title: Improving survival of retinoblastoma in Uganda.
abstract: BACKGROUND
  Diagnostic delay results in relatively high mortality among children with retinoblastoma in Uganda, where treatment was limited to surgery and, for some, radiotherapy. In order to improve outcomes, a simple programme of neoadjuvant and adjuvant chemotherapy was introduced. Here we report survival before and after this change to medical practice.
  
  
  METHODS
  Affordable standard off-patent chemotherapy agents were administered by trained paramedical staff to groups of patients at the same time. Survival before and after the introduction of chemotherapy was monitored. Between 2006 and 2013 a total of 270 patients with retinoblastoma were included, 181 treated prior to chemotherapy and 89 after (beginning in 2009). We had 94% follow-up and 249 had histological verification of diagnosis.
  
  
  RESULTS
  Using a proportional hazards model adjusted for age, sex and laterality, children treated after chemotherapy was introduced had a 37% lower risk of dying (HR 0.63, 95% CI 0.41 to 0.99) compared with children treated before. Prior to the introduction of chemotherapy only 15% of children who survived bilateral disease retained vision after treatment compared with 71% after chemotherapy.
  
  
  CONCLUSIONS
  The introduction of chemotherapy proved safe and cost-effective in non-specialist hands and was associated with significant improvements in survival and, among bilateral cases, in preserving vision.
authors.affiliation: Ruharo Eye Hospital, Mbarara, Uganda Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Waddell
authors.affiliation: Ruharo Eye Hospital, Mbarara, Uganda Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kagame
authors.affiliation: Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ndamira
authors.affiliation: Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Amos
authors.initials: A
authors.lastname: Twinamasiko
authors.affiliation: Departments of Ophthalmology and Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Susan V
authors.initials: SV
authors.lastname: Picton
authors.affiliation: Departments of Ophthalmology and Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Simmons
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Revill
authors.affiliation: Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK.
authors.forename: W Tom
authors.initials: WT
authors.lastname: Johnston
authors.affiliation: Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Research Unit on AIDS, Entebbe, Uganda International Agency for Research on Cancer, Lyon, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Newton
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D018572:Disease-Free Survival; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D020360:Neoadjuvant Therapy; D016016:Proportional Hazards Models; D019572:Retinal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D012175:Retinoblastoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate; D014454:Uganda / Q000453:epidemiology; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D014750:Vincristine; D005047:Etoposide; D016190:Carboplatin
keywords: Epidemiology; Retina