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Editorial
Foundational Elements for Collaboration in Ophthalmic Oncology
Paul T. Finger, MD, FACS - New York, New York
Sharing a common scientific language (staging system) allows us to communicate our ideas and enable progress.1e3
The American Joint Committee on Cancer (AJCC), the
Union for International Cancer Control (UICC), the American Brachytherapy Society, and The Eye Cancer Foundation have worked to sponsor and support the Ophthalmic
Oncology Task Force (OOTF) efforts toward collaboration
in our field. 1,4e7
The first OOTF “foundational project” was to design the
most clinically useful TNM-based (tumorenodeemetastasis)
classification for eye cancers.8 The seventh and now eighth
editions of the AJCC staging system included 10
subcommittees composed of >50 eye cancer specialists
(ophthalmic pathologists, oculoplastic surgeons, ophthalmic
oncologists, medical oncologists, pediatric oncologists) and
their subspecialty colleagues from around the world.1 Just
published in October of 2016, the eighth edition will be
adopted by the UICC and hundreds of oncology groups
around the world. It represents the most collaborative,
current, and consensus-driven guidelines our subspecialty
has to offer.1,4,5
During the 6 years since the previous edition, each subcommittee undertook a new, detailed review of the literature. Then, multiple teleconferences and face-to-face
discussions were led to achieve consensus regarding
methods of ocular tumor diagnosis and treatment. With this
foundation, tumor-specific committees (uveal melanoma,
retinoblastoma, ocular adnexal lymphoma, orbital sarcoma,
orbital carcinoma, eyelid carcinoma, conjunctival melanoma, conjunctival carcinoma) decided how eye cancer
patients should be TNM staged. In addition, there were 2
supplemental committees to review ophthalmic pathology,
genetic, molecular biology, and biomarker aspects. Held to
strict editorial standards, each committee made every effort
to include the latest, statistically significant medical evidence into eye cancer staging.9e18
To supplement this process, members of the OOTF had
formed independent, multicenter international tumor registries. The bioinformatics group (eg, EyeCaBIG) data registries provided essential, statistically significant medical
evidence for the uveal melanoma, retinoblastoma, and
ocular adnexal lymphoma and other committees.19,20 For
example, data from 18 909 cases of uveal melanoma now
support its TNM classification of uveal melanoma and
>2000 eyes provided a new evidence-based retinoblastoma
staging system.6,21e23 From registries and multicenter
studies, >1000 cases of ocular adnexal lymphoma helped to
better define site-specific risk and uncovered evidence that
radiation treatment was associated with less systemic
recurrence.19,24e26
Ó 2017 by the American Academy of Ophthalmology
Published by Elsevier Inc.
Tough decisions were made concerning the maturity of
rapidly accumulating new evidence. Examples include genetic prognostication of uveal melanoma (eg, gene expression profiling, BAP1, and others) as well as the subdividing
stages of in situ conjunctival melanoma.27,28 These controversies stress the need for more data collection and a
continuously evolving AJCC-UICC staging system.
However, the addition of a new biomarker, “H,” to form
TNMH for retinoblastoma is most exciting.29e31 For the
first time, the AJCC has allowed heredity to be part of
cancer staging. This pioneering decision was based on clear
medical evidence we presented to the AJCC Editorial
Board. Just as Knudson’s hypothesis had done, ophthalmology is leading the way into a new world of cancer
staging.32
Clearly, a tremendous, world-wide effort was made to
ensure that the eighth edition of the AJCC Cancer Staging
Manual is the most clinically useful TNM-based staging
system for ophthalmic oncology. Use of this system provides a “snapshot” of the patients’ condition before, during,
and after treatment. It improves our ability to communicate
with our local oncology team. It allows us to compare our
patient care, research and results. By speaking a scientific
language understood by our nonophthalmic colleagues
around the world, AJCC-UICC staging allows ophthalmology access to the mainstream of cancer care. We urge
you to adopt the eighth edition of the AJCC-UICC classification system in your clinic, for research and in all eye
cancer publications.
Members of the AJCC Ophthalmic
Oncology Task Force
Daniel M. Albert, MD, MS; Anush G. Amiryan, MD;
Claudia Auw-Hädrich, MD; Diane Baker, CTR (Data
Collection Core Representative); Raymond Barnhill, MD,
MSc; José M. Caminal, MD, PhD; William L. Carroll, MD;
Nathalie Cassoux, MD, PhD; Jaume Català-Mora, MD;
Guillermo Chantada, MD; Patricia Chévez-Barrios, MD; R.
Max Conway, MD, PhD, FRANZCO; Sarah E. Coupland,
MBBS, PhD, FRCPath (AJCC Vice Chair); Bertil E.
Damato, MD, PhD; Hakan Demirci, MD; Laurence G.
Desjardins, MD; François Doz, MD, MSc; Jonathan J.
Dutton, MD, PhD, FACS; Bita Esmaeli, MD, FACS; Paul
T. Finger, MD, FACS (Chair); Brenda L. Gallie, MD,
FACSC; Gerardo F. Graue, MD; Hans E. Grossniklaus, MD
(CAP Representative); Steffen Heegaard, MD; Leonard M.
Holbach, MD; Santosh G. Honavar, MD, FACS; Martine J.
Jager, MD, PhD; Tero Kivelä, MD, FEBO; Emma Kujala,
http://dx.doi.org/10.1016/j.oret.2017.01.002
ISSN 2468-6530/17
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Ophthalmology Retina Volume -, Number -, Month 2017
MD; Livia Lumbroso-Le Rouic, MD; Ashwin C. Mallipatna, MBBS, MS, DNB; Giulio M. Modorati, MD; Francis
L. Munier, MD; Timothy G. Murray, MD, MBA, FACS;
Anna C. Pavlick, DO, MBA; Jacob Pe’er, MD; David E.
Pelayes, MD, PhD; Gaelle Pierron, PhD; Victor G. Prieto,
MD, PhD; Manuel Jorge Rodrigues, MD; Svetlana Saakyan,
MD; Wolfgang A.G. Sauerwein, MD, PhD; Ekaterina
Semenova, MD; Stefan Seregard, MD; Carol Shields, MD;
E. Rand Simpson, MD, FRCS(C); Arun D. Singh, MD;
Shigenobu Suzuki, MD, PhD; Mary Kay Washington, MD,
PhD (Editorial Board); Valerie A. White, MD, MHSc,
FRCPC; Michelle Williams, MD; Matthew W. Wilson, MD,
FACS; Christian W. Wittekind, MD (UICC Representative);
and Vivian Yin, MD, MPH, FRCSC.
References
1. The AJCC Ophthalmic Oncology Task Force. The AJCC
Cancer Staging Manual. 8th ed. New York: Springer; 2016.
2. Finger PT. Do you speak ocular tumor? Ophthalmology.
2003;110:13e14.
3. Finger PT. Cancer staging. In: Singh AD, Damato B, eds.
Clinical Ophthalmic Oncology: Basic Principles and Diagnostic Techniques. 2nd ed. New York: Springer; 2014:69e75.
4. Finger PT. Eye: choroidal melanoma, retinoblastoma, ocular
adnexal lymphoma and eyelid cancers. In: O’Sullivan B,
D’Cruz A, Fey M, et al., eds. UICC Manual of Clinical
Oncology. 9th ed. Hoboken, NJ: John Wiley and Sons; 2015:
726e744.
5. American Brachytherapy Society, Ophthalmic Oncology Task
Force, Electronic address pec, Committee AO. The American
Brachytherapy Society consensus guidelines for plaque
brachytherapy of uveal melanoma and retinoblastoma.
Brachytherapy. 2014;13:1e14.
6. The AJCC Ophthalmic Oncology Task Force. International
Validation of the American Joint Committee on Cancer’s 7th
Edition Classification of Uveal Melanoma. JAMA Ophthalmol.
2015;133:376e383.
7. Chiu-Tsao ST, Astrahan MA, Finger PT, et al. Dosimetry of
(125)I and (103)Pd COMS eye plaques for intraocular tumors:
report of Task Group 129 by the AAPM and ABS. Med Phys.
2012;39:6161e6184.
8. Finger PT. The 7th edition AJCC staging system for eye
cancer: an international language for ophthalmic oncology.
Arch Pathol Lab Med. 2009;133:1197e1198.
9. Yousef YA, Finger PT. Predictive value of the seventh edition
American Joint Committee on Cancer staging system for
conjunctival melanoma. Arch Ophthalmol. 2012;130:
599e606.
10. Yousef YA, Al-Hussaini M, Mehyar M, et al. Predictive value
of TNM classification, international classification, and ReeseEllsworth staging of retinoblastoma for the likelihood of
high-risk pathologic features. Retina. 2015;35:1883e1889.
11. Yin VT, Warneke CL, Merritt HA, Esmaeli B. Number of
excisions required to obtain clear surgical margins and prognostic value of AJCC T category for patients with eyelid
melanoma. Br J Ophthalmol. 2014;98:1681e1685.
12. Sniegowski MC, Warneke CL, Morrison WH, et al. Correlation
of American Joint Committee on Cancer T category for eyelid
carcinoma with outcomes in patients with periocular Merkel cell
carcinoma. Ophthal Plast Reconstr Surg. 2014;30:480e485.
13. Shinder R, Ivan D, Seigler D, et al. Feasibility of using
American Joint Committee on Cancer Classification criteria for
staging eyelid carcinomas. Orbit. 2011;30:202e207.
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14. Freton A, Chin KJ, Raut R, et al. Initial PET/CT staging for
choroidal melanoma: AJCC correlation and second nonocular
primaries in 333 patients. Eur J Ophthalmol. 2012;22:
236e243.
15. Shields CL, Kaliki S, Al-Dahmash SA, et al. American Joint
Committee on Cancer (AJCC) clinical classification predicts
conjunctival melanoma outcomes. Ophthal Plast Reconstr
Surg. 2012;28:313e323.
16. Ahmad SM, Esmaeli B, Williams M, et al. American Joint
Committee on Cancer classification predicts outcome of patients with lacrimal gland adenoid cystic carcinoma.
Ophthalmology. 2009;116:1210e1215.
17. The Ophthalmic Oncology Task Force. Local recurrence
significantly increases the risk of metastatic uveal melanoma.
Ophthalmology. 2016;123:86e91.
18. Kivela T, Kujala E. Gene expression profiling versus TNM
classification. Ophthalmology. 2013;120:1109.e1101.
19. Sniegowski MC, Roberts D, Bakhoum M, et al. Ocular
adnexal lymphoma: validation of American Joint Committee
on Cancer seventh edition staging guidelines. Br J Ophthalmol. 2014;98:1255e1260.
20. Sniegowski M, Yin V, Esmaeli B. Re: “American Joint
Committee on Cancer (AJCC) clinical classification predicts
conjunctival melanoma outcomes”. Ophthal Plast Reconstr
Surg. 2013;29:326.
21. Kujala E, Damato B, Coupland SE, et al. Staging of ciliary
body and choroidal melanomas based on anatomic extent.
J Clin Oncol. 2013;31:2825e2831.
22. Kivela T, Kujala E. Long-term risk of melanoma-related
mortality after uveal melanoma. JAMA Ophthalmol.
2016;134:238e239.
23. Shields CL, Kaliki S, Furuta M, et al. American Joint
Committee on Cancer Classification of uveal melanoma
(anatomic stage) predicts prognosis in 7,731 patients: the
2013 Zimmerman lecture. Ophthalmology. 2015;122:
1180e1186.
24. Rasmussen PK, Coupland SE, Finger PT, et al. Ocular adnexal
follicular lymphoma: a multicenter international study. JAMA
Ophthalmol. 2014;132:851e858.
25. Graue GF, Finger PT, Maher E, et al. Ocular adnexal lymphoma staging and treatment: American Joint Committee on
Cancer versus Ann Arbor. Eur J Ophthalmol. 2013;23:
344e355.
26. Munch-Petersen HD, Rasmussen PK, Coupland SE, et al.
Ocular adnexal diffuse large B-cell lymphoma: a multicenter international study. JAMA Ophthalmol. 2015;133:
165e173.
27. Onken MD, Worley LA, Char DH, et al. Collaborative Ocular
Oncology Group report number 1: prospective validation of a
multi-gene prognostic assay in uveal melanoma. Ophthalmology. 2012;119:1596e1603.
28. Damato B, Coupland SE. Conjunctival melanoma and melanosis: a reappraisal of terminology, classification and staging.
Clin Exp Ophthalmol. 2008;36:786e795.
29. Mallipatna A, Gallie BL, Chévez-Barrios P, et al. Retinoblastoma. In: Amin M, Edge SB, Greene FL, et al., eds.
The AJCC Cancer Staging Manual. 8th ed. New York:
Springer; 2016.
30. Mallipatna A, Marino M, Singh AD. Genetics of retinoblastoma. Asia Pac J Ophthalmol (Phila). 2016;5:260e264.
31. Soliman SE, Dimaras H, Khetan V, et al. Prenatal versus
postnatal screening for familial retinoblastoma. Ophthalmology. 2016;123:2610e2617.
32. Knudson Jr AG. Mutation and cancer: statistical study of
retinoblastoma. Proc Natl Acad Sci U S A. 1971;68:820e823.
Editorial
Footnotes and Financial Disclosures
Funding: This work was supported by the American Joint Committee on
Cancer, the Union for International Cancer Control, the American College
of Surgeons and The Eye Cancer Foundation (http://eyecancercure.com).
Correspondence:
Paul T. Finger, MD, FACS, The New York Eye Cancer Center, Suites 5A/B,
115 E 61st St, New York, NY 10065. E-mail: pfi[email protected].
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