Annual Report 2019
> Stopping cancer in its tracks
• SOAR Residency Program lays foundation for independent research careers
• Creating a field of molecular surgery to guide new therapies
• Developing cures with stem cells and regenerative medicine
Stopping cancer in its tracks
Stanford Ocular Oncology team saves the life of child with retinoblastoma
To a passerby, Cru Silva looks like your average three-year-old. His energy is contagious as he runs around the room laughing and playing with his new toy garbage truck.
It seems that he hasn’t a care in the world, but Cru has spent the past two years battling bilateral retinoblastoma, a serious eye cancer that occurs in children. Only 300 patients are diagnosed with retinoblastoma in the United States annually.
Cru’s mother, Janelle Silva, who previously worked at an eye clinic located on their home island of Maui, Hawaii, noticed a glare in his eye when he was just 18 months old in a photograph taken at a party. She then began to notice his left eye was swollen and turning inward.
This white reflection or glare is an important clinical sign called leukocoria, seen in some cases of retinoblastoma, instead of the typical red reflex. Janelle thought it best to have Cru seen by an ophthalmologist, who after finding tumors in both of Cru’s eyes, immediately contacted Stanford and was connected to Prithvi Mruthyunjaya, MD, MHS,an ophthalmologist and ocular oncologist and director of the Stanford Ocular Oncology Service.
Arriving at Stanford
Within a week, Cru was brought to Byers Eye Institute with his mother and Shane, his father.
“When we first came to Stanford, we didn’t know whether Cru’s left eye would have to be removed,” Janelle said. “His left eye’s tumor was larger than the right eye’s tumor, and particles had begun to break off, so there was a possibility the cancer had spread.”
At Byers, Cru was seen by a multidisciplinary team in the Pediatric Ocular Oncology service including Mruthyunjaya; Arun Rangaswami, MD, a pediatric hematologist/oncologist; and Huy Do, MD, an interventional neuroradiologist.
“Stanford’s Ocular Oncology is a new service where we care for both adults and children with life- and vision-threatening cancers by seeking to improve and save lives,” Mruthyunjaya said.
“We are so thankful to Dr. Mruthyunjaya and his team. If it weren’t for him, Cru wouldn’t be where he is now.
Mruthyunjaya said that ocular oncology differs from other fields in ophthalmology that seek primarily to restore or protect vision. Even greater than these goals, the main priority in ocular oncology is saving lives.
“Our ultimate mission on the ocular oncology service is to have healthy children who can lead not just functional, but exceptional lives,” Mruthyunjaya said.
Mruthyunjaya, who came to Stanford in 2016, was previously a faculty member at Duke University for 15 years, where he helped build the Retina-Ocular Oncology Program as the director of the Ocular Oncology Service. He saw patients with similar conditions and built a team comprised of colleagues from many specialties.
“In my experience, I have seen the importance of collaborating and partnering with individuals of different expertise,” Mruthyunjaya said. “It’s a well understood model of pediatric cancer that has continued to advance here at Stanford.”
Resilient through rounds of chemotherapy
In Mruthyunjaya’s evaluation of Cru’s condition, he identified the extent of the disease, assessed tolerance for various treatments, and discussed with the team the options that would be safest and most effective.
Cru began treatment with systemic chemotherapy over a period of six months. When Mruthyunjaya detected continued tumor activity, chemotherapy was then carefully injected into Cru’s eyes and then a new treatment, intra-arterial chemotherapy (IAC), was used.
“Intra-arterial chemotherapy is a delicate treatment where a small catheter is threaded into the tiny ophthalmic artery that brings blood to the eye, and in turn the tumor,” Mruthyunjaya said. “This targeted chemotherapy allows precise delivery of medication only into the eye without having to treat the rest of the patient’s body. It helps to significantly reduce side effects from the chemotherapy.”
“It was crucial that we adapt to any new changes that developed in the tumor, and because of the severity, we decided to bring in Dr. Do’s IAC treatment,” Mruthyunjaya said.
“The first several months during systemic chemotherapy were difficult,” Janelle said. “As a parent you want to set a good example for your children, but it was really Cru who gave us inspiration through his resilience and happy attitude.”
Now after nearly two years, the tumors in both his eyes appear inactive and well treated, but they must be monitored closely over the next few years. Cru returned home to Maui in 2018 and travels to Stanford for his monthly check-ups with Mruthyunjaya.
“Throughout Cru’s treatment, the Silva parents were dedicated to keeping things normal, and even through the many rounds of chemotherapy he could always be brought to a smile,” Mruthyunjaya said.
“We are so thankful to Dr. Mruthyunjaya and his team,” Janelle said. “He made this process comfortable and seamless, and if it weren’t for him, Cru wouldn’t be where he is now.”
By KATHRYN SILL
Kathryn Sill is a web and communications specialist for the Byers Eye Institute in the Department of Ophthalmology, at Stanford University School of Medicine. Email her at email@example.com.