Clinical outcomes of Group D Retinoblastoma at a tertiary care hospital in Pakistan

Abstract

Purpose To retrospectively analyse globe salvage rates in group D retinoblastoma (RB) with currently available treatment options in Pakistan over a period of nine years. Methods A retrospective, cross-sectional analysis including all patients who presented with Group D RB according to the International Classification of Retinoblastoma (ICRB), from April 2013 to December 2022 at Patel Hospital, Karachi, Pakistan. Indirect ophthalmoscopy done under anaesthesia was used to visualise and evaluate tumour characteristics and clinical response to the treatment offered. Globe salvage was attempted with systemic chemotherapy, local consolidative therapy along with intravitreal melphalan. Survival analysis was performed using Kaplan-Meier curves on SPSS version 26. Results The mean age at diagnosis was 17.2 months.14 (93%) patients had bilateral disease and one (7%) had unilateral disease. Globe salvage was achieved in 11 out of 15 eyes (73.33%) in a mean follow up time of 57.5 weeks (range 7–263 weeks). All eyes received laser therapy, 5 required additional cryotherapy and 1 eye was given adjuvant intravitreal melphalan. 4 eyes underwent secondary enucleation. All eyes amongst this group received systemic chemotherapy, laser, cryotherapy and 3 eyes received intravitreal melphalan (4 cycles). Kaplan-Meier survival analysis showed an overall globe salvage rate of 93%, 76%, and 65% at 1, 2 and 3 years, respectively. No metastasis or deaths were reported. Conclusion Intravenous chemotherapy (IVC) coupled with local therapy remains an effective mode of treatment in select patients with Group D RB despite advancements in treatment modalities like intra-arterial chemotherapy. This is especially promising for developing countries with limited resources and socioeconomic barriers.