title: Visual outcomes in children with neurofibromatosis type 1-associated optic pathway glioma following chemotherapy: a multicenter retrospective analysis.
abstract: Optic pathway gliomas (OPGs) occur in 15%-20% of children with neurofibromatosis type 1 (NF1); up to half become symptomatic. There is little information regarding ophthalmologic outcomes after chemotherapy. A retrospective multicenter study was undertaken to evaluate visual outcomes following chemotherapy for NF1-associated OPG, to identify risks for visual loss, and to ascertain indications for treatment. Subjects included children undergoing initial treatment for OPGs with chemotherapy between January 1997 and December 2007. Of 115 subjects, visual acuity (VA) decline and tumor progression were the primary reasons to initiate treatment, although there were significant differences in the pattern of indications cited among the institutions. Eighty-eight subjects and 168 eyes were evaluable for VA outcome. At completion of chemotherapy, VA improved (32% of subjects), remained stable (40%), or declined (28%). Tumor location was the most consistent prognostic factor for poor VA outcome. There was poor correlation between radiographic and VA outcomes. Although visual outcomes for NF1-associated OPG are not optimal, approximately one-third of children regain some vision with treatment. Since radiographic outcomes do not predict visual outcomes, their use as the primary measure of treatment success is in question. The lack of consensus regarding the indications for treatment underlines the need for better standardization of care. Future clinical trials for OPG require standardized visual assessment methods and clear definitions of visual outcomes.
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Colket Translational Research Building, 10th Floor, 3501 Civic Center Blvd, Philadelphia, Pennsylvania 19104, USA. fisherm@email.chop.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisher
authors.forename: Michael
authors.initials: M
authors.lastname: Loguidice
authors.forename: David H
authors.initials: DH
authors.lastname: Gutmann
authors.forename: Robert
authors.initials: R
authors.lastname: Listernick
authors.forename: Rosalie E
authors.initials: RE
authors.lastname: Ferner
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Ullrich
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Packer
authors.forename: Uri
authors.initials: U
authors.lastname: Tabori
authors.forename: Robert O
authors.initials: RO
authors.lastname: Hoffman
authors.forename: Simone L
authors.initials: SL
authors.lastname: Ardern-Holmes
authors.forename: Trent R
authors.initials: TR
authors.lastname: Hummel
authors.forename: Darren R
authors.initials: DR
authors.lastname: Hargrave
authors.forename: Eric
authors.initials: E
authors.lastname: Bouffet
authors.forename: Joel
authors.initials: J
authors.lastname: Charrow
authors.forename: Larissa T
authors.initials: LT
authors.lastname: Bilaniuk
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Balcer
authors.forename: Grant T
authors.initials: GT
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009456:Neurofibromatosis 1 / Q000150:complications / Q000188:drug therapy*; D020339:Optic Nerve Glioma / Q000150:complications / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage; D014792:Visual Acuity / Q000187:drug effects*
chemical_list: D014750:Vincristine; D014747:Vinblastine; D016190:Carboplatin