Prognostic factors and treatment outcomes of retinoblastoma in pediatric patients: a single-institution study.
OBJECTIVE
Since 1997, our institute has used neoadjuvant chemotherapy for intraocular retinoblastoma. However, some of the patients showed signs of recurrence months to years later. We therefore attempted to determine the prognostic factors of treatment outcomes and survival in our patients.


METHODS
We reviewed 90 patients treated from 1997 to 2006. The following information was recorded: demographic and ophthalmological data, clinical classification, histopathological data, and treatment methods and outcomes.


RESULTS
Enucleation was avoided in two of 57 eyes in the unilateral group. Sixteen of 54 eyes in the bilateral group were salvaged by systemic chemotherapy with local treatment. There was no difference in histopathological findings between the two groups. Nine of 57 patients in the unilateral group demonstrated poor outcomes, compared with four of 27 in the bilateral group. Significant poor prognostic factors for survival were optic nerve head invasion, orbital involvement, abnormal results on bone marrow aspiration, lumbar puncture, bone scan, and group E or F classification.


CONCLUSIONS
The 15% mortality rate in our patients is slightly higher than that reported in developed countries. Delayed diagnosis and treatment is the main cause of avoidable deaths. Improving education of both clinicians and parents would increase survival rates in this potentially fatal disease.
Atchaneeyasakul
La-Ongsri
LO
Department of Ophthalmology, Siriraj Hospital Mahidol University, Bangkok, Thailand. atchanee@hotmail.com.|Department of Ophthalmology, Siriraj Hospital Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand. atchanee@hotmail.com.
Wongsiwaroj
Chutima
C
Department of Ophthalmology, Siriraj Hospital Mahidol University, Bangkok, Thailand.
Uiprasertkul
Mongkol
M
Department of Pathology, Siriraj Hospital Mahidol University, Bangkok, Thailand.
Sanpakit
Kleebsabai
K
Department of Pediatrics, Siriraj Hospital Mahidol University, Bangkok, Thailand.
Thephamongkhol
Kullathorn
K
Department of Radiology, Siriraj Hospital Mahidol University, Bangkok, Thailand.
Trinavarat
Adisak
A
Department of Ophthalmology, Siriraj Hospital Mahidol University, Bangkok, Thailand.
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D017679:Cryotherapy; D005047:Etoposide / Q000627:therapeutic use; D015353:Eye Enucleation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007223:Infant; D017075:Laser Coagulation; D008297:Male; D011379:Prognosis; D019572:Retinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012175:Retinoblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
D014750:Vincristine; D005047:Etoposide; D016190:Carboplatin