ISOO 2017 Second Working Day Completed!
International Collaboration in Ocular Oncology
The ISOO 2017 Second Working Day was integrated within the meeting in Sydney, Australia, where our specialty continued work on multicenter, international collaboration in ocular oncology.
The Second Working Day took place on the first day of the ISOO meeting on March 24 at the International Convention Centre in Sydney. The day focused on ongoing initiatives including:
- International Medical Evidence (WD-ME), Coordinated by Bita Esmaeli MD.
- Retinoblastoma Fellowships (WD-RBF), Lead by Ashwin Mallipatna MD.
- Quality Assurance (WD-QA), Coordinated by Tero Kivela MD.
- Surgical Standards (WD-SS), Lead by Santosh Honavar MD.
These initiatives currently involve over 100 eye cancer specialists from four continents. The second Working Day provided an opportunity to work together, face-to-face answering those questions that require consensus. We shared our knowledge and experience to help our subspecialty move forward into the mainstream of oncologic care, with a focus on creating evidence-based medicine, educational programs, outreach to the underserved, and multicenter quality assurance.
What is made by the community will be used by the community to help each other and those who do not have access to subspecialty care.
The First Working Day was held at The Curie Institute in Paris, immediately prior to the ISOO 2015.
Second Working Day Sessions
Working Day Conveners: Paul T. Finger, MD and Santosh G. Honavar, MD
Session 1: International Medical Evidence (WD-ME)
Bita Esmaeli MD will be coordinating this session. ISOO members will be made aware of all the international multi-center projects that have been completed, those in progress, and others just starting.
There now exists ongoing, multi-center international eye cancer registries for uveal melanoma, conjunctival melanoma, vitreoretinal lymphoma, eyelid carcinoma, lacrimal gland carcinoma, and ocular adnexal lymphoma. We need the medical evidence provided by these registries to improve patient care and defend our methods of diagnosis and treatment.
- 3,800 cases of intraocular melanoma were contributed from 10 sites in 4 continents. Thus far, data analysis has provided much needed medical evidence that confirmed the validity of AJCC-UICC tumor-staging and showed that failure of initial local tumor control is associated with a 6.3X hazard ratio for metastatic disease. Additional uveal melanoma publications are in the pipeline.
- 4,250 eyes from 2,125 children were contributed from 23 centers in 6 continents. Thus far, data analysis has allowed for a new and statistically proven method of RB staging that is incorporated into the 8th edition of the AJCC-UICC systems. Registry related retinoblastoma publications will be providing additional evidence-based medicine.
- >1,000 ocular adnexal lymphomas from 7 eye cancer centers around the world were collected in a Denmark based registry. This provides us with the largest material worldwide by far. Several articles have already been published and more articles are to come on the major lymphoma subtypes. This work has produced valuable information about the efficacy of different treatments with the purpose of improving prognosis for this patient category.
- ASOPRS oncology database currently includes over 1,500 cases with s variety of orbital eyelid and conjunctival tumors; 12 centers to date (11 from US, 1 from Canada); 5 studies initiated to date; 1 publication to date; 4 abstracts with manuscripts.
Convenor: Dr. Bita Esmaeli is a Professor of Ophthalmology, MD Anderson Cancer Center, where she has had an orbital oncology and oncologic ophthalmic plastic surgery practice. Bita has developed an ongoing multi-institutional orbital oncology database registry. She will convene the database and registry section of the Working Day. There will be introductory summaries of current results, introduction of actively recruiting and proposed registries and discussion of outstanding issues.
Session 2: Retinoblastoma Fellowships (WD-RBF)
Ashwin Mallipatna MD (leader of the 8th edition AJCC TNMH staging system) will lead this session. ISOO members will help define basic educational standards for our retinoblastoma fellows and create a strategy to support their work as they return to their underserved countries.
Two sessions of the first Working Day highlighted the need for international RB outreach from our specialty. It became clear that as many as 7,000 children were dying due to lack of early diagnosis and prompt curative treatment. We learned that many centers are trying to help on their own. We learned that reaching and treating these children will take time, dedication, and funding.
During that meeting, Paul T. Finger MD challenged the ISOO community to provide low-cost retinoblastoma fellowship education for young, aspiring ophthalmologists from unserved countries and underserved areas. He believes that unless we seed each unserved country with at least one advocate, children in those countries have no chance. Therefore, with the support of The Eye Cancer Foundation, The International Council of Ophthalmology, and The Children’s Eye Cancer Foundation of Germany, we are currently training retinoblastoma fellows in India, Jordan, Mexico, Iran, China, Canada, Finland, France, Sweden, the UK, and the USA. The Eye Cancer Foundation and Princess Margaret Cancer Center have funded training for over 8 RB fellows, as well as 12 additional scholarships yet-to-be-awarded through a new ECF-ICO-KAK combined effort. Most recently, Hans Grossniklaus has agreed to train 1 ECF funded fellow per year. These fellows will focus on RB ophthalmic pathology for the purpose of providing supportive pathology services to aid in this initiative.
Colleagues, this will be a long process. However, we are committed to place at least 20 functioning eye cancer specialists in 20 unserved countries by the year 2020. And that is just the beginning!
Convenor: Dr. Ashwin Mallipatna is a paediatric ophthalmologist specialized in the management of retinoblastoma at Women's and Children's Hospital in Adelaide. Ashwin, who was the section leader of the AJCC-UICC staging initiative, offers a depth of experience with multicenter international cooperation and will convene this session. This session will include discussions regarding the potential, problems and solutions for tailor-made RB fellowships that maintain a basic standard of care in every corner of the world. The first fellows will work towards the goal of reducing RB related mortality in their unserved or underserved countries.
Session 3: Quality Assurance (WD-QA)
Tero Kivela MD will be coordinating this session. As a start, we challenge all centers to post their published results on their own web sites. Then 10 centers will voluntarily share their prospective outcomes for choroidal melanoma and retinoblastoma. During the second working day, our specialty will discuss these efforts and decide how we should move forward.
Eye cancer specialists cannot know how to improve, unless they know the outcomes of their work. Current methods include periodic publication of research articles and didactic presentations at international meetings. These efforts are hampered by use of variable categorizations and lack of matching reference bases. Over the last decade, international standards (e.g. AJCC staging, ABS and AAPM radiation guidelines) have allowed for standardized comparisons. However, these standards remain underused and published works only offer a small sample of measurable outcomes. As a start, we encourage all centers to post their published results on their own websites. We also take steps to allow voluntary centers to share their prospective outcomes for choroidal melanoma and retinoblastoma. During the second Working Day, our specialty will discuss these efforts and decide how to move forward and expand.
Convenor: Dr Tero Kivelä is Professor and Chair, Department of Ophthalmology, University of Helsinki, Finland. Tero will convene this section aimed at improving quality assurance by enabling outcome comparisons between centers. A doctor reported outcome (DRO) platform requires a data set that is both meaningful, concise and easy to collect. This committee will present their work describing available methods of data collection (and sharing) for comment and approval by ISOO community. Volunteer centers will participate by sharing their outcomes in a closed system to form a basis for further discussion and critique at the time of the Sydney workshop.
Session 4: Surgical Standards Text (WD-SS)
Santosh Honavar MD will lead this session to create a consensus-based, open-access online surgical text. International outreach doesn’t have to take that long! This text is being created by our community, will be vetted by ISOO members and will be posted online with free access for all. This allows our community to provide surgical guidance to all the general ophthalmologists currently treating eye cancer patients in otherwise unserved areas. This text will be the best gift our eye cancer community can give until our trained specialists arrive in those areas.
Convenor: Dr. Santosh G Honavar is Director of Ophthalmic Plastic Surgery and Ocular Oncology at Centre For Sight Super-specialty Eye Hospital in Hyderabad. Santosh will convene this section during which the ongoing chapters will be presented for comments prior to completion. Each chapter is constructed by committee in order to achieve consensus and pool experience. A predictable and precise surgical technique incorporating shared and consensus oncology principles is important for achieving the best possible outcomes and decreased mortality. This open-access text will help all the practicing ophthalmologists around the world.
Session 5: Consensus Guidelines (WD-CG)
Paul T Finger MD will lead this meeting. One designated representative from each eye cancer will receive a free copy of the newly published 8th edition, AJCC Staging Handbook. All 70 contributors will be acknowledged and ongoing AJCC-UICC initiatives and other consensus guideline initiatives will be introduced for construction.
Convenor: Dr. Paul T Finger is the Chairman of The Eye Cancer Foundation. He is the founding Director of Ocular Tumor Services at several renowned institutions, including the New York University School of Medicine (where he also serves as a Clinical Professor of Ophthalmology), The New York Eye and Ear Infirmary of Mt. Sinai, Tisch Hospital, and Manhattan Eye, Ear and Throat Hospital. His 35 years in ophthalmic oncology have been dedicated to learning, improving and inventing new methods for the diagnosis and treatment of cancers in and around the eye.