A 12-year epidemiological review of retinoblastoma in Omani children

Retinoblastoma and uveal melanoma in Jordan: incidence, demographics, and survival (2011-2020)

PURPOSE

We present an epidemiologic analysis of retinoblastoma (RB) and uveal melanoma (UM) in Jordan to aid national strategies for improved ocular cancer surveillance and control.

METHODS

A retrospective cohort of all Jordanian patients with RB and UM diagnosed over 10 years (2011-2020). Outcome measures included incidence, demographics, and outcomes.

RESULTS

Retinoblastoma (n = 124) was more common than UM (n = 82); there was no sex predilection for either group. The median age at diagnosis of RB was 15 months(Six and 28 months for bilateral and unilateral cases, respectively), and the mean age-adjusted incidence was 8.2 cases per-million-children per year for children aged five years or less(one per 15,620 newborn per year). Fifty-one(41%) had bilateral disease, and 18(15%) had familial disease. Ninety-six(55%) eyes were group D or E(78% were T3/T4), and the five-year survival rate was 96%.For UM, the median age at diagnosis was 45 years with an incidence of 1.39 new cases per year per one million population. All(100%) had nonfamilial unilateral disease. Seventy-three(89%) had the tumor in the choroid, and 48(58%) had an advanced tumor that had invaded the sclera or the orbit (T3/T4) tumor. Sixty-two(76%) were treated by I-125 radioactive plaque, with globe salvage in 59(95%); the five-year survival rate was 85%.

CONCLUSION

In Jordan, RB is more common and has better survival than UM. RB in Jordan and Western countries is equal in terms of incidence, globe salvage, and survival. UM is less common, with lower age at diagnosis (that was associated with better survival) in Jordan than in Western countries.

Incidence of retinoblastoma in children and adolescents in Brazil: A population-based study

OBJECTIVE

To estimate the incidence of retinoblastoma in children and adolescents in Brazil based on Population-Based Cancer Registry (PBCR), describing temporal trends and some quality indicators of this registry.

METHODS

Based on secondary data from the PBCR of the National Institute of Cancer (INCA) (2000-2018), by selecting the morphological code of retinoblastoma, the annual incidences per million (0-19 years of age) in each local PBCR were estimated by sex and age group, global combined and by region, in addition to the percentage of diagnosis only by death certificate (DC) or not informed (NI), and the male/female ratio (M/F). An annual incidence trend in the five Brazilian geographic regions was also analyzed using the inflection point regression technique.

RESULTS

675 patients were identified in 28 PBCR, 91% between 0 and 4 years of age. The overall combined incidence per million by age group was: 7.02 (0-4 years old), ranging from 5.25 in the Midwest to 11.26 in the Northeast; 0.46 (5-9 years old); 0.05 (10-14 years old) and 0.03 (15-19 years old). The combined incidence per million, adjusted for the world population, was 2.23 (0-14 years old) and 2.24 (0-19 years old). The DC and NI percentages were 13% and 18%, respectively; the M/F ratio was 1.3. The incidence remained stable throughout the study period, except for the city of São Paulo, where there was a significant reduction of 3.4% per year.

CONCLUSIONS

In Brazil, except for the Northeast region, the incidences of retinoblastoma were lower than those reported in several countries worldwide, suggesting possible underreporting, and the time series analysis showed a stable trend. Although this pioneering study brings a recent panel of available data on retinoblastoma in Brazil, more precise estimates are needed and welcome for better planning of onco-ophthalmologic care in the country.

Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. "Alive, with good vision and no comorbidity"

Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.

Retinoblastoma in the United States: A 40-Year Incidence and Survival Analysis

PURPOSE

To determine the incidence of retinoblastoma in the United States from 1973 to 2012 (40 years) and characterize the 5-year overall survival rate of the included patients.

METHODS

Cases of retinoblastoma were derived from the Surveillance, Epidemiology, and End Results (SEER) Program (National Cancer Institute, Rockville, MD). Incidence rates were calculated using U.S. Census Bureau data as the standard population, and trends over time were determined using the chi-square test. Hazard ratios with a 95% confidence interval (CI) were estimated for variables associated with mortality using Cox regression models. Survival rates were calculated using the Kaplan-Meier method and compared among different clinical and demographic categories.

RESULTS

A total of 879 cases of retinoblastoma were derived from the SEER databases. The annual incidence rates of retinoblastoma for a period of 40 years were 12.14 (95% CI: 11.32 to 12.96) cases per 1 million children 4 years or younger and 0.49 (95% CI: 0.36 to 0.65) cases per 1 million children between the ages of 5 and 9 years. There was no significant trend for children 4 years or younger (P = .6324) or between the ages of 5 and 9 years (P = .7695). The 5-year overall survival rates were 97.6%, 92.7%, 91.1%, and 96.4% for children diagnosed at the first, second, third, and after the third year of life, respectively (P = .0136). The 5-year overall survival rates were 92.5% for bilateral and 96.3% for unilateral cases (P = .0116). The 5-year overall survival rates were 90.8%, 92.5%, 97.6%, 97.3% for increasing time intervals (1973 to 1979, 1980 to 1989, 1990 to 1999, and 2000 to 2012, respectively; P = .0017).

CONCLUSIONS

The incidence rate of retinoblastoma in the United States has remained stable for the past 40 years. Survival rate analysis indicates a significant effect of laterality of tumor, age at diagnosis, and decade of diagnosis. [J Pediatr Ophthalmol Strabismus. 2018;55(3):182-188.].

Paediatric retinoblastoma in India: evidence from the National Cancer Registry Programme

BACKGROUND

Globally, retinoblastoma is the most common primary intraocular malignancy occurring in children. This paper documents the recent incidence rates of retinoblastoma by age and sex groups from the Population Based Cancer Registries (PBCRs) of Bangalore, Mumbai, Chennai, Delhi and Kolkata using the data from the National Cancer Registry Programme.

MATERIALS AND METHODS

Relative proportions, sex ratio, method of diagnosis, and incidence rates (crude and age standardized) for each PBCR and pooled rates of the five PBCRs were calculated for the years 2005/06 to 2009/10. Standard errors and 95% confidence limits of ASIRs by sex group in each PBCR were calculated using the Poisson distribution. Standardised rate ratios of ASIR by sex group and rate ratios at risk were also calculated.

RESULTS

The maximum retinoblastoma cases were in the 0-4 age group, accounting for 78% (females) and 81% (males) of pooled cases from five PBCRs. The pooled crude incidence rate in the 0-14 age group was 3.5 and the pooled ASIR was 4.4 per million. The pooled ASIR in the 0-4, 5-9 and 10-14 age group were 9.6, 2.0 and 0.1 respectively. The M/F ratio in Chennai (1.9) and Bangalore PBCRs (2.0) was much higher than the other PBCRs. Among the PBCRs, the highest incidence rate in 0-4 age group was found in males in Chennai (21.7 per million), and females in Kolkata (18.9 per million). There was a distinct variation in incidence rates in the PBCRs in different geographic regions of India.

[Retinoblastoma in Kenya: survival and prognostic factors]

BACKGROUND

In industrialized nations a curative therapy of retinoblastoma can be achieved in a large number of patients due to timely diagnosis and therapy. In developing countries the survival rates are much lower and very little data have been published especially from Africa.

OBJECTIVES

This study was performed to investigate the survival and prognostic factors of retinoblastoma patients admitted to Kenyatta National Hospital, the national referral hospital in Kenya.

MATERIAL AND METHODS

In this study all records of patients admitted with retinoblastoma from January 2000 to December 2004 were reviewed. Demographic data, clinical presentation, intraoperative findings and histology reports were recorded and the patients or their relatives were contacted during follow-up to investigate the outcome and survival.

RESULTS

Files of 160 patients (86 males and 74 females) were retrieved for this study. Data on 3-year survival could be acquired from 105 patients and the cumulative 3-year survival rate was 26.6 %. Factors significantly influencing survival were age at presentation less than 12 months, early disease at presentation (leukocoria only), no extraocular growth and total delay of management ≤ 5 months. Proptosis and tumor recurrence were associated with a 3-year mortality of 100 %.

CONCLUSION

The main reasons for poor outcome were late presentation and recurrent disease after initial treatment elsewhere, extraocular growth and delay between initial presentation and treatment. Awareness of the public and of healthcare workers should be increased in order to reduce the time delay until diagnosis and treatment.

Characteristics and clinical presentations of pediatric retinoblastoma in North-western Iran

AIM

To report the characteristics and clinical presentations of retinoblastoma in a series of pediatric patients from Iran.

METHODS

In this retrospective study, profiles of pediatric patients with retinoblastoma archived in a referral eye hospital in north-west of Iran during 7 years (n=40 patients with 57 eyes) were reviewed. Demographics, as well as the laterality, clinical manifestations and the types of treatment were the major endpoints. The Student's t test, Mann-Whitney U-test, Chi-square or Fishers' Exact test was used for analysis where appropriate.

RESULTS

There were 23 cases (57.7%) with unilateral and 17 cases (42.5%) with bilateral involvement. The male to female ratio was 1 to 1.4 with a mean admitting age of 24.0±11.3 (range: 5-62) months. The mean diagnosis delay was 7.4±9.6 months (range: 10 days to 13 months). The most common presenting sign was leukocoria (97.5%) followed by proptosis (7.5%), strabismus (7.5%), hyphema (5%), orbital cellulitis (5%) and glaucoma (2.5%). Enucleation was performed in 95.7% of the cases with unilateral involvement and at least one eye of the patients with bilateral disease. A second enucleation was performed in other 3 patients (17.6%) of the latter group.

CONCLUSION

This is the first study evaluating a series of Iranian children with retinoblastoma.