Enucleation for retinoblastoma: the experience of a single center in Jordan

Abstract

Despite multiple advances in the management of retinoblastoma, enucleation remains an essential therapeutic modality. We studied patients who underwent enucleation at the King Hussein Cancer Center in Jordan. We retrospectively reviewed medical records of children with retinoblastoma who were treated at our center from June 2002 to February 2008. Twenty-eight eyes from 27 patients were enucleated. Median age at diagnosis was 1.1 years (range, 0.3-6.3 years). Twenty-six eyes (93%) had advanced disease (RE groups IV and V). Seventeen patients (61%) had unilateral retinoblastoma, and 11 (39%) had bilateral retinoblastoma. The median time from diagnosis to enucleation was 0.45 months (range, 0-45 months; mean, 4.4 months) and was longer for patients with bilateral retinoblastoma (median, 2.2 vs. 0.2 months; P = 0.034). Twenty enucleated eyes (71%) did not show high-risk pathologic features. Seventeen eyes with advanced intraocular disease were enucleated at the time of presentation, whereas chemoreduction was attempted for the other 19 eyes with advanced intraocular disease. Enucleation was then recommended for nine (47%) of those eyes. Enucleation at the time of diagnosis was feasible for most patients with advanced disease. Attempted salvage of eyes with advanced disease is justified, particularly in patients with bilateral disease. We were able to salvage almost half of these eyes. We hope our study provides new insights for counseling patients.

Improved care of rhabdomyosarcoma in Jordan using less intensive therapy

“…Although there was a higher male/female ratio in this study, this does not reflect the referral pattern at our institution. None of the patients with RMS treated at KHCC reported abandonment of care, which is similar to what has been reported for patients treated for other malignancies at the center [11][12][13]. A multidisciplinary team comprising of pediatric oncologists, pediatric surgeons, radiation oncologists, radiologists, pathologists, and psycho-social team was formed in 2006 and meets biweekly to discuss the care of children with solid tumors and sarcoma.…”

SIOP‐PODC recommendations for graduated‐intensity treatment of retinoblastoma in developing countries

“…In developed countries, patients with unilateral disease can be cured by enucleation of the affected eye, whereas those with bilateral disease undergo eye‐conserving therapies in at least on one eye. Enucleation is a relatively simple surgical procedure that requires no special facility or equipment and is potentially available in centers with limited resources 3. However, even children who could be cured by enucleation, present with substantial challenges in developing countries.…”

Bilateral enucleation for retinoblastoma: A study of 14 patients

“…After invading these structures, the disease often metastasizes to the central nervous system. [ 1 ] If the disease is left untreated, it can metastasize to the brain within 1 or 2 years of diagnosis.…”

“…The current main modalities of treatment of intraocular RB comprise transpupillary thermotherapy, cryotherapy, plaque radiotherapy, intravenous chemotherapy, intra-arterial chemotherapy, intravitreal chemotherapy, subtenon's chemotherapy, external-beam radiotherapy (rarely used currently), and enucleation. [ 1 2 3 4 5 6 7 8 9 10 ] Intravenous chemoreduction has been popular for nearly three decades and continues to provide favorable tumor control for most eyes classified as Groups A, B, or C and some D eyes, using the International Classification of RB. Intra-arterial chemotherapy involves the injection of chemotherapeutic agent into the ophthalmic artery under neurointerventional guidance.…”