{"title":"Therapy for Vitreous Seeding Caused by Retinoblastoma. A Review.","authors":"M Kodetová, K Švojgr, J Širc, J Vaněček, P Pochop","doi":"10.31348/2023/35","DOIUrl":null,"url":null,"abstract":"<p><p>Retinoblastoma is the most common primary malignant intraocular tumor in children. Seeding, specifically the dispersion of the tumor into the adjacent compartments, represents a major parameter determining the degree of retinoblastoma according to the International Classification of Retinoblastoma. In this article we focused on vitreous seeding, one of the main limiting factors in the successful \"eye preservation treatment\" of retinoblastoma. This article presents an overview of the history of vitreous seeding of retinoblastoma, established treatment procedures and new-research modalities. The introduction of systemic chemotherapy in the treatment of retinoblastoma at the end of the 1990s represented a significant breakthrough, which enabled the progressive abandonment of radiotherapy with its attendant side effects. However, the attained concentrations of chemotherapeutics in the vitreous space during systemic chemotherapy are not sufficient for the treatment of vitreous seeding, and the toxic effects of systemic chemotherapy are not negligible. A significant change came with the advent of chemotherapy in situ, with the targeted administration of chemotherapeutic drugs, namely intra-arterial and intravitreal injections, contributing to the definitive eradication of external radiotherapy and a reduction of systemic chemotherapy. Although vitreous seeding remains the most common reason for the failure of intra-arterial chemotherapy, this technique has significantly influenced the original treatment regimen of children with retinoblastoma. However, intravitreal chemotherapy has made the greatest contribution to increasing the probability of preservation of the eyeball and visual functions in patients with advanced findings. Novel local drug delivery modalities, gene therapy, oncolytic viruses and immunotherapy from several ongoing preclinical and clinical trials may represent promising approaches in the treatment of vitreous retinoblastoma seeding, though no clinical trials have yet been completed for routine use.</p>","PeriodicalId":39839,"journal":{"name":"Ceska a Slovenska Oftalmologie","volume":"3 Ahead of Print","pages":"1001-1014"},"PeriodicalIF":0.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ceska a Slovenska Oftalmologie","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.31348/2023/35","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Retinoblastoma is the most common primary malignant intraocular tumor in children. Seeding, specifically the dispersion of the tumor into the adjacent compartments, represents a major parameter determining the degree of retinoblastoma according to the International Classification of Retinoblastoma. In this article we focused on vitreous seeding, one of the main limiting factors in the successful "eye preservation treatment" of retinoblastoma. This article presents an overview of the history of vitreous seeding of retinoblastoma, established treatment procedures and new-research modalities. The introduction of systemic chemotherapy in the treatment of retinoblastoma at the end of the 1990s represented a significant breakthrough, which enabled the progressive abandonment of radiotherapy with its attendant side effects. However, the attained concentrations of chemotherapeutics in the vitreous space during systemic chemotherapy are not sufficient for the treatment of vitreous seeding, and the toxic effects of systemic chemotherapy are not negligible. A significant change came with the advent of chemotherapy in situ, with the targeted administration of chemotherapeutic drugs, namely intra-arterial and intravitreal injections, contributing to the definitive eradication of external radiotherapy and a reduction of systemic chemotherapy. Although vitreous seeding remains the most common reason for the failure of intra-arterial chemotherapy, this technique has significantly influenced the original treatment regimen of children with retinoblastoma. However, intravitreal chemotherapy has made the greatest contribution to increasing the probability of preservation of the eyeball and visual functions in patients with advanced findings. Novel local drug delivery modalities, gene therapy, oncolytic viruses and immunotherapy from several ongoing preclinical and clinical trials may represent promising approaches in the treatment of vitreous retinoblastoma seeding, though no clinical trials have yet been completed for routine use.
视网膜母细胞瘤是儿童最常见的原发性眼内恶性肿瘤。根据《视网膜母细胞瘤国际分类》(International Classification of retinoblastoma),播种,特别是肿瘤向相邻腔室的分散,是决定视网膜母细胞瘤程度的一个主要参数。在这篇文章中,我们聚焦于玻璃体种植,这是视网膜母细胞瘤“保眼治疗”成功的主要限制因素之一。本文概述了视网膜母细胞瘤玻璃体植入的历史,建立的治疗方法和新的研究模式。20世纪90年代末引入全身化疗治疗视网膜母细胞瘤是一项重大突破,它使放疗及其伴随的副作用得以逐步放弃。然而,在全身化疗过程中,玻璃体间隙中获得的化疗药物浓度不足以治疗玻璃体播散,全身化疗的毒性作用不可忽视。随着原位化疗的出现,化疗药物的靶向施用,即动脉注射和玻璃体内注射,发生了重大变化,有助于彻底根除外部放疗和减少全身化疗。尽管玻璃体植入仍然是动脉内化疗失败的最常见原因,但这项技术已经显著影响了儿童视网膜母细胞瘤的原始治疗方案。然而,玻璃体内化疗对于提高晚期患者眼球和视觉功能保存的可能性做出了最大的贡献。一些正在进行的临床前和临床试验中的新的局部药物递送方式、基因治疗、溶瘤病毒和免疫治疗可能是治疗玻璃体视网膜母细胞瘤种子的有希望的方法,尽管尚未完成常规使用的临床试验。
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