Modes of presentation, management and outcome of retinoblastoma treatment at University Teaching Hospital

Abstract

Objectives: To establish the presentation, management and short-term outcomes of retinoblastoma treatment at UTH from January 2006- December 2012. treatment outcomes 6 months after initiation of treatment at The statistical analyses were performed using the statistical package SPSS version 20.

Method: This was a retrospective case series study of the modes of presentation, management of retinoblastoma and UTH from January 2006- December 2012. The data was collected from registers for the eye unit inpatient and outpatient, histopathology laboratory, pediatric oncology department as well as patients' files. The data collected included demographics, clinical presentation, histopathology reports, treatment modalities, and treatment outcome at 6 months after initiation of treatment.

Results: There were 57 African participants in the study of which 26 (45.6%) were males and 31 (54.4%) were females. The youngest was 0.75 months old while the oldest was 132 month old. The average age of the participants was 31.1 months old (with a standard deviation of 21.96). The average time lag from the onset of symptoms to treatment at UTH was 9.27 months with a minimum of one month and a maximum of 36 months. 71.2% had unilateral retinoblastoma, 28.8% had bilateral retinoblastoma however no trilateral retinoblastoma was observed. The most common presentations were proptosis (47.3%), leukocoria (36.8%), phthisis bulbi (4%), hyphema (2%), orbital cellulitis (1%) and uveitis (1%). The common treatment regimens were enucleation and chemotherapy (28.8%), exenteration and  chemotherapy (15%), enucleation, chemotherapy and radiotherapy (3.4%). Moreover, 8.5% had enucleation only whilst 3.4% had exenteration, chemotherapy and radiotherapy treatment regimen. In the study, the treatment outcomes 6 months post initiation of treatment were abandoned treatment 17.5%, while 49.2% died and 33.3% were alive.

Conclusion: The common presentation was proptosis (47.3%) and leukocoria (36.8%). The most common treatment outcome was death, alive followed by abandonment treatment. Treatment was completed in 22% of the participants. Delay in diagnosis of retinoblastoma remains a challenge as seen in the study by the high mean lag time and late presentation. The diagnosis of retinoblastoma from the referral centers was accurate in 50 % of the patients. Awareness of retinoblastoma to primary health care givers and parents will help to improve early referrals. Further, we recommend the integration of knowledge of retinoblastoma into the curriculum of primary health care giver to facilitate quick referral of patient.

Keywords: Retinoblastoma, outcomes, management, lag time, modes of presentation