Retinoblastoma: changing trend in a tertiary eye centre

Lama, Ang Jangmu; Gurung, Hom Bahadur; Limbu, Ben; Brown, Hamish E.; Saiju, Rohit

doi:10.18231/j.idjsr.2019.059

Cited by 2 publications

(5 citation statements)

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“…21,26,30 Of the total 34, 14 (41.2%) patients had undergone primary enucleation which is lower than that reported in previous studies in Nepal (51-90%). 8,9,25 The primary enucleation for RB was found to be similar in India (35%), Indonesia (22%), and Mongolia (61%). 26,30,33 However, more than 50% of newly diagnosed cases were planned for primary enucleation.…”

Section: Discussionmentioning

confidence: 96%

“…None of our cases underwent exenteration while other previous studies have reported exenteration rates ranging from 5 to 38%. 8,9,25 Out of 34, 23 (67%) patients were referred to a higher center for further treatment. The most common reason for referral was for systemic chemotherapy (82.6%) which is available only in few medical colleges and government hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…However, none of the patients had received TTT and cryotherapy for RB in previous studies in Nepal. 8,9,25,34 This indicates that management of RB is shifting toward a conservative treatment modality due to early presentation and availability of conservative measures. Other modalities of treatment like genetic screening and counseling, brachytherapy, and intra-arterial chemotherapy are not available in our country, so we have to refer some cases abroad.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 In the context of Nepal, chemotherapy is limited to certain centers, and focal therapy like transpupillary thermotherapy (TTT), laser, and cryotherapy are available only in major cities. 9 Other advanced treatment modalities like genetic screening and counseling, intra-arterial chemotherapy, and brachytherapy are not available throughout the nation.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiological and Clinical Presentation of Retinoblastoma among Nepalese Children in 2019

Limbu

Kafle

Lamichanne

et al. 2022

South Asian J Cancer

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Objectives Retinoblastoma (RB) is rare but potentially fatal if left untreated. This study aimed to evaluate the epidemiological profile, clinical manifestation, classification, and affordability of RB treatment among Nepalese children in the year 2019. Materials and Method A multicentric, multiethnic hospital-based cross-sectional study after ethical approval from the National Health Research Council was conducted from January 2019 to December 2019 by incorporating ophthalmologists all over the nation. Twenty-seven RB centers were selected. All the RB presented in the RB centers either newly diagnosed or ongoing treatment consented to the study were included and failed to consent for the study, RB survivors were excluded from the study. Data based on demographic profile, clinical manifestation, ethnical and geographical distribution, and treatment received were collected in the customized Google Form. Each case was classified at the time of diagnosis as per the International Classification of Retinoblastoma groups and different treatment modalities offered as per grouping and staging. The affordability of treatment was calculated using a catastrophic approach. Statistical Analysis Data were entered into Microsoft Excel 2010 and analyzed using Statistical Package for Social Sciences version 20. Result A total of 34 RB cases, 21 (61.76%) in ongoing treatment group and 13 (38.2%) in newly diagnosed group presented in the RB centers. Out of total, 32 (64.7%) had unilateral and 12 (35.3%) cases had bilateral involvement. The majority of patients was from Province 1 (35.3%) and belonged to the upper caste (38.2%). Leukocoria was the most common presentation (73.9%) followed by proptosis, red eye, and phthisis bulbi. More than 75% patients presented at advanced group D (54%) and E (21%) and stage 0 (90%). More than 90% of patients received systemic chemotherapy, and 42.6% received transpupillary thermotherapy. The average cost of RB treatment was estimated to be 521% of the nonfood expense of the family which is unaffordable to almost all cases (100%). Conclusion Leukocoria is the most common mode of clinical presentation in both unilateral and bilateral RBs. Early diagnosis and appropriate treatment are key to success for saving life, sight, and eye. However, community awareness programs against RB, active referral networks, and the establishment of chemotherapy centers with trained human resources are needed to reduce loss of life, sight, and eye.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Epidemiological and Clinical Presentation of Retinoblastoma among Nepalese Children in 2019

Limbu

Kafle

Lamichanne

et al. 2022

South Asian J Cancer

Self Cite

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“…28 A similar pattern of improved globe and patient survival has been observed in developing countries implementing a multidisciplinary approach and new treatment modalities. [29][30][31][32] Although IAC and IVitC have been proven to be effective in globe salvaging, especially in group D and E disease 33 and refractory vitreous seeding, 34 they have sometimes been associated with significant adverse events. Systemic and local toxic side effects, such as neutropenia, cranial nerve palsy, periorbital edema, vitreous hemorrhage, and diffuse chorioretinal atrophy are reported as complications of IAC.…”

Section: Discussionmentioning

confidence: 99%

Targeted chemotherapy in retinoblastoma: A step forward from patient survival to globe survival

Naseripour

Sedaghat

Mirshahi

et al. 2022

European Journal of Ophthalmology

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Background/ Objectives Despite being the most common intraocular malignancy in childhood, there is a substantial disparity between developing and developed countries in terms of patient and globe survival in retinoblastoma (Rb). The current study intends to determine patient and globe survival before and after the introduction of the new targeted treatment modalities in a developing country. Methods Medical records of 350 patients (516 eyes) with retinoblastoma referred to a tertiary referral center for Rb in Tehran, Iran, were reviewed. In order to compare patient and globe survival before and after the availability of the new treatment modalities, including intra-arterial and intravitreal chemotherapy, the patients were divided into group 1 (2001–2007) and group 2 (2008–2018) based on the calendar period of diagnosis. Results Two-hundred-twenty-three eyes of 149 patients and 293 eyes of 201 patients were categorized into groups 1 and 2, respectively. The 5-year patient survival was 97% across the current survey, and the overall survival rate was 96% in group 1 and 99% in group 2 (P = 0.08). Overall, 50% of eyes with retinoblastoma underwent enucleation, which was the primary in 63% (116/184) of the unilateral and 30% (99/322) of the bilateral cases. Primary enucleation was significantly lower in group 2 (35%) in contrast to group 1 (50%) (P < 0.001). In addition, globe survival improved significantly in the International Classification of Retinoblastoma Groups D (17% in group 1 vs. 66% in group 2, P < 0.001) and E (1% in group 1 vs. 23% in group 2 P < 0.001) during the two timelines. In enucleated eyes, despite the increased rate of prelaminar involvement in group 2 (13% vs. 2% in group 1, P = 0.003), the rate of high-risk histopathologic findings was similar between the two groups. Conclusion Similar to developed countries, the application of new targeted treatment modalities, including intra-arterial and intravitreal chemotherapy, has been associated with significantly improved globe survival in Rb patients. However, it should be noted that even with the availability of these novel treatment options, the decision for on-time enucleation should not be deferred.

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Retinoblastoma: changing trend in a tertiary eye centre

Cited by 2 publications

References 0 publications

Epidemiological and Clinical Presentation of Retinoblastoma among Nepalese Children in 2019

Epidemiological and Clinical Presentation of Retinoblastoma among Nepalese Children in 2019

Targeted chemotherapy in retinoblastoma: A step forward from patient survival to globe survival

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