title: Development of retinoblastoma programs in Central America.
abstract: BACKGROUND
  Retinoblastoma, a curable eye tumor, is associated with poor survival in Central America (CA). To develop a retinoblastoma program in El Salvador, Guatemala, and Honduras, twinning initiatives were undertaken between local pediatric oncology centers, nonprofit foundations, St. Jude Children's Research Hospital, and the University of Tennessee Hamilton Eye Institute.
  
  
  METHODS
  The retinoblastoma program focused on developing early diagnosis programs in Honduras with national vaccination campaigns, developing treatment protocols suited to local conditions, building local networks of oncologists and ophthalmologists, training local healthcare providers, using modern donated equipment for diagnosis and treatment, and the ORBIS Cybersight consultation program and Internet meetings to further education and share expertise. Pediatric ophthalmologists and oncologists worked with foundations to treat patients locally with donated equipment and Internet consultations, or at the center in Guatemala.
  
  
  RESULTS
  Number of patients successfully treated increased after the program was introduced. For 2000-2003 and 2004-2007, patients abandoning/refusing treatment decreased in Guatemala from 20 of 95 (21%) to 14 of 123 (11%) and in Honduras from 13 of 37 (35%) to 7 of 37 (19%). Survival in El Salvador was good and abandonment/refusal low for both periods. Of 18 patients receiving focal therapy for advanced disease, 14 have single remaining eyes.
  
  
  CONCLUSIONS
  Development of the program in CA has decreased abandonment/refusal and enabled ophthalmologists at local centers to use modern equipment to provide better treatment. This approach might serve as a guide for developing other multispecialty programs.
authors.affiliation: International Outreach Program and Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. judith.wilimas@stjude.org
authors.forename: Judith A
authors.initials: JA
authors.lastname: Wilimas
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Wilson
authors.forename: Barrett G
authors.initials: BG
authors.lastname: Haik
authors.forename: Margarita
authors.initials: M
authors.lastname: Barnoya
authors.forename: Ligia
authors.initials: L
authors.lastname: Fu
authors.forename: Mauricio
authors.initials: M
authors.lastname: Castellanos
authors.forename: Miguel
authors.initials: M
authors.lastname: Bonilla
authors.forename: Blanca
authors.initials: B
authors.lastname: Phillips
authors.forename: Eugene M
authors.initials: EM
authors.lastname: Helveston
authors.forename: Sandra
authors.initials: S
authors.lastname: Luna-Fineman
authors.forename: Raul
authors.initials: R
authors.lastname: Ribeiro
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez-Galindo