Clinicoepidemiological Profile and Treatment Outcomes in Children with Retinoblastoma: Experience from a Cancer Care Center in Northeast India

Abstract

Background Retinoblastoma (RB) is the most common primary intraocular malignancy in children. We sought to provide a comprehensive assessment of epidemiological profile and treatment outcomes of children with RB. Methods In this retrospective study, we analyzed 189 children diagnosed with RB at our center between 2004 and 2017. Survival was analyzed with the Kaplan–Meier method and log-rank test. Results Median age at presentation was 14 months with male: female ratio 1.2:1. Mean duration between onset of symptoms and presentation was 49 days (standard deviation ± 79). Most common presenting symptom was white pupillary reflex in 60% of children. Family history of RB and other cancers was found in one (0.5%) and seven (4%) children, respectively. Primary mode of diagnosis and staging was ocular ultrasonography (bone scan) in 87% of patients. Computed tomographic scan and magnetic resonance imaging were done in 124 (66%) and 30 (16%) patients, respectively. International staging system grade E disease was found in 144 (76%), extraocular disease in 55 (29%), bilateral disease in 49 (26%), and trilateral disease in 3 (1.5%) children. Out of 189 children with RB, 33 (18%) refused treatment and 156 children received treatment (24 children [15%] abandoned treatment midway and 132 [85%] completed treatment). One hundred children (64%) received systemic therapy as neoadjuvant or adjuvant chemotherapy and 20 (13%) received local therapy. Eyeball and vision salvage rate with chemotherapy were 20 (13%) and 9 (6%), respectively. Cryotherapy was the most common modality of local treatment used in 11 (55%) children. Five-year survival for patients who received treatment was 76% (median survival not reached). In the treatment refusal group, median survival was 9 months. Conclusion In developing countries, RB is mostly detected in advanced stages resulting in poor outcomes. Increased awareness and accessibility to dedicated centers for treating childhood malignancy can lead to early diagnosis, better prognosis, and increased vision salvage.

Retinoblastoma: Poster-Child Tumor of the Low-Middle Income Countries (LMICs)!!!

“…Hazarika M et al from India 3 report the outcomes of 189 RB patients from a tertiary cancer care center, where the median age of presentation was 14 months and the median time to reach the hospital from symptom onset was only 49 days. Two-third of the patients received computerized tomography(CT) for staging workup.…”

“… 5 At diagnosis, Tan RJD et al report more than 50% of their patients with advanced disease 2 and Hazarika M et al study had around one-third of the patient with extraocular disease. 3 …”

“…5 At diagnosis, Tan RJD et al report more than 50% of their patients with advanced disease 2 and Hazarika M et al study had around one-third of the patient with extraocular disease. 3 Refusal to therapy and poor compliance to prescribed treatment are other major issues that contribute to poor outcomes of Rb in a LMIC setting. Tan RJD et al report 18% of their patient refusing treatment upfront.…”