger has participated in the AJCC for over 14 years. His work with the AJCC includes developing the AJCC Ophthalmic Oncology Task Force of over 50 eye cancer specialists from 13 countries on 6 continents. Dr. Finger put together specialty committees to develop a useful classifications to standardize how doctors describe their patients tumors and patterns of metastatic disease. For example, in 2014 the American Brachytherapy Society’s Ophthalmic Oncology Task Force adopted the AJCC staging rules for intraocular melanoma! 

Dr. Fingers’ hard work and dedication is further epitomized by his creation of The Eye Cancer Foundation, a community that aims to provide support to patients with ocular cancers, promote the education of the diagnosis and treatment of eye cancers, and train eye cancer specialists around the world. Numerous physicians from underserved and unserved countries have been trained under the sponsorship of the ECF and gone on to use their newfound knowledge to benefit patients in their home countries. 

The ECF will never stop saving lives and saving sight.

Click here to make a donation to the foundation and save the life of a child suffering from retinoblastoma!


Dr. Ann Musika Completes ECF Fellowship

From Uganda to Israel, and Back Home Again

Hailing from Kampala, Uganda, Dr. Ann Musika has completed her 6-month ophthalmic oncology fellowship training sponsored by the Eye Cancer Foundation.

From Left: Dr. Ann Musika, Dr. Alezam, Dr. Didi Fabian, and Dr. Vicktoria Vishnevska-Dai

For the past six months, Dr. Musika has trained at Sheba Medical Centre at the Goldschleger Eye Institute under supervision of the director of the ocular oncology unit, Dr. Vicktoria Dai. Her training included all aspects of eye cancer care––from diagnosis, to treatment, to intravitreal injections for radiation retinopathy. Additionally, she took part in various research studies at Goldschleger’s ophthalmology department.

The Eye Cancer Foundation places an emphasis world-class training as well as practical and applicable training. So while Dr. Musika learned all aspects of eye cancer treatment practiced at Goldschleger’s, she specifically focused on treatments and techniques that would be just as readily available to her in Kampala.

Dr. Ann Musika (second from the left) alongside Senior ocular oncologists (Presenters) with after the ocular oncology training at the University of Sienna Italy on December 6th-7th, 2018

“It is with great pleasure that I express my sincere gratitude

to you for the great support that you offered me…all this wouldn’t have been possible without your generous support. The knowledge and skills acquired from this training I hope to apply to improve the quality of care for our ocular oncology patients in my nation. I am forever grateful.”

Prior to Dr. Musika, there were no fellowship-trained eye cancer specialists in Uganda. Consequently, patients with eye cancer suffered not only from their disease, but also from a lack of specialized care. However, now upon the completion of her training, Dr. Musika intends to return to Uganda and provide her nation with much-needed specialty care.

 

To Learn More about the Eye Cancer Foundation, its mission, and fellowship opportunities, visit the website at www.eyecancercure.com.


Day 3: Live From the ISOO 2019!

Day 3 at the ISOO: Melanoma, Other Intraocular Cancers, and Basic Retinoblastoma Science

Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.

For details on the ISOO Biennial Conference, read more here.


Dr. Puneet Jain presenting his iris varix poster

Dr. Puneet Jain returned to give us some insight on iris varix by presenting his paper Iris varix: 10-year experience with 28 eyes, published alongside Dr. Paul Finger during his Eye Cancer Foundation fellowship. The study began with the intention to more clearly define iris varix, consistent characteristics, imaging findings, and note any consistent change that might occur with observation. The results showed that iris varix is “primarily located in the inferotemporal quadrant, not associated with dysmorphic pupillary findings, progression, secondary glaucoma, or malignancy.” Essentially, “iris varices were benign vasculopathies with no associated ocular or vision-related morbidity.”


Dr. Ekaterina Semenova’s poster presentation

Why are some cases naturally suppressed by the immune system? Dr. Ekaterina Semenova raised the question, noting five cases in which choroidal melanoma in the patient had spontaneously regressed in her paper Spontaneously Regressed and Apparently Dormant Choroidal Melanomas, also published alongside Dr. Finger. She opened up discussion to the audience, though consensus was that this would be an interesting topic for future research in order to determine the cause. Now that such cases have been documented, we have this data to look back on and, hopefully, make additions to.


Dr. Abhilasha Maheshwari (left) and Dr. Paul Finger (right) after another successful poster presentation!

Finger’s Slotted Plaques was recognized in Dr. Abhilasha Maheshwari presentation, A 12-Year Study of Slotted Eye Plaque Radiation for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve. Over a decade’s worth of data was analyzed and slotted plaques were found to be very effective and resulted in good patient outcomed for patients whose tumor lies close to the optic nerve. These plaques offer more proper positioning of the plaque, allowing radiation to the entire melanoma plus a 2-3 mm margin. Dr. Maheshwari concluded that even after 12 years, “slotted plaque radiation therapy resulted in high rates of local tumor control and vision and eye retention.”


That’s all for today’s ECF highlights! Day 4 will be fully dedicated to retinoblastoma. Stay tuned!

 

To help sponsor fellowships and fellow research, donate to The Eye Cancer Foundation at www.eyecancercure.com/donate.


Day 2: Live From the ISOO 2019!

Day 2 at the ISOO: Melanoma Day

Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.

For details on the ISOO Biennial Conference, read more here.


How Can You Tell a Choroidal Melanoma is Regressing?

Dr. Abhilasha Maheshwari, ECF fellow

Dr. Abhilasha Maheshwari was the first Eye Cancer Foundation fellow to lecture today with her presentation on the paper Regression Patterns of Choroidal Melanoma after Plaque Brachytherapy, published alongside Dr. Paul T. Finger. In the two-minute rapid-fire session, Dr. Maheshwari filled us in on her data points from the study, concluding that there are various markers that show us when a choroidal melanoma is controlled after treatment with plaque brachytherapy. She provided us various markers, such as:

  • Dr. Finger and Dr. Maheshwari

    Increased tumor pigmentation.

  • Ultrasonography results:
    • maintenance of dome/mushroom shape
    • decreased tumor thickness
    • increased internal reflectivity
  • Fundus autofluorescence imaging showed a pattern of increased followed by decreased organge pigment lipofuscin
  • OCT showed decreased exudative subretinal fluid, and resolved drusenoid retinal pigment epithelial detachments (DRPED)
  • Flurocein angiography showed resolution of intrinsic tumor vascularity

Each of these characteristics serve as indicators of tumor regression. Dr. Maheshwari gave us one final take-away message: better initial local control means extremely less systemic spread, which overall means better patient outcomes.

Dr. Finger and Dr. Maheshwari in the “hot seats” up on stage – Every new session rotates a panel of doctors who have given lectures in order to ask and answer questions and foster discussion.

Interesting New Finding: One talk updated us on recent clinical trials for a drug that showed promise in laboratory studies for reversal of the effect of BAP1-related tumor progression. Perhaps we will hear more on this at the next ISOO!

Unique Case Report: Two, Simultaneous Primary Melanomas

Dr. Maheshwari returned for her second talk of the day, presenting results from Bilateral Simultaneous Primary Choroidal Melanomas: Treated with Palladium-103 Plaque Radiation, published along with Dr. Paul Finger. She elaborated on an interesting case who presented with separate, unrelated choroidal melanomas, one in each eye. After sequential treatment to maximize outcomes, the patient remains at 20/25 vision and shows great outcomes since their latest follow-up.


Unique Case Report: 7 Years After Treatment of a Primary Melanoma, A Second Primary is Found

Dr. Finger gave his first talk of the event to present a unique case of a patient who had been successfully treated for a stage T1 ocular melanoma. Seven years after treatment, however, she developed choroidal metastasis (this one, T3). Following intensive immunotherapy, the patient showed tumor controlled and marked decrease in liver metastasis. Upon follow-up, the patient still sees 20/25 and is maintained with anti-VEGF therapy.

With this talk, Dr. Finger wants to emphasize “the importance of consistent, long-term, post-treatment periodic ophthalmic and systemic surveillance for patients with choroidal melanoma.”

Dr. Finger Presents a Unique Case!

Identifying Genes Associated with Cancer Predisposition

Dr. Colleen Cebulla presented interesting findings in her presentation, Whole exome sequencing to identify candidate genes associated with hereditary predisposition to uveal melanomaShe covered various, possibly cancer-related genes other than the well-known, BAP1 mutation. At the beginning stages of research, the project has already analyzed 29 cases and identified a significantly large incidence of the genes SMARCE1,, PALB2, and MLH1. Particularly of interest are  PALB2, which has already been linked to breast, ovarian, and pancreatic cancer risk, and MLH1, which has been linked to Lynch syndrome and has been deemed responsible for multitudes of different tumors.

Dr. Cebulla is happy to welcome additions to the study and to be contacted if any centers are willing!


“SORTT” for Short: Study of Ophthalmic Radiation Therapy Toxicity 

Unfortunately unable to attend, Dr. Wolfgang Sauerwein requested Dr. Finger to present on Study of Ophthalmic Radiation Therapy Toxicity (SORTT): a prospective international survey. A major talk of the day, SORTT proposes “a prospective, multicenter, international data registry that collects structured information on toxicities after radiotherapy for eye cancer. This will offer the medical evidence needed for ophthalmic radiation side effect staging and modality selection.” This data may also help to create an AI to help physicians select the optimal radiation modality for each individual case.


Another jam-packed session of presentations, lectures, research findings, and plans for greater multicenter cooperation. As Day 2 comes to a close, Day 3 promises more on melanoma, other intraocular cancers, and the beginning of retinoblastoma discussions.


Day 1: Live From the ISOO 2019!

Day 1 at the ISOO: International Collaboration & Eye Cancer Care Worldwide

Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.

For details on the ISOO Biennial Conference, read more here.

International Collaboration

The day began with a few talks instigating discussion on how to approach international, collaborative efforts, and how to improve on how we currently approach international cooperation. How do we get over international boundaries and laws restricting data-sharing, and varying laws surrounding research across countries? Much is yet to be done, though discussion is expected to continue as specialists from all over the world have convened at this conference.

Read on how Dr. Finger encourages international cooperation here.

What Do We Register and Why?

Featured ECF Fellow: Dr. Puneet Jain

Dr. Puneet Jain, on Registering Conjunctival Melanoma
Dr. Paul Finger (left) and ECF fellow Dr. Puneet Jain (right) immediately after his debut lecture.

Registries were a huge topic of discussion today. What is possible to be registered, what details should we include within the registry, how do avoid duplicate cases within separate registries, and how do we apply this to international cooperation? Among other points of discussion, however, it was unanimous that functional registries would assist greatly both with research and patient outcomes. The New York Eye Cancer Center’s recently graduated fellow, Dr. Puneet Jain, spoke particularly on the registering of conjunctival melanoma. His research with Dr. Finger evidenced the accuracy of the AJCC’s TMN classification for predicting metastasis.

 

Developing Worldwide Retinoblastoma Care

Dr. Brenda Gallie credits the Eye Cancer Foundation for research support.
Dr. Brenda Gallie credits the Eye Cancer Foundation for research support.

 

 

 

 

 

 

 

 

 

Dr. Brenda Gallie discussed the development of retinoblastoma care worldwide. She noted the growing importance of genetic testing, stating a case in which laser treatment was sufficient enough to control the disease. She briefly mentioned project DepictRB as a way to display anonymized patient data, and offered the audience a demo of the program.

Conclusion

The day concluded with unanimous agreement that worldwide collaboration within the field of eye cancer needs to continue and needs to improve. With enhanced cooperation and worldwide registries, the

amount of shared data will assist greatly in advancement of research, diagnosis, and patient outcomes.

Tomorrow we cover ocular melanoma in great detail. Stay tuned, out fellows and Dr. Finger will be informing us with their expertise!

ISOO 2019 Day 1 Complete!

Rebuilding the Eye Using Amniotic Membrane Grafts

Byline: Published in The American Journal of Ophthalmology, 2019;198:45-53

 

Since 1940, a single, thin layer of amniotic membrane graft (AMG) has often been used for repairing the cornea and conjunctiva. However, Dr. Finger says:

“our research shows that super-thick AMG (ST-AMG), up to ten times thicker than the prior AMG, is more effective for reconstruction of the eye’s surface.”

Research supported by The Eye Cancer Foundation has proved greater efficacy of this new  technique in recreating the outer surface of the eye and inner surface of the eyelids. As published in the American Journal of Ophthalmology on November 2018, tumors of the conjunctiva and eyelids were surgically removed, then amniotic membranes from donor human placentas were sewn into the defects to recreate a normal ocular and inner eyelid surface. 

Thus, amnion can provide a foundational platform for new cells to grow and flourish. In this case series, super thick amniotic membrane grafts (AMGs) were found to facilitate the healing of wounds.

How exactly does graft thickness affect the success of treatment? Well, the greater thickness means it is more easily sewn into the affected area, and

 also helps the grafts to remain several weeks after placement. Thicker grafts are less likely to tear, rupture, or dissolve during the postoperative period. Most importantly, following treatment with ST-AMG, every single patient retained their sight and found their wounds successfully healed.

Super-thick amniotic membrane grafts have proven benefits to their thinner counterpart, and perhaps its versatility hints at potential for greater medical applications in the near future.

 



To keep up-to-date on the latest in Eye Cancer News, bookmark our website or follow us on facebook!

Click here to read the full research paper

Funding/Support for this study was provided by The Eye Cancer Foundation, Inc.

Click here to donate to further advancements in eye cancer research.


Rare Myxomas Discovered to Have Unique Ultrasound Results

What is a myxoma?

With a minuscule incidence of less than 0.005%, a myxoma is a staggeringly rare condition. Defined as noncancerous tumors of our connective tissue, myxomas present similarly to other, slightly more common conditions such as conjunctival lymphoma, lymphangioma, ocular surface squamous neoplasia (OSSN), or amelanotic melanoma. Consequently, they are usually misdiagnosed, or, at the very least, are difficult to diagnose.

 

Unique Ultrasound Findings!

Very limited literature exists describing cases and interventions of myxoma. In an effort to offset this shortage of research, The Eye Cancer Foundation sponsored a publication describing a myxoma case with unique ultrasonographic findings.

Other tumors of the conjunctiva often appear as a single, solid mass. Myxomas in particular present as smooth, yellow-pink masses on the eyeball, ranging in size from 4 mm to 20 mm. In this particular case under study, the patient’s myxoma showed scattered cells rather than a uniform image. So, while they are similar in many ways to other tumors, myxomas can have unique features that separate them from the others.

 

The Verdict…

Dr. Finger, Chairman of the ECF and Chief Researcher in this case study, concludes that:

“Though conjunctival myxomas can masquerade as various other conditions, high-frequency ultrasound proves myxomas have a distinct vascular pattern and no evidence of intraocular tumor invasion.”

 

 

Donate for Eye Cancer Research | Read the Full Case Report |  About Paul T. Finger, MD


Two Extensive ECF-Sponsored Studies Presented at the AAOOP Annual Meeting

The New York Eye Cancer Center and the Eye Cancer Foundation were quite actively represented at the 2017 American Association of Ophthalmic Oncologists and Pathologists (AAOOP) Annual Meeting. The meeting was held on Friday, November 10, 2017 at the Hampton Inn & Suites Convention Center, located in the vibrant city of New Orleans, Louisiana, and was attended by Dr. Paul Finger as well as notable ECF-ICO Fellowship alumni, Dr. Sonal Chaugule, Dr. Ekatrina Semenova, and Dr. Abhilasha Maheshwari.

At the conference, Dr. Chaugule gave an oral presentation titled Adjuvant intravitreal triamcinolone acetate (ITA) for radiation maculopathy (RM) recalcitrant to high-dose intravitreal bevacizumab. This research was supported by the Eye Cancer Foundation and conducted at the New York Eye Cancer Center, where Dr. Chaugule worked alongside Dr. Richard Kaplan (ophthalmologist) and Dr. Paul T. Finger. She is pictured speaking on this paper at AAOOP below:

Now, what are ITA, RM, and Bevacizumab? Often, patients undergoing eye plaque radiation in order to treat their cancerous tumor can be subject  to vision-impairing radiation side-effects, or radiation maculopathy (RM), as a result of treatment. Intravitreal anti-VEGF therapy (which is otherwise commonly used to treat macular degeneration) such as Bevacizumab (Avastin), Lucentis, and Eyelea, are used to prolong the effects of radiation maculopathy. Itravitreal triamcinolone acetate (ITA) is a steroid used in conjunction with this anti-VEGF therapy to treat swelling that occurs in the affected eye, called macular edema.

The paper aims to evaluate the effects of using ITA for the treatment of RM in patients with choroidal melanoma after plaque radiotherapy. Eight choroidal melanoma patients undergoing this treatment were studied, having ITA treatment at 4-16 week intervals in addition to continued injections of Avastin. Results found that after starting ITA, vision was stable or improved for patients, leading to the conclusion that ITA can be used as a supplement to decrease macular edema (swelling) and preserve vision in choroidal melanoma patients with RM.

The evaluation of ITA steroids as valuable treatment for RM is not to be underestimated. It provides a new treatment option for patients experiencing loss of vision due to radiation therapy, patients whose loss of vision can no longer be controlled with maximum, standard anti-VEGF therapy. To read more on the findings of this paper and its effect on eye cancer patients, click here. And to read this paper in full, published in the British Journal of Ophthalmology, click here.

Dr. Abhilasha Maheshwari had separately presented ECF-supported research — a 12-year study evaluating patients with slotted, low energy photon eye plaque radiation therapy. The purpose? To measure the efficacy of this treatment for eye cancer patients, especially those who have tumors located near, touching, or surrounding the optic disc (a critical area that allows for  vision) were treated. Forty six patients of these eye cancer patients were treated with eye plaque radiation therapy, using seeds of the chemical isotope Palladium-103 to radiate the affected eye. Over the next 12 years, these patients were monitored for any changes to tumor thickness, visual acuity, and whether or not the cancer had reoccured or metastasized. Results found that the local control rate (i.e, total tumor destruction) was 95.6%, and lead to the conclusion that Slotted Eye Plaque Radiation Therapy is indeed an efficient method of treatment for eye cancer patients.  To read the paper, published in the American Journal of Ophthalmology, click here.

But the AAO updates do not end here! Stay tuned for upcoming information on even more presentations at AAO 2017 by ECF alumni.


The Global Effort

 

The 2020 Campaign continues to make tremendous strides in the advancement of eye cancer care through the exciting completion of Dr. Milly Shakoor’s 6-month fellowship in retinoblastoma training. This news arrives unitedly with the announcement of another ECF Fellow’s completed training, Dr. Veronica Molleda, from Bolivia. With every fellowship thus offered and completed, The Eye Cancer Foundation and its supporters come closer to fully realizing the goal of training 20 specialists in 20 countries to treat childhood eye cancer.

Eye Cancer Foundation fellowships offer doctors to be trained in the specialized treatment of retinoblastoma, training that they cannot otherwise receive in their home country. These ECF fellowships, partnered with the International Council of Ophthalmology (ICO), are available to candidates from unserved or underserved countries. After doctors complete their six months of training, they agree to return to their home country to start or participate in eye cancer treatment for the unserved.

But what is retinoblastoma? Retinoblastoma is the most common eye cancer in children and affects approximately 8,200 children each year. In developed countries like the United Sates,  the survival rate reaches beyond an astounding 96%, with early diagnosis and treatment being key to saving patients’ lives and sight. However, the incidence rate is higher in developing countries, where most of the children succumb to metastatic retinoblastoma. In areas where children and families have no means of traveling to treatment centers far away from them, these afflicted children often endure their untreated disease untreated, which eventually leads to death. Because no child or family should have to suffer these losses, especially due to inability to simply reach a treatment center, the ECF has launched the 2020 Campaign.

Dr. Milly Shakoor comes from Dhaka, the capital of the highly densely-populated country of Bangladesh, where availability of retinoblastoma care is certainly low. She trained at The Centre for Sight in Hyderabad, India with the renown Director of Medical Services, Dr. Santosh G. Honavar (pictured above), who specializes both in oculoplasty and ocular oncology. Since her return to Dhaka, she has been met with several retinoblastoma cases and continues her treatment of them.

As always, The Eye Cancer Foundation these fellowships could not have been completed without the support of readers and donors — and so, the ECF thanks you for helping to provide hope for eye cancer patients around the world. To our audiences, we hope that you will continue to support these projects through your continued readership, word of mouth, and well wishes!


New Details Regarding the NYECC Support Group!

As you may have read in our blog the week prior, The New York Eye Cancer Center is pleased to announce that we, with the support of The Eye Cancer Foundation, are hosting periodic group therapy sessions for our patients. Life after diagnosis and treatment of an ocular melanoma can cause stress and anxiety. Although it’s normal to feel this way, many people do find that having a solid support system is crucial in finding their bearings and coming to terms with “a new normal”, both of which are important in overall quality of life.

Friends and family can be excellent support systems, but there can also be a benefit to sharing your feelings with other patients who have had very similar experiences. The New York Eye Cancer Center Support Group is seeking to provide you with this emotional outlet. Our support group is facilitated by wonderful licensed clinical social worker, Karen Campbell.

You can find Karen’s short biography below:

“I am a Licensed Clinical Social Worker (LCSW) and have been practicing in the field for 24 years. In addition to my private psychotherapy practice, most recently, I was in the Director of Vision Rehabilitation Services at the Lighthouse Guild. I started up the Social Work Department at Lighthouse International in 2010 and, as part of that, developed and faciliated the Department’s Support Group program. I also have a background in medical social work, including oncology, having worked at NYU/Langone. I have found support groups to be a valuable way for people to manage their medical challenges and address issues such as family adjustment, depression, anxiety and loss. Although I work primarily with individuals and couples in my private practice, I really enjoy working with groups!”

Karen brings to the practice her years of experience in counseling patients with both cancer and vision loss, making her a perfect fit for the NYECC family.

You can meet her and other patients at our next group therapy session at the NYECC on Friday, October 13, 2017 at 1:30 PM, Eastern Standard Time.

We hope to see you there!

And to stay updated on all upcoming sessions, please keep our website, eyecancer.com in your bookmarks!


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