Conference Proceeding

Retinoblastoma - pattern, presentation and management – a quintessential experience of 5 years

Dr. Anvesh Karthik Yalavarthy,
Vydehi Institute of Medical Sciences and Research Center, India

Retinoblastoma is the most common primary intraocular malignancy of childhood.

Dr. Anvesh Karthik Yalavarthy is a Fellow in Medical Oncology at Vydehi Institute of Medical Sciences & Research Institute, Bengaluru, India. He graduated M.D. General Medicine from Sri Ramachandra University, Chennai, India. He has been a university topper and received gold medals for his merit. He did his clerkship at Massachusetts General Hospital, under Harvard Medical School, USA.

Background: Retinoblastoma is the most common primary intraocular malignancy of childhood. The diagnosis is mainly clinical, but histology determines the diagnosis and the extent of the tumour. Prompt referral and appropriate management by a multidisciplinary team are necessary to optimize visual outcome and survival.
Objective: To determine the pattern of presentation and management of retinoblastoma patients at a tertiary cancer care centre in South India, during a period of 5 years (1st November 2009 to 1st December 2014).
Materials and Methods: The study is a retrospective case series. It was carried out primarily by identifying the hospital number of relevant records of retinoblastoma patients from attendance, admission and discharge/death at the cancer care centre. The hospital number was used to retrieve relevant files from the records department with the help of a records clerk. Relevant clinical information recorded was extracted and entered into a structured data excel sheet for analysis. Information sought is demographic characteristics, clinical presentation, investigations done, the methods of management of retinoblastoma patients and the discharge/death records.
Analysis: Data collected was analyzed. Descriptive statistics were used to summarize the data and results were presented.
Results: Total number of cases studied was 31. Out of which, 18 (58%) were female and 13 (42%) were male. Of the 31 cases, 16 (52%) had bilateral involvement and 15 (48%) had unilateral involvement. Age of onset of 13 (42%) cases was less than or equal to 12 months. Age of onset of 11 (35%) was between more than 12 months to less than or equal to 36 months. Age of onset of 7 cases (22%) was more than 36 months. History of consanguinity in the parents was found in 2 cases (6.5%). Both of these cases had bilateral eye involvement. The commonest mode of presentation was a white reflex in the eye (17out of 31 cases 55%). Other presentations included defective vision and swelling of the eye. Out of 47 eyes studied, 1 (2%) was in Group A, 1 (2%) was in Group B, 4 (9%) were in Group C, 14 (30%) were in Group D and 27 (57%) were in Group E. Out of the 47 eyes, 20 (43%) eyes were enucleated. Out of 47 eyes, 13 (28%) eyes were irradiated. 7 (23%) out of 31 cases were metastatic at presentation. Out of the 10 metastatic eyes, 5 eyes were Group D and 5 eyes were Group E. 6 (19%) out of 31 cases succumbed to death.
Conclusion: Retinoblastoma continues to be a challenge both diagnostically and therapeutically. Many factors enter into management decisions such as patient age, tumor laterality, size, location, and extent, and anticipated visual prognosis. Chemotherapy has changed the approach to retinoblastoma in recent years and have permitted many children to maintain their eye(s) and avoid external beam radiotherapy. E-nucleation still proves to be useful for advanced tumor.

Published: 11 May 2017