Retinoblastoma in Asia: Clinical Presentation and Treatment Outcomes in 2112 Patients from 33 Countries

Kaliki S. Vempuluru V.S. Mohamed A. Al-Jadiry M.F. Bowman R. Chawla B. Hamid S.A. Ji X. Kapelushnik N. Kebudi R. Sthapit P.R. Rojanaporn D. Sitorus R.S. Yousef Y.A. Fabian I.D. Abdulqader R.A. Aggarwal P. Ahmad A. Akib M.N.R. Al Mesfer S.A. Al Ani M.H. Al-Badri S.A.F. Angeles Alcasabas A.P. Al-Dahmash S.A. Al-Haddad C. Yahya Al-Hussaini H.H. Al-Jumaily U. Alkatan H.M. Razzaq Mahmood Al-Mafrachi A.A. Samad Majeed Al-Shaheen A.A. Al-Shammary E.H. Amiruddin P.O. Armytasari I. Astbury N.J. Atalay H.T. Ataseven E. Atchaneeyasakul L.-O. Balayeva R. Bascaran C. Begimkulova A.S. Bhaduri A. Bhat S. Bhattacharyya A. Blum S. Buaboonnam J. Burton M.J. Caspi S. Chaudhry S. Chen W. Chuluunbat T. Dangboon W. Das A. Das P. Das S. Du Y. Dudeja G. Eka Sutyawan I.W. Fadoo Z. Faranoush M. Foster A. Frenkel S. Ghassemi F. Gomel N. Gunasekera D.S. Gündüz A.K. Gupta H. Gupta S. Gupta V. Hamzah N. Hasanreisoglu M. Hassan S. Haydar H.A. Hongeng S. Hussein Al-Janabi A.N. Islamov Z. Janjua T.A. Jeeva I. Jo D.H. Kantar M. Keomisy J. Khan Z.J. Khaqan H.A. Khetan V. Khodabande A. Kim J.H. Kiratli H. Koç I. Kulvichit K. Kuntorini M.W. Li C. Li K. Limbu B. Liu C. Lutfi D. Mahajan A. Maitra P. Makimbetov E.K. Maktabi A.M.Y. Manzhuova L. Masud S. Mehrvar A. Menon V. John V Mercado G. Chandra Mishra D.K. Mohammad M.T. Mudaliar S.S. Mushtaq A. Nair A.G. Natarajan S. Nency Y.M. Neroev V. Nuruddin M. Pagarra H. Palanivelu M.S. Papyan R. Peer J. Polyakov V. Qadir A.O. Qayyum S. Qian J. Quah B. Rahman A. Rajkarnikar P. Ramanjulu R. Rashid R. Roy S.R. Saab R.H. Saakyan S. Sabhan A.H. Saiju R. Sayalith P. Sedaghat A. Seth R. Shakoor S.A. Sharma M.K. Siddiqui S.N. Singh U. Singha P. Soebagjo H.D. Sultana S. Sun X. Supriyadi E. Surukrattanaskul S. Suzuki S. Tan D. Tang J. Tashvighi M. Teh K.H. Tehuteru E.S. Thawaba A.D.M. Toledano H. Le Trang D. Tripathy D. Tuncer S. Unal E. Ushakova T.L. Usmanov R. Verma N. Victor A.A. Vishnevskia-Dai V. Wang Y.-Z. Wangtiraumnuay N. Riono W.P. Wiwatwongwana A. Wiwatwongwana D. Wong E.S. Wongwai P. Wu S.-Q. Xiang D. Xiao Y. Xu B. Xue K. Yam J.C. Yang H. Yaqub M.A. Yarovaya V.A. Yarovoy A.A. Ye H. Yuliawati P. Zhang Y. Zia N. Zondervan M.
April 2024 Elsevier Inc.

Ophthalmology
2024 #131 Issue 4 468 - 477 pp.

Purpose: To describe the clinical presentation and treatment outcomes of children who received a diagnosis of retinoblastoma in 2017 throughout Asia. Design: Multinational, prospective study including treatment-naïve patients in Asia who received a diagnosis of retinoblastoma in 2017 and were followed up thereafter. Participants: A total of 2112 patients (2797 eyes) from 96 retinoblastoma treatment centers in 33 Asian countries. Interventions: Chemotherapy, radiotherapy, enucleation, and orbital exenteration. Main Outcome Measures: Enucleation and death. Results: Within the cohort, 1021 patients (48%) were from South Asia (SA), 503 patients (24%) were from East Asia (EA), 310 patients (15%) were from Southeast Asia (SEA), 218 patients (10%) were from West Asia (WA), and 60 patients (3%) were from Central Asia (CA). Mean age at presentation was 27 months (median, 23 months; range, < 1–261 months). The cohort included 1195 male patients (57%) and 917 female patients (43%). The most common presenting symptoms were leukocoria (72%) and strabismus (13%). Using the American Joint Committee on Cancer Staging Manual, Eighth Edition, classification, tumors were staged as cT1 (n = 441 [16%]), cT2 (n = 951 [34%]), cT3 (n = 1136 [41%]), cT4 (n = 267 [10%]), N1 (n = 48 [2%]), and M1 (n = 129 [6%]) at presentation. Retinoblastoma was treated with intravenous chemotherapy in 1450 eyes (52%) and 857 eyes (31%) underwent primary enucleation. Three-year Kaplan-Meier estimates for enucleation and death were 33% and 13% for CA, 18% and 4% for EA, 27% and 15% for SA, 32% and 22% for SEA, and 20% and 11% for WA (P < 0.0001 and P < 0.0001), respectively. Conclusions: At the conclusion of this study, significant heterogeneity was found in treatment outcomes of retinoblastoma among the regions of Asia. East Asia displayed better outcomes with higher rates of globe and life salvage, whereas Southeast Asia showed poorer outcomes compared with the rest of Asia. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Asia , Eye , Retinoblastoma , Tumor

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The Operation Eyesight Universal Institute for Eye Cancer, L.V. Prasad Eye Institute, Hyderabad, India
Pediatric Oncology Unit, Children Welfare Teaching Hospital, Medical City, College of Medicine, University of Baghdad, Bagdad, Iraq
International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
Department of Ophthalmology, Great Ormond Street Childrens Hospital, London, United Kingdom
Ocular Oncology Service, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
Department of Ophthalmology, The Indus Hospital, Karachi, Pakistan
Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
Department of Pediatric Hematology-Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
Department of Ophthalmology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Department of Ophthalmology, King Hussein Cancer Center, Amman, Jordan
The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
Basra Children Specialty Hospital, Basra, Iraq
Department of Pediatrics, Banaras Hindu University, Varanasi, India
The Children Hospital & the Institute of Child Health, Lahore, Pakistan
RS Dr. Wahidin Sudirohusodo, Makassar, Indonesia
King Khalid eye specialist hospital, Riyadh, Saudi Arabia
Hawler Medical University, Erbil, Iraq
University of the Philippines - Philippine General Hospital, Manila, Philippines
College of Medicine, King Saud University, Riyadh, Saudi Arabia
Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
Pediatric Oncology Department, National Oncology Center, Sanaa, Yemen
Imam Hussein Cancer Center, Kerbala, Iraq
Ibn AlHaitham Teaching Eye Hospital, Baghdad, Iraq
Oncology Unit, Childs Central Teaching Hospital, Baghdad, Iraq
National Eye Center-Cicendo Eye Hospital, Bandung, Indonesia
Sardjito Hospital-Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
International Centre for Eye Health London School of Hygiene & Tropical Medicine, London, United Kingdom
Gazi University School of Medicine, Department of Ophthalmology, Ankara, Turkey
Ege University, School of Medicine, Division of Pediatric Oncology, Izmir, Turkey
Siriraj Hospital Mahidol University, Bangkok, Thailand
Zarifa Aliyeva National Centre of Ophthalmology, Baku, Azerbaijan
National Center of Oncology and Hematology, Bishkek, Kyrgyzstan
Susrut Eye Foundation & Research Institute, Kolkata, India
Department of Pediatric Hematology and Oncology, Narayana Health City, Bangalore, India
Department of Pediatric Hematology Oncology, Tata Medical Center, Kolkata, India
Tel Aviv Sourasky Medical Center and The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Ophthalmology Department, Great Ormond Street Childrens Hospital, London, United Kingdom
Pediatric Oncology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
Paediatric Ophthalmology Department, Mayo Hospital & College of Allied Visual Sciences (COAVS), King Edward Medical University, Lahore, Pakistan
Department of Pediatric Ophthalmology, Guangzhou Childrens Hospital and Guangzhou Women and Childrens Medical Center, Guangzhou Medical University, Guangzhou, China
National Center for Maternal and Children Health of Mongolia, Ulaanbaatar, Mongolia
Department of Ophthalmology, Songklanagarind Hospital, Prince of a Songkla university, Songkla, Thailand
The Calcutta Medical Research Institute, Kolkata, India
Ocular Oncology Services, Dr Shroffs Charity Eye Hospital, New Delhi, India
Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
Departement of Opthalmology Udayana University, Sanglah Eye Hospital, Bali, Indonesia
Aga Khan University, Karachi, Pakistan
Pediatric Growth and Development Research Center, Institute of Endocrinology, Iran University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
Hadassah Hebrew University Medical Center, Jerusalem, Israel
Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
National Cancer Institute, Maharagama, Sri Lanka
Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
Bai Jerbai Wadia Hospital for Children, Mumbai, India
King Georges Medical University, Uttar Pradesh, Lucknow, India
The Indus Hospital, Karachi, Pakistan
Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
Department of Pediatric Ophthalmology and Strabismus, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
Department of pediatrics Faculty of medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Oncology Unit, Child Central Teaching Hospital, Baghdad, Iraq
National Cancer Center of Uzbekistan, Tashkent, Uzbekistan
Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan
Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
Istanbul University, Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey
Mahosot Hospital, Vientiane, Laos
Dhaka Medical College Hospital, Dhaka, Bangladesh
Department of Ophthalmology, Post Graduate Medical Institute, Ameer Ud Din Medical College, Lahore General Hospital, Lahore, Pakistan
Sankara Nethralaya, Chennai, India
Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
Ocular Oncology Service, Hacettepe University School of Medicine, Ankara, Turkey
Vitreo-Retina Research Unit, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
The first hospital of Dali University, Yunnan Province, China
Tilganga Institute of Ophthalmology, Kathmandu, Nepal
Chang Gung Memorial Hospital, Taipei, Taiwan
Ophthalmology Department, Airlangga University - Dr. Soetomo General Hospital, Surabaya, Indonesia
Pediatric Hematology-Oncology Unit, Apollo Center for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, India
Scientific Centre for Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
Mahak childrens Hematology Oncology Research Center (Mahak-HORC), Mahak Hospital, Tehran, Iran
Centre for Sight, New Delhi, India
Sankara Eye Hospital, Bangalore, India
King Hussein Cancer Center, Amman, Jordan
Aditya Jyot Eye Hospital, Mumbai, India
Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
Child Health Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russian Federation
Chittagong Eye Infirmary & Training Complex, Chittagong, Bangladesh
Yerevan State Medical University, Department of Oncology and Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after R.H. Yeolyan, Yerevan, Armenia
Head and Neck Tumors Department, SRI of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Center of Oncology of Russian Federation, Medical Academy of Postgraduate Education, Moscow, Russian Federation
Hiwa Cancer Hospital, Al Sulaimaniyah, Iraq
Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
Singapore National Eye Centre and KK Womens and Childrens Hospital in Singapore, Singapore
Ophthalmology Department, Dr. M. Djamil General Hospital, Medical Faculty Andalas University West Sumatra, Indonesia
Department of Oculoplasty and Ocular Oncology, Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh
Childrens Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
National Institute of Ophthalmology, Dhaka, Bangladesh
East Timor Eye Program, Dili, Timor-Leste
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Henan Childrens Hospital, Affiliated Childrens Hospital of Zhengzhou University, Zhengzhou, China
Queen Sirikit National Institute of Child Health, Bangkok, Thailand
Department of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo, Japan
National Cancer Center - “Dharmais” Cancer Hospital, Jakarta, Indonesia
Department of Pediatric HematologyOncology, Schneider Childrens Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
Vietnam National Institute of Ophthalmology, Vietnam, Ha Noi, Viet Nam
LV Prasad Eye Institute, MTC Campus, Odisha, Bhubaneswar, India
Istanbul University, Faculty of Medicine, Department of Ophthalmology, Ocular Oncology Service, Istanbul, Turkey
Ankara University Department of Pediatrics, Division of Pediatric Hematology-Oncology, Ankara, Turkey
Department of Paediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
Hong Kong Eye Hospital, Chinese University of Hong Kong, Hong Kong
Department of ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Kunming Childrens Hospital, Kunming, China
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
S.Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation

The Operation Eyesight Universal Institute for Eye Cancer
Pediatric Oncology Unit
International Centre for Eye Health
Department of Ophthalmology
Ocular Oncology Service
Department of Ophthalmology
Department of Ophthalmology
Goldschleger Eye Institute
Department of Pediatric Hematology-Oncology
Department of Ophthalmology
Department of Ophthalmology
Department of Ophthalmology
Department of Ophthalmology
The Operation Eyesight Universal Institute for Eye Cancer
Basra Children Specialty Hospital
Department of Pediatrics
The Children Hospital & the Institute of Child Health
RS Dr. Wahidin Sudirohusodo
King Khalid eye specialist hospital
Hawler Medical University
University of the Philippines - Philippine General Hospital
College of Medicine
Department of Ophthalmology
Pediatric Oncology Department
Imam Hussein Cancer Center
Ibn AlHaitham Teaching Eye Hospital
Oncology Unit
National Eye Center-Cicendo Eye Hospital
Sardjito Hospital-Faculty of Medicine
International Centre for Eye Health London School of Hygiene & Tropical Medicine
Gazi University School of Medicine
Ege University
Siriraj Hospital Mahidol University
Zarifa Aliyeva National Centre of Ophthalmology
National Center of Oncology and Hematology
Susrut Eye Foundation & Research Institute
Department of Pediatric Hematology and Oncology
Department of Pediatric Hematology Oncology
Tel Aviv Sourasky Medical Center and The Sackler Faculty of Medicine
Ophthalmology Department
Pediatric Oncology
Paediatric Ophthalmology Department
Department of Pediatric Ophthalmology
National Center for Maternal and Children Health of Mongolia
Department of Ophthalmology
The Calcutta Medical Research Institute
Ocular Oncology Services
Department of Ophthalmology
Departement of Opthalmology Udayana University
Aga Khan University
Pediatric Growth and Development Research Center
Hadassah Hebrew University Medical Center
Retina & Vitreous Service
National Cancer Institute
Department of Ophthalmology
Bai Jerbai Wadia Hospital for Children
King Georges Medical University
The Indus Hospital
Hospital Kuala Lumpur
Department of Pediatric Ophthalmology and Strabismus
Department of pediatrics Faculty of medicine Ramathibodi Hospital
Oncology Unit
National Cancer Center of Uzbekistan
Armed Forces Institute of Ophthalmology
Department of Anatomy and Cell Biology
Istanbul University
Mahosot Hospital
Dhaka Medical College Hospital
Department of Ophthalmology
Sankara Nethralaya
Department of Ophthalmology
Ocular Oncology Service
Vitreo-Retina Research Unit
The first hospital of Dali University
Tilganga Institute of Ophthalmology
Chang Gung Memorial Hospital
Ophthalmology Department
Pediatric Hematology-Oncology Unit
Scientific Centre for Pediatrics and Pediatric Surgery
Mahak childrens Hematology Oncology Research Center (Mahak-HORC)
Centre for Sight
Sankara Eye Hospital
King Hussein Cancer Center
Aditya Jyot Eye Hospital
Lokmanya Tilak Municipal Medical College and General Hospital
Child Health Department
Moscow Helmholtz Research Institute of Eye Diseases
Chittagong Eye Infirmary & Training Complex
Yerevan State Medical University
Head and Neck Tumors Department
Hiwa Cancer Hospital
Department of Ophthalmology
Singapore National Eye Centre and KK Womens and Childrens Hospital in Singapore
Ophthalmology Department
Department of Oculoplasty and Ocular Oncology
Childrens Cancer Institute
Eye Research Center
Department of Pediatrics
National Institute of Ophthalmology
East Timor Eye Program
Department of Ophthalmology
Department of Ophthalmology
Henan Childrens Hospital
Queen Sirikit National Institute of Child Health
Department of Ophthalmic Oncology
National Cancer Center - “Dharmais” Cancer Hospital
Department of Pediatric HematologyOncology
Vietnam National Institute of Ophthalmology
LV Prasad Eye Institute
Istanbul University
Ankara University Department of Pediatrics
Department of Paediatrics
Department of Ophthalmology
Hong Kong Eye Hospital
Department of ophthalmology
Kunming Childrens Hospital
State Key Laboratory of Ophthalmology
S.Fyodorov Eye Microsurgery Federal State Institution

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