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ABSTRACT Purpose: The purpose of the following study was to describe the sociodemographic, clinical, and therapeutic characteristics of patients with retinoblastoma (RB), the most common intraocular tumor in children, receiving medical care in an eyecare institution in the Caribbean region of Colombia. Methods: A case series between 2016 and 2021 was carried out. Eyes of patients with RB, receiving medical care in a single health care institution, and in compliance with the established follow-up protocol, were included. Descriptive analyzes of relevant variables were performed. Results: In this study, a total of 21 eyes of 16 patients were examined. The average age at the time of diagnosis was 17.7 months, and 50% of children were male. Using the International Classification for Intraocular Retinoblastoma, 42.9% of the total cases were classified as group D. Out of the 21 cases, 71.4% went into total remission without the necessity for enucleation, and the most common treatment was chemotherapy, using Melphalan® via intraarterial or intravitreal administration. Conclusion: Specific findings of patients with RB in the Caribbean Coast of Colombia were identified. These findings imply that, despite the obstacles to healthcare access, an early diagnosis and a treatment plan using intraarterial chemotherapy may provide a satisfactory clinical outcome (remission).
RESUMEN. Objetivo: El propósito del siguiente estudio fue describir las características sociodemográ-ficas, clínicas y terapéuticas de los pacientes con retinoblastoma (RB), el tumor intraocular más frecuente en niños, que reciben atención médica en una institución oftalmológica de la región Caribe de Colombia. Métodos: Se realizó una serie de casos entre 2016 y 2021. Se incluyeron ojos de pacientes con RB, que recibían atención médica en una sola institución de salud y cumplían con el protocolo de seguimiento establecido. Se realizaron análisis descriptivos de variables relevantes. Resultados: En este estudio se examinaron un total de 21 ojos de 16 pacientes. La edad media en el momento del diagnóstico fue de 17,7 meses y el 50% de los niños eran varones. Utilizando la Clasificación Internacional para el retinoblastoma intraocular, el 42,9% del total de los casos se clasificaron en el grupo D. De los 21 casos, el 71,4% entraron en remisión total sin necesidad de enucleación, y el tratamiento más habitual fue la quimioterapia con Melfalán® vía intraarterial o intravítrea. Conclusiones: Se identificaron hallazgos específicos de pacientes con RB en la costa caribe de Colombia. Estos hallazgos implican que, a pesar de los obstáculos en el acceso a la salud, un diagnóstico temprano y un plan de tratamiento con quimioterapia intraarterial pueden proporcionar un resultado clínico satisfactorio (remisión).
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BACKGROUND: The feasibility and results of intraarterial chemotherapy, also termed ophthalmic artery chemosurgery (OAC), for retinoblastoma in less developed countries have seldom been reported. PROCEDURE: A retrospective evaluation of a program of OAC in Argentina from 2010 to 2015. RESULTS: Ninety-seven eyes from 81 patients (61 bilateral) were analyzed. In 35 eyes, OAC was given as primary therapy and in 62 it was used for the treatment of tumors with partial response or those relapsing after systemic chemoreduction with focal therapy or external-beam radiotherapy. Twenty-two primarily treated eyes had group D and 13 groups B/C. A total of 400 procedures were carried out. Chemotherapy used included combinations of melphalan, carboplatin, and topotecan. There was no mortality associated with OAC. Toxicity included fever and neutropenia in five (1.25%), hypotension and bradycardia during anesthesia in two and femoral thrombosis in one, eyelid edema in nine, and neutropenia or thrombocytopenia in 28 cycles. With a median follow-up of 48.7 months (range 12-79), the 3-year probability of event-free survival (pEFS) (enucleation and/or radiotherapy were considered events) was comparable for patients who received first-line therapy and those treated at relapse (0.65 vs. 0.63, P = 0.5). In the former, the pEFS was 0.91 and 0.43 for groups B/C and D, respectively (P = 0.01). Two patients died of extraocular dissemination after refusal of enucleation. CONCLUSIONS: OAC was feasible with low toxicity. pEFS improved in all groups compared to the previous experience with systemic chemotherapy reducing the use of radiotherapy. The overall mortality associated with OAC is comparable to our previous experience with systemic chemoreduction.