title: Team management, twinning, and telemedicine in retinoblastoma: a 3-tier approach implemented in the first eye salvage program in Jordan.
abstract: BACKGROUND
  This study evaluated the outcome of retinoblastoma patients, when employing a telemedicine-based twinning program in Jordan.
  
  
  METHODS
  This cohort study included patients at the King Hussein Cancer Centre (KHCC; Amman, Jordan) who received consultations for retinoblastoma from March 2003 to September 2006. A collaborative program was established with the International Outreach Program at St. Jude Children's Research Hospital in Memphis, Tennessee. Cases were discussed using an Internet consultation service where fundus images, clinical history, and proposed treatment were reviewed. Selected cases were further discussed via videoconferencing and electronic mail.
  
  
  RESULTS
  Thirty-three children with retinoblastoma (20 bilateral) were treated at KHCC. The median age at diagnosis was 7 months for patients with bilateral retinoblastoma and 35 months for patients with unilateral retinoblastoma. Of the 20 patients with bilateral disease, 12 were newly diagnosed and 8 had received prior treatment. Our success in the bilateral cases was most evident in the previously untreated group, in which only six eyes (25%) were enucleated and four eyes (17%) were irradiated. Of the 13 patients with unilateral retinoblastoma, 12 underwent enucleation, and 6 required radiation. Neither group experienced mortality.
  
  
  CONCLUSIONS
  Twinning has positively impacted survival and ocular salvage in Jordan. By partnering a team of professionals with mentors willing to provide close supervision, the highly specialized management of retinoblastoma can be successfully implemented in a developing country.
authors.affiliation: Department of Pediatric Oncology, King Hussein Cancer Centre (KHCC), Amman, Jordan. ibrahim.qaddoumi@stjude.org
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Qaddoumi
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Nawaiseh
authors.forename: Mustafa
authors.initials: M
authors.lastname: Mehyar
authors.forename: Bassem
authors.initials: B
authors.lastname: Razzouk
authors.forename: Barrett G
authors.initials: BG
authors.lastname: Haik
authors.forename: Saamir
authors.initials: S
authors.lastname: Kharma
authors.forename: Imad
authors.initials: I
authors.lastname: Jaradat
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez-Galindo
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Wilson
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010348:Patient Care Team; D012017:Referral and Consultation; D019572:Retinal Neoplasms / Q000628:therapy*; D012175:Retinoblastoma / Q000628:therapy*; D017216:Telemedicine