RESUMEN
The fast proliferation of tumor cells develops faster than the vasculature, resulting, in most malignant tumors, in generation of hypoxic regions. Hypoxia renders solid tumors resistant to radiation and chemotherapeutics while providing opportunities for tumor-selective therapies targeting tumor hypoxia. Here we exploit two properties of tumors: propagation of tumor cells and ongoing generation of hypoxic regions to construct a system that preferentially leads to the death of tumor cells and thus hinders tumor growth. We constructed murine leukemia virus replication-competent (RCR) viruses that infect only propagating cells. These viruses express small hairpin RNAs (shRNAs) targeting cyclic AMP-response-element binding protein (CREB), hypoxia-inducible factors 1 (HIF)-1 or HIF-2 individually or all three together (X3). These viruses efficiently infected in vitro human hepatocellular carcinoma (HepG2 and FLC4) cells and established persistence of the virus and knocked down the expression of the regulators of the hypoxia-responding genes. Knockdown of either HIF-1 or CREB or both in hypoxia reduced the expression of hypoxia-response elements- and CRE-mediated gene expression, diminished cell proliferation and increased caspase-3 activity. We did not detect any significant effect of the efficiently knocked down HIF-2 on any of the functions tested in vitro. Moreover, severe combined immunodeficiency mice implanted subcutaneously with HepG2 stably infected with recombinant RCRs showed reduction of tumor growth and vascular endothelial growth factor expression, and no hypoxia-guided neovascularization. Combined treatment (RCRs+doxorubicin) improved efficacy in the context of in vitro hypoxia and in vivo (with either vACE-CREB or vACE-X3). This synergistic effect may lead to an improved efficacy and safety profile of the treatment that may result in fewer side effects.
Asunto(s)
Factores de Transcripción con Motivo Hélice-Asa-Hélice Básico/genética , Carcinoma Hepatocelular/genética , Proteína de Unión a Elemento de Respuesta al AMP Cíclico/genética , Factor 1 Inducible por Hipoxia/genética , Neoplasias Hepáticas/genética , Animales , Factores de Transcripción con Motivo Hélice-Asa-Hélice Básico/metabolismo , Biomarcadores , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/patología , Línea Celular Tumoral , Proliferación Celular/genética , Proteína de Unión a Elemento de Respuesta al AMP Cíclico/metabolismo , Modelos Animales de Enfermedad , Regulación Neoplásica de la Expresión Génica , Técnicas de Silenciamiento del Gen , Orden Génico , Vectores Genéticos/genética , Humanos , Hipoxia/genética , Hipoxia/metabolismo , Factor 1 Inducible por Hipoxia/metabolismo , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patología , Ratones , Neovascularización Patológica/genética , ARN Interferente Pequeño/genética , Retroviridae/genética , Carga Tumoral/genética , Ensayos Antitumor por Modelo de XenoinjertoRESUMEN
AIMS: Ruthenium-106 brachytherapy is an effective method for treating small to medium uveal melanomas. The purpose of this study was to examine its effectiveness and safety in the management of thick posterior uveal melanoma (apical height >/=8.0 mm) and to compare it with enucleation. METHODS: 126 consecutive patients with thick uveal melanoma were included. 63 patients treated with Ruthenium-106 brachytherapy were compared with 63 patients treated with enucleation. The main outcome measures were visual acuity, eye retention, local recurrence, metastases, all-cause mortality and melanoma-related mortality. RESULTS: Patients treated with brachytherapy were significantly younger and had significantly smaller tumours, compared with patients treated with enucleation. Tumour thickness in the brachytherapy group was 9.3 (SD 0.9) mm compared with 12.2 (1.9) mm in the enucleation group. The 5- and 10-year melanoma-related mortality was 20.5% and 46.2% for brachytherapy patients and 28.1% and 44.0% for enucleation patients (p = 0.6 and p = 0.9). When comparing 15 brachytherapy with 15 matched enucleation patients, the 5-year melanoma-related mortalities were similar, 28.6% and 33.3% respectively (p = 0.7). Complications associated with brachytherapy included tumour regrowth (n = 15), scleral melt (n = 3), neovascular glaucoma (n = 5) and vitreous haemorrhage (n = 3). In the brachytherapy group, no significant difference in survival was noted between patients who did and did not develop local recurrence (p = 0.9). Of the eyes that were initially treated with brachytherapy, 71.4% were saved from enucleation. Of these, 70.8% had a final visual acuity of 20/200 or better. CONCLUSIONS: Ruthenium-106 brachytherapy is an alternative to enucleation in some thick posterior uveal melanomas.
Asunto(s)
Braquiterapia/métodos , Enucleación del Ojo/estadística & datos numéricos , Melanoma/radioterapia , Compuestos de Rutenio/uso terapéutico , Neoplasias de la Úvea/radioterapia , Braquiterapia/mortalidad , Enucleación del Ojo/métodos , Enucleación del Ojo/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Melanoma/mortalidad , Melanoma/cirugía , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/radioterapia , Pronóstico , Resultado del Tratamiento , Neoplasias de la Úvea/mortalidad , Neoplasias de la Úvea/patología , Neoplasias de la Úvea/cirugía , Agudeza VisualRESUMEN
AIMS: To evaluate the posthepatectomy survival of uveal melanoma patients with liver metastases. METHODS: Data were collected from the files in the Departments of Ophthalmology, General Surgery and Oncology, for uveal melanoma patients who were seen in the Ocular Oncology Clinic at the Hadassah Medical Center from 1988 to 2007. The main outcome was posthepatectomy survival. Statistical analysis was performed using JMP statistical software. RESULTS: Of the 558 patients, 74 (13%) developed metastases after a median of 35.0 months from the initial diagnosis. Thirty-five patients underwent hepatectomy. These patients had similar clinical characteristics as those who did not undergo hepatectomy. The median survival time from the detection of metastasis was 3.7-fold higher in the operated patients in comparison with the non-operated patients. Posthepatectomy survival of patients who were found in surgery to have 1-5 metastatic nodules was 3.1 times longer than those with six or more lesions. The hepatectomies of 13 patients resulted in complete resection of the hepatic metastases with clean histological margins (R0). These patients survived 1.9 times longer than those with residual disease (R1/R2). CONCLUSION: It is possible to extend significantly the life expectancy of uveal melanoma patients who develop isolated hepatic metastases by complete resection of the lesions.
Asunto(s)
Neoplasias Hepáticas/secundario , Melanoma/secundario , Neoplasias de la Úvea , Estudios de Seguimiento , Hepatectomía/métodos , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/cirugía , Melanoma/mortalidad , Melanoma/cirugía , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Lesions of the caruncle are uncommon. On account of the histological composition of the caruncle, which includes, in addition to conjunctiva, hair follicles, sebaceous glands, sweat glands, and accessory lacrimal tissue, the caruncle may develop lesions that may be similar to those found in the skin, conjunctiva, or lacrimal gland. Clinical preoperative diagnosis is very difficult and reached only in about half of the cases. The vast majority of lesions of the caruncle are benign, mainly nevi. Reported malignant lesions are very rare but can be potentially fatal. Although malignancy is clinically overestimated, any suspected malignant lesion should be excised and examined histopathologically by an experienced pathologist. This study presents the clinical and histological data of 42 consecutive caruncular lesions processed at our laboratory and reviews previously reported cases of caruncular lesions.
Asunto(s)
Neoplasias del Ojo/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de la Conjuntiva/patología , Enfermedades de la Conjuntiva/cirugía , Neoplasias del Ojo/cirugía , Femenino , Humanos , Enfermedades del Aparato Lagrimal/patología , Enfermedades del Aparato Lagrimal/cirugía , Masculino , Persona de Mediana Edad , Neoplasias de las Glándulas Sebáceas/patología , Neoplasias de las Glándulas Sebáceas/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: A feasibility study comparing retinal nerve fibre layer (RNFL) thickness values obtained with imaging devices against RNFL thickness measurements obtained histologically in a human eye. DESIGN: A single patient scheduled for orbital exenteration, who still possessed a healthy functioning eye. METHODS: Before surgery, the eye was imaged using optical coherence tomography (OCT) and scanning laser polarimetry (SLP). After orbital exenteration, the globe was sectioned, and 100 equidistant RNFL thickness measurements were obtained for each of four concentric rings centred on the optic disc, with diameters of 3.0, 3.5, 4.0, and 4.5 mm. RESULTS: RNFL thickness was found to be inversely related to the distance from the centre of the optic disc along each radial meridian. Peripapillary RNFL thickness was found comparable for histology, OCT, and SLP. RNFL thickness measured histologically confirmed a 'double hump' pattern, peaking at the superior and inferior poles. Histologically derived RNFL thickness (microm), at 3.0 and 3.5 mm diameter ring ranged between 30-135 and 25-115 respectively. In comparison, the 3.0 mm diameter GDx data ranged between 25 and 100, and the 3.4 mm diameter OCT data between 40 and 175. CONCLUSIONS: Imaging data appear qualitatively similar when compared to the histologically derived data. Quantitative differences may be partly due to scaling differences and histological artefacts. The histological analysis approach demonstrated in this study can potentially serve to validate imaging-derived data, as well as help improve our understanding of RNFL loss in glaucoma.
Asunto(s)
Fibras Nerviosas , Nervio Óptico/anatomía & histología , Estudios de Factibilidad , Angiografía con Fluoresceína , Humanos , Masculino , Microscopía Confocal , Persona de Mediana Edad , Tomografía de Coherencia ÓpticaRESUMEN
AIM: To describe our experience in treating vitreoretinal involvement of primary central nervous system lymphoma, by intravitreal injections of methotrexate (MTX). METHODS: Patients with suspected intraocular lymphoma underwent a diagnostic vitrectomy. Samples were sent for cytology, genetic evaluation and for interleukin level measurements. Treatment protocol included injection of 400 microg/0.1 ml MTX intravitreally twice weekly for 4 weeks, once weekly for 8 weeks, and then once monthly for 9 months, for a total of 25 injections. Data were collected from the patients' records and included, inter alia, response to intravitreal MTX measured by time to disappearance of vitreal cells and retinal infiltrates, changes in visual acuity, and clinical recurrence rate. RESULTS: In the past 10 years we have treated 44 eyes of 26 patients; seven patients had monocular involvement, and 19 binocular. Six patients were initially diagnosed as having a non-responsive uveitis, and 16 with either CNS or systemic lymphoma with later involvement of the eye. Four patients had systemic lymphoma; one of them was found to have CNS lymphoma after the ocular involvement. Three patients had T cell lymphoma, and the rest had B cell lymphoma. Clinical remission was reached after 6.4 (3.4) (2-16) injections of MTX (mean (SD) (range)), with 95% of the eyes needing 13 injections or less to be cleared of malignant cells. None of the patients had an intraocular recurrence. Among the side effects, the most common was corneal epitheliopathy, which usually appeared after the third injection and began to subside when the intervals between injections increased. CONCLUSIONS: Vitreoretinal involvement of lymphoma can be controlled effectively and without serious adverse reactions by intravitreal MTX injections. The treatment protocol described herein has resulted in no intraocular recurrence so far and has had bearable side effects. The accumulating clinical results bring us to propose the consideration of this protocol as a good first-line treatment option for intraocular lymphoma.
Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Neoplasias del Ojo/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Metotrexato/uso terapéutico , Adulto , Anciano , Antimetabolitos Antineoplásicos/administración & dosificación , Antimetabolitos Antineoplásicos/efectos adversos , Protocolos Clínicos , Esquema de Medicación , Evaluación de Medicamentos , Neoplasias del Ojo/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Inyecciones , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B/fisiopatología , Linfoma no Hodgkin/fisiopatología , Linfoma de Células T/tratamiento farmacológico , Linfoma de Células T/fisiopatología , Masculino , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Persona de Mediana Edad , Resultado del Tratamiento , Agudeza Visual/efectos de los fármacos , Vitrectomía , Cuerpo VítreoRESUMEN
AIM: To determine the incidence and characteristics of maculopathy associated with blood-brain barrier disruption (BBBD) which is used in treating primary central nervous system lymphoma (PCNSL). METHODS: Files of all 56 patients with PCNSL, with or without intraocular lymphoma (IOL), treated at Hadassah University Hospital during the years 1997-2007 were reviewed. Data on 46 patients for whom we had documentation of ocular examination were studied. Those who were alive at the time of the data collection were invited for further evaluation of the presence or absence of maculopathy. The patients were divided into four groups according to treatment protocol. Group 1: systemic intravenous chemotherapy; Group 2: systemic intravenous chemotherapy and intravitreal methotrexate (MTX); Group 3: systemic intra-arterial (IA) chemotherapy and BBBD; Group 4: systemic IA chemotherapy, BBBD, and intravitreal MTX. RESULTS: Of the 23 patients of Groups 1 and 2 who were not treated by BBBD, none developed maculopathy. Of those 23 patients who were treated by BBBD, 12 of 17 (70.5%) in Group 3 and three of six (50%) in Group 4, for a total of 15 of 23 (65.2%) developed maculopathy. The maculopathy did not significantly affect visual acuity in any of them. CONCLUSIONS: BBBD may cause maculopathy in almost two-thirds of patients treated for PCNSL, without affecting significantly the visual acuity. Intravitreal injection of MTX, according to the protocol which we apply, is not associated with maculopathy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias del Sistema Nervioso Central/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Mácula Lútea/patología , Enfermedades de la Retina/inducido químicamente , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Barrera Hematoencefálica/diagnóstico por imagen , Barrera Hematoencefálica/efectos de los fármacos , Carboplatino/administración & dosificación , Carboplatino/efectos adversos , Neoplasias del Ojo/tratamiento farmacológico , Femenino , Humanos , Infusiones Intravenosas , Inyecciones , Mácula Lútea/efectos de los fármacos , Masculino , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Persona de Mediana Edad , Enfermedades de la Retina/fisiopatología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Cuerpo VítreoRESUMEN
PURPOSE: Vasculogenic mimicry patterns, formed by highly invasive melanoma cells, connect to endothelial cell-lined blood vessels and contain fluid in vitroand in vivo. This study was designed to determine if fluid leaks into vasculogenic mimicry patterns without circulation, or if fluid circulates in and clears from these patterns. METHODS: Indocyanine green (ICG) laser scanning confocal angiography (Heidelberg Retinal Angiograph (HRA); Heidelberg Engineering, Heidelberg, Germany) was performed on nine patients with posterior choroidal melanoma in an institutional setting. Blood was drawn before the ICG injection and from the contralateral arm of the ICG injection site and 1 min after the injection. Outcome measures include time to first filling of retinal vessels and vasculogenic mimicry patterns and the time at which no fluorescence could be detected by the HRA instrument. After fluorescence was no longer detected in vessels or patterns, the tubes containing the patient's blood was imaged by the Heidelberg HRA. RESULTS: Looping vasculogenic mimicry patterns were detected focally in five patients within 30 s after injection and were detectable up to 12 min post-injection. Blood drawn before ICG injection did not autofluoresce but ICG-containing blood pooled in the tube continued to fluoresce at 1-month post-injection. CONCLUSIONS: Vasculogenic mimicry patterns are not part of the endothelial cell-lined vascular system and fluid enters these patterns through leakage. The rapid infusion of ICG into these patterns after injection and the disappearance of fluorescence detectable by the Heidelberg HRA suggest that fluid circulates in these patterns and does not accumulate as a stagnant pool.
Asunto(s)
Melanoma/irrigación sanguínea , Neovascularización Patológica/patología , Neoplasias de la Úvea/irrigación sanguínea , Endotelio Vascular/patología , Angiografía con Fluoresceína , Humanos , Verde de Indocianina , MicrocirculaciónAsunto(s)
Braquiterapia/efectos adversos , Neoplasias de la Coroides/radioterapia , Melanoma/radioterapia , Traumatismos por Radiación/etiología , Enfermedades de la Retina/etiología , Femenino , Humanos , Oxigenoterapia Hiperbárica , Persona de Mediana Edad , Enfermedades del Nervio Óptico/etiologíaRESUMEN
AIMS: To compare ultrasonographic (US) predicting factors for conversion of choroidal naevi into melanomas. METHODS: 659 consecutive eyes with choroidal naevi were examined between 1984 and 2004. 165 clinically suspicious naevi were followed clinically and ultrasonographically (thickness, base diameters, internal reflectivity and location in the eye) for 5.08 (SE 0.24) years. RESULTS: 17 naevi (2.6% of all naevi, 10.3% of suspicious naevi) converted to small choroidal melanomas. The thickness of benign and premalignant naevi differed significant only after 1.5 years of follow up. The mean initial thickness of benign and premalignant naevi was significantly different (p = 0.001), as was mean initial internal reflectivity (p = 0.002) and mean initial largest base diameter (LBD, p = 0.05). Posterior pole and nasally located naevi were more likely to become malignant. A thickness of > or = 2 mm and a LBD > or = 7 mm were most predictive of conversion to melanoma, as was a combined K(I) index of > or = 14.5 (KI = LBD + 4 x thickness + 1 (for nasal location) + 1 (for posterior pole location)). An artificial neural network did not have a better forecasting accuracy than the KI index. Logistic regression found the only significant parameters to influence the risk of conversion to melanoma to be the KI value and the initial tumour thickness. CONCLUSIONS: A follow up of at least 1.5 years is necessary to detect conversion of naevi to choroidal melanomas. The thickness and LBD of the lesion can be used for predicting the risk.
Asunto(s)
Neoplasias de la Coroides/diagnóstico por imagen , Melanoma/diagnóstico por imagen , Nevo/diagnóstico por imagen , Transformación Celular Neoplásica/patología , Neoplasias de la Coroides/patología , Progresión de la Enfermedad , Métodos Epidemiológicos , Humanos , Redes Neurales de la Computación , Nevo/patología , Dispersión de Radiación , UltrasonografíaRESUMEN
BACKGROUND: The amniotic membrane (AM), which is the innermost layer of the placenta, was shown to possess anti-inflammatory and anti-fibrotic properties in various in vitro and clinical studies. PURPOSE: To evaluate the anti-fibrotic and anti-inflammatory effects of the AM matrix (AMM) on human conjunctival and lung fibroblasts in an in vitro system that tests fibrotic and inflammatory responses at the effector stages of allergic inflammation. METHODS: Human conjunctival or lung fibroblasts were seeded on plastic or on the stromal aspect of the AM, which was mounted on plastic inserts. Sonicates of human peripheral blood eosinophils activated with lipopolysaccharide (LPS), or human mast cell (HMC-1) leukaemia cell sonicates, were added to sub-confluent fibroblast monolayers. Proliferation of the sub-confluent fibroblasts was assessed using the [3H]-thymidine incorporation assay. The production of transforming growth factor (TGF)-beta1, granulocyte-macrophage colony-stimulating factor (GM-CSF) and IL-8 in conjunctival or lung fibroblasts was measured in conditioned media from these cultures by ELISA. RESULTS: After 4 days in culture, the [3H]-thymidine incorporation assay indicated a reduced proliferation of activated conjunctival and lung fibroblasts when cultured directly on the AMM. The production of both TGF-beta1 and IL-8 was significantly suppressed in activated conjunctival fibroblasts cultured on the AMM compared with those cultured on plastic, while the production of both TGF-beta1 and GM-CSF was decreased in human lung fibroblast cultured on the AMM. CONCLUSIONS: The AMM is capable of suppressing fibrotic responses in an in vitro system of effector stages of ocular allergic inflammation. These data may provide a basis for exploring matrix components in the AM for the treatment of allergic eye disease.
Asunto(s)
Amnios/inmunología , Fibroblastos/inmunología , Adhesión Celular/inmunología , División Celular/inmunología , Supervivencia Celular/inmunología , Células Cultivadas , Conjuntiva/citología , Regulación hacia Abajo/inmunología , Eosinófilos/inmunología , Fibrosis/inmunología , Factor Estimulante de Colonias de Granulocitos y Macrófagos/inmunología , Humanos , Hipersensibilidad/inmunología , Inflamación/inmunología , Interleucina-8/inmunología , Pulmón/citología , Mastocitos/inmunología , Factor de Crecimiento Transformador beta/inmunologíaRESUMEN
BACKGROUND: Nerve growth factor (NGF) and nerve growth factor receptor (NGFR) expressions have been found to be increased in sub-conjunctival scarring. OBJECTIVE: The aim of this study was to investigate the in vitro effects of NGF on some pro-fibrogenic properties of human conjunctival fibroblasts. METHODS: Expression of NGF, trkA(NGFR) and p75NTR on human fibroblasts grown from conjunctival biopsies and incubated for 2 or 6 days with NGF were evaluated by immunofluorescence, RT-PCR, flow cytometry and ELISA. The fibrogenic effect of NGF on conjunctival fibroblasts was investigated by evaluating their migration (wound model), proliferation ([3H]-thymidine incorporation), collagen production (3H]-proline incorporation), expression of alpha-smooth muscle actin (alpha-SMA) (cell surface ELISA) and contraction of 3D collagen gels. RESULTS: NGF induced the expression of p75NTR in the fibroblasts that constitutively expressed only trkA(NGF) and increased the migration of wounded fibroblasts, but not their proliferation and collagen production. NGF induced the conversion of fibroblasts into myofibroblasts expressing alpha-SMA, and enhanced their contraction of a collagen matrix. Interestingly, chronic NGF treatment induced transforming growth factor-beta1 (TGF-beta1) production by fibroblasts, and following specific TGF-beta neutralization, all the NGF-induced effects were completely abrogated. CONCLUSION: Our findings indicate that NGF, via TGF-beta induction, is likely to be involved in the healing or fibrotic processes occurring in conjunctiva during some pathological conditions.
Asunto(s)
Conjuntiva/efectos de los fármacos , Fibroblastos/efectos de los fármacos , Factor de Crecimiento Nervioso/farmacología , Actinas/análisis , Adulto , Diferenciación Celular/efectos de los fármacos , División Celular/efectos de los fármacos , Movimiento Celular/efectos de los fármacos , Células Cultivadas , Colágeno/biosíntesis , Colágeno/efectos de los fármacos , Conjuntiva/citología , Femenino , Fibrosis/fisiopatología , Geles , Sustancias de Crecimiento/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Músculo Liso/metabolismo , Factor de Crecimiento Nervioso/metabolismo , Receptor de Factor de Crecimiento Nervioso , Receptor trkA/análisis , Receptores de Factor de Crecimiento Nervioso/análisis , Factor de Crecimiento Transformador beta/metabolismo , Factor de Crecimiento Transformador beta1 , Cicatrización de Heridas/fisiologíaRESUMEN
AIM: To confirm the prognostic value of post-brachytherapy initial tumour regression rate in posterior uveal melanoma. METHODS: A prospective, comparative, observational cohort study was carried out on 147 eyes (147 patients) with choroidal melanoma (mean age 61 years) treated with Ru-106 brachytherapy. OBSERVATION PROCEDURE: Patients were followed clinically and ultrasonically every 6.7 (SD 0.3) months (1001 examinations). On average each patient was examined 5.8 times (mean follow up 9.6 (3.7) years). The echographic parameters included tumour base size, height, internal reflectivity, regularity, vascularity, and extrascleral extension. The clinical follow up included ocular examination and periodic metastatic screening (liver function tests and liver imaging). Main outcome measures were risk of liver metastasis in correlation with the post-brachytherapy initial tumour regression rate. RESULTS: At brachytherapy the mean tumour height was 5.2 mm (range 2.2-11.8 mm). After brachytherapy 142 tumours (96.6%) responded by a decrease in height. The initial height regression rate was 6.1% (0.8%) per month in patients who later developed metastasis v 4.3% (0.4%) per month in those who did not. Tumours higher than 6 mm, tumours with an internal reflectivity smaller than 50%, and tumours with an initial rate of height regression larger than 0.7 mm/month (10% per month) had higher 5 year melanoma related mortality. Kaplan-Meier survival analysis and the multivariate Cox proportional hazards model showed a significant role for tumour height and initial tumour regression rate on patients' survival. CONCLUSION: This study confirms that post-brachytherapy initial tumour regression rate has a prognostic value.
Asunto(s)
Braquiterapia , Melanoma/radioterapia , Neoplasias de la Úvea/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Melanoma/mortalidad , Melanoma/patología , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Inducción de Remisión , Análisis de Supervivencia , Neoplasias de la Úvea/mortalidad , Neoplasias de la Úvea/patologíaRESUMEN
BACKGROUND: Orbital growth retardation, after enucleation and/or external beam radiation for retinoblastoma (RB), is a serious late effect. We measured orbital volumes of RB survivors treated at Hadassah University Hospital, Jerusalem, between 1980-1998. PROCEDURE: Forty-five orbits of 28 children with RB (17 bilateral, 11 unilateral) were examined. Thirty-six orbits were irradiated, 19 enucleated, and 10 both enucleated and irradiated. The orbital volumes were calculated from a three-dimensional orbital CT reconstruction. The orbits of RB survivors were compared to age-matched controls. RESULTS: The mean age at diagnosis was 13 months, mean follow-up time was 56 months. The mean volume of RB orbits (14.4 cc) was statistically significantly smaller than control orbits (17.8 cc). There was no difference between the mean volume of orbits treated with enucleation, irradiation or both. The orbital volume of children treated before the age of 12 months was statistically significantly smaller than those treated later. There was no difference between mean volume of fellow orbits in unilateral RB and controls. The mean orbital asymmetry index in control children (2.6%) was statistically significantly smaller than in RB survivors (14%). CONCLUSIONS: There was a significant orbital growth retardation after enucleation and/or irradiation for RB. There was no difference between mean orbital volumes after enucleation, radiation or both. Orbital growth retardation was most prominent in children treated in the first year of life. Although small in number, our study suggests that deferring enucleation and/or irradiation until after the age of 12 months may reduce long-term complications.
Asunto(s)
Enucleación del Ojo/efectos adversos , Órbita/crecimiento & desarrollo , Neoplasias de la Retina/radioterapia , Neoplasias de la Retina/cirugía , Retinoblastoma/radioterapia , Retinoblastoma/cirugía , Factores de Edad , Preescolar , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Órbita/efectos de la radiación , Complicaciones Posoperatorias , Radioterapia/efectos adversos , Neoplasias de la Retina/patología , Retinoblastoma/patologíaRESUMEN
AIM: To evaluate the cell proliferation activity in posterior uveal melanomas after Ru-106 brachytherapy. METHODS: Eyes containing choroidal or ciliary body melanoma from seven ocular oncology centres, which were enucleated after first being treated by Ru-106 brachytherapy and which had enough melanoma tissue to enable histological assessment, were included. The 57 eligible specimens were divided into a group of 44 eyes that were enucleated because of tumour regrowth, and a non-recurrent group of 13 eyes that were enucleated because of complications such as neovascular glaucoma. 46 non-irradiated eyes harbouring uveal melanoma served as a control group. All specimens underwent routine processing. They were cut into 5 microm sections, and were stained with two main cell proliferation markers: PC-10 for PCNA and MIB-1 for Ki-67. The stained sections were assessed, and the cells that were positive in the immunostaining were counted in each section. The results were evaluated by various statistical methods. RESULTS: The PC-10 score showed a statistically significant difference across the three groups (p = 0.002). The control group showed the highest PC-10 score (median 31.0 PCC/HPF) followed by the tumour regrowth group (median 4.9 PCC/HPF). The lowest PC-10 scores were found in the non-recurrent tumours (median 0.05 PCC/HPF). The MIB-1 score in the control group (median 5.77 PCC/HPF) was similar to the regrowth group (median 5.4 PCC/HPF). In contrast, the MIB-1 score in the non-recurrent tumours was statistically significantly lower (median 0.42 PCC/HPF). The PC-10 and MIB-1 scores were similar in tumours composed of either spindle cells or epithelioid cells in all groups. CONCLUSIONS: The non-recurrent melanomas demonstrate significantly lower cellular proliferation activity than melanomas that showed regrowth or that were not irradiated at all. In our hands, PCNA gave more meaningful information than Ki-67. Our findings strongly support the need for treating regrowing posterior uveal melanoma either by enucleation or re-treatment by brachytherapy. On the other hand, also in the non-recurrent uveal melanomas there are viable cells with potential for proliferation, although fewer in number, with unknown capacity for metastatic spread. Therefore, the irradiated tumours should be followed for many years, probably for life.
Asunto(s)
Melanoma/radioterapia , Radioisótopos de Rutenio/uso terapéutico , Neoplasias de la Úvea/radioterapia , Análisis de Varianza , Antígenos Nucleares , Braquiterapia/métodos , División Celular/efectos de la radiación , Neoplasias de la Coroides/patología , Neoplasias de la Coroides/radioterapia , Cuerpo Ciliar , Femenino , Humanos , Antígeno Ki-67/análisis , Masculino , Melanoma/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Proteínas Nucleares , Antígeno Nuclear de Célula en Proliferación/análisis , Coloración y Etiquetado/métodos , Estadísticas no Paramétricas , Neoplasias de la Úvea/patologíaRESUMEN
AIMS: To test the feasibility of gene transfer into hyaloid blood vessels and into preretinal neovascularisation in a rat model of retinopathy of prematurity (ROP), using different viral vectors. METHODS: Newborn rats were exposed to alternating hypoxic and hyperoxic conditions in order to induce ocular neovascularisation (ROP rats). Adenovirus, herpes simplex, vaccinia, and retroviral (MuLV based) vectors, all carrying the beta galactosidase (beta-gal) gene, were injected intravitreally on postnatal day 18 (P18). Two sets of controls were also examined: P18 ROP rats injected with saline and P18 rats that were raised in room air before the viral vectors or saline were injected. Two days after injection, the rats were killed, eyes enucleated, and beta-gal expression was examined by X-gal staining in whole mounts and in histological sections. RESULTS: Intravitreal injection of the adenovirus and vaccinia vectors yielded marked beta-gal expression in hyaloid blood vessels in the rat ROP model. Retinal expression of beta-gal with these vectors was limited almost exclusively to the vicinity of the injection site. Injection of herpes simplex yielded a punctuate pattern of beta-gal expression in the retina but not in blood vessels. No significant beta-gal expression occurred in rat eyes injected with the retroviral vector. CONCLUSIONS: Adenovirus is an efficient vector for gene transfer into blood vessels in an animal model of ROP. This may be a first step towards utilising gene transfer as a tool for modulating ocular neovascularisation for experimental and therapeutic purposes.
Asunto(s)
Técnicas de Transferencia de Gen , Terapia Genética/métodos , Vasos Retinianos , Retinopatía de la Prematuridad/terapia , Animales , Animales Recién Nacidos , Modelos Animales de Enfermedad , Estudios de Factibilidad , Expresión Génica , Vectores Genéticos/administración & dosificación , Humanos , Recién Nacido , Mastadenovirus/genética , Ratas , Ratas Endogámicas , Retroviridae/genética , Simplexvirus/genética , Virus Vaccinia/genética , Cuerpo Vítreo , beta-Galactosidasa/genéticaRESUMEN
PURPOSE: To evaluate the potential of laser photocoagulation as a method of treating small metastatic lesions of breast carcinoma in the choroid. METHODS: The 10 eyes of 7 patients were treated by Krypton red or argon green laser applications for small choroidal breast carcinoma metastasis with serous detachment of the retina. Before treatment 5 eyes had visual acuity of finger counting and 5 eyes had visual acuity of 6/15 or better. The treatment was repeated once in all eyes, except 1 eye in which it was repeated 3 times. RESULTS: In all eyes, one to two weeks after the treatment the tumor shrunk, the subretinal serous detachment absorbed, the retina flattened, and the visual acuity improved to 6/6-6/21. No reduction in vision was seen after the second treatment until the end of the follow-up period. In 1 eye, new tumors located elsewhere were again twice successfully treated. Patients reported a significant improvement of their quality of vision, as judged subjectively. CONCLUSIONS: Laser treatment is a feasible, easy, rapid, and effective therapy for small choroidal breast carcinoma.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Coroides/secundario , Neoplasias de la Coroides/cirugía , Coagulación con Láser , Adulto , Femenino , Angiografía con Fluoresceína , Humanos , Persona de Mediana Edad , Reoperación , Resultado del Tratamiento , Agudeza VisualRESUMEN
We have recently developed a novel mouse model for studying the infiltration of malignant lymphoma to the eye and brain. After i.p. inoculation of variant S49 mouse lymphoma cells into young mice (optimum: day 7 postnatal), specific homing of these cells (named Rev-2-T-6) to the brain and eyes took place. This model offers an opportunity to study the routes of infiltration to these sites and spread thereof, as well as the molecular mechanisms that govern this metastasis. By applying a time course histopathological analysis, we demonstrate that infiltration of the brain and eyes can be visualized as early as days 9 and 14 after inoculation, respectively. The lymphoma cells enter the brain preferentially through the choroid plexus and cranial nerves. Infiltration of the rostral part occurs before the caudal part of the brain. Once within the brain, the cells spread within it as well as migrate along the optic nerve sheath into the eyes, where they continue to migrate along the choroid, ciliary body, iris, and into the anterior chamber of the eye. The orbit is also infiltrated by the lymphoma cells. However, this occurs independent of the brain-optic nerve-intraocular route.
Asunto(s)
Neoplasias Encefálicas/secundario , Neoplasias del Ojo/secundario , Linfoma de Células T/patología , Animales , Neoplasias Encefálicas/patología , Modelos Animales de Enfermedad , Neoplasias del Ojo/patología , Ratones , Ratones Endogámicos BALB CRESUMEN
In a population-based study of posterior uveal malignant melanoma (755 incidence cases), the authors found a stabilized incidence in Israel from 1961-1996. Overall, Jewish immigrants to Israel had a relative rate (RR) of 2.2 [95% confidence interval [1.5-2.6] as compared to the reference population (Israeli-born Jews with Israel-born parents, i.e. third generation). Whereas individuals born in Eastern Europe or the Americas experienced the highest age adjusted incidence rates per million [for example; from 1972-1996, 8.3 for those from Poland, 8.2 from Romania, 6.4 from the former Union of Soviet Socialist Republics, 7.6 from the Americas], the lowest incidence rates were observed among immigrants from Algeria-Morocco-Tunisia (rate of 2.8), Iraq (1.7), Iran (3.2). Jews born in Israel exhibited incidence patterns similar to those individuals from the place of their parent's birth; high rates were observed among individuals born of American- or European-born parents (rate of 7.2), and low rates among offspring of parents who migrated from Africa or Asia (2.6). A low incidence was found among Israeli-born Arabs (2.6 in men, and 2.0 in women). The stable differences in incidence rates, according to populations of Jews, and the persistence of these variations within the descendants of these populations suggest that underlying susceptibility states are related to an individual's origin.
Asunto(s)
Judíos/genética , Melanoma/epidemiología , Neoplasias de la Úvea/epidemiología , Emigración e Inmigración , Femenino , Humanos , Incidencia , Israel/epidemiología , Masculino , Melanoma/genética , Vigilancia de la Población , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/genética , Neoplasias de la Úvea/genéticaRESUMEN
PURPOSE: The object of this study is to determine the velocity and migration course of meibomian gland cells. MATERIALS AND METHODS: Twenty-seven adult rats weighing about 200 g were injected intraperitoneally with a single dose of 0.5 microCi [3H]-thymidine/g body weight. Three rats were sacrificed 1 h after injection and 3 rats each on days 3, 6, 9, 12, 15, 18, 21 and 28 after injection. The eyes and eyelids were removed in one piece, fixed in formalin, embedded in paraffin and cut into 5-micron-thick vertical sections along the pupillary-optic nerve axis. The sections were dipped in liquid autoradiographic emulsion, exposed for 3 weeks, and stained with HE. Meibomian glands were scanned in the lower eyelid of the left eye using an ocular micrometer grid. In each scan the basement membrane of each acinus served as a point of origin. Along the entire gland two parameters were noted for each nucleus with three grains or more: the distance from the basement membrane (Y) and grain count. RESULTS: This study demonstrates for the first time the exact timing and direction of meibomian gland cell migration. We have shown that the cells migrate from the basement membrane to the center of the acinus at an average rate of 0.62 +/- 0.11 micron/day. Cell generation time was an average of 4.1 days. CONCLUSIONS: The stem cells of meibomian glands lie at the circumference of each acinus. These cells migrate synchronously with a constant velocity towards the center of the acinus, and are secreted as sebaceous material.