RESUMO
BACKGROUND: Early detection and timely referral are keys to improve survival in patients with retinoblastoma (Rb). In México, one of the main obstacles for an early diagnosis is the lack of knowledge of the disease. The objective of this study was to evaluate Rb comprehension in students in their last year of medical school. PROCEDURE: A questionnaire was completed by 791 students from 12 universities. Descriptive statistics from the population were obtained and every answer to each question was analyzed. RESULTS: Only 3.3% of the students got a proficiency grade. Less than 50% diagnosed Rb when an image was shown. CONCLUSIONS: The students evaluated do not have the knowledge to detect the disease. It is necessary to develop continuous educational programs for first contact physicians.
Assuntos
Competência Clínica , Neoplasias da Retina/diagnóstico , Retinoblastoma/diagnóstico , Estudantes de Medicina , Educação de Graduação em Medicina , Feminino , Humanos , Masculino , México , MédicosRESUMO
INTRODUCTION: Retinoblastoma (RB) is the most frequent malignant eye tumor in childhood. In developing countries advanced stages are common. The purpose of this paper is to present our 21-year clinical experience with metastatic extra ocular RB patients treated with 5 different chemotherapy schemas at a single Mexican Pediatric referral center. MATERIALS AND METHODS: A retrospective analysis was carried out reviewing the clinical characteristics of patients with metastatic RB. The information analyzed included the delay in diagnosis after first symptoms, age, sex, ocular staging, and anatomic site of metastases, treatment scheme, initial response and status at the last contact or date of death. RESULTS: Eighty-one patients were included; age range was from 3 to 80 months. The most common site of metastasis was central nervous system (83.9%). From those patients treated with chemotherapy (n = 74), 89.2% presented a complete initial response (n = 66). Early mortality occurred in 7 cases before any treatment. Fifty-six received treatment and died with progressive disease. All patients without radiotherapy died with tumor activity (n = 15). The use of cisplatin was related with longer disease free intervals; no other variable was related with survival. Four patients were alive and disease free at 33 to 144.3 months of follow up from diagnosis. The prevalent cause of death was tumor progression. CONCLUSIONS: In our experience, metastatic RB has a very high mortality rate in spite of the use of different chemotherapy regimens.
Assuntos
Neoplasias Oculares/mortalidade , Retinoblastoma/secundário , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Neoplasias do Sistema Nervoso Central/mortalidade , Neoplasias do Sistema Nervoso Central/radioterapia , Neoplasias do Sistema Nervoso Central/secundário , Criança , Pré-Escolar , Cisplatino/administração & dosagem , Radioisótopos de Cobalto/uso terapêutico , Terapia Combinada , Irradiação Craniana , Progressão da Doença , Intervalo Livre de Doença , Neoplasias Oculares/tratamento farmacológico , Neoplasias Oculares/patologia , Neoplasias Oculares/radioterapia , Neoplasias Oculares/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Tábuas de Vida , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Masculino , México/epidemiologia , Terapia Neoadjuvante , Modelos de Riscos Proporcionais , Indução de Remissão , Retinoblastoma/tratamento farmacológico , Retinoblastoma/mortalidade , Retinoblastoma/patologia , Retinoblastoma/radioterapia , Retinoblastoma/cirurgia , Estudos Retrospectivos , Neoplasias Cranianas/tratamento farmacológico , Neoplasias Cranianas/mortalidade , Neoplasias Cranianas/radioterapia , Neoplasias Cranianas/secundário , Análise de Sobrevida , Resultado do TratamentoRESUMO
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Introduction. Retinoblastoma (RB) is the most frequentmalignant eye tumor in childhood. In developingcountries advanced stages are common. The purposeof this paper is to present our 21-year clinicalexperience with metastatic extra ocular RB patientstreated with 5 different chemotherapy schemas at asingle Mexican Pediatric referral center.Materials and methods. A retrospective analysiswas carried out reviewing the clinical characteristicsof patients with metastatic RB. The information analyzedincluded the delay in diagnosis after firstsymptoms, age, sex, ocular staging, and anatomicsite of metastases, treatment scheme, initial responseand status at the last contact or date of death.Results. Eighty-one patients were included; agerange was from 3 to 80 months. The most commonsite of metastasis was central nervous system (83.9%).From those patients treated with chemotherapy(n = 74), 89.2% presented a complete initial response(n = 66). Early mortality occurred in 7 cases beforeany treatment. Fifty-six received treatment anddied with progressive disease. All patients withoutradiotherapy died with tumor activity (n = 15). Theuse of cisplatin was related with longer disease freeintervals; no other variable was related with survival.Four patients were alive and disease free at 33to 144.3 months of follow up from diagnosis. Theprevalent cause of death was tumor progression.Conclusions. In our experience, metastatic RB hasa very high mortality rate in spite of the use of differentchemotherapy regimens
