RT Journal Article
SR Electronic
T1 Improving survival of retinoblastoma in Uganda
JF British Journal of Ophthalmology
JO Br J Ophthalmol
FD BMJ Publishing Group Ltd.
SP 937
OP 942
DO 10.1136/bjophthalmol-2014-306206
VO 99
IS 7
A1 Keith M Waddell
A1 Kenneth Kagame
A1 Andrew Ndamira
A1 Amos Twinamasiko
A1 Susan V Picton
A1 Ian G Simmons
A1 Paul Revill
A1 W Tom Johnston
A1 Robert Newton
YR 2015
UL http://bjo.bmj.com/content/99/7/937.abstract
AB Background Diagnostic delay results in relatively high mortality among children with retinoblastoma in Uganda, where treatment was limited to surgery and, for some, radiotherapy. In order to improve outcomes, a simple programme of neoadjuvant and adjuvant chemotherapy was introduced. Here we report survival before and after this change to medical practice.Methods Affordable standard off-patent chemotherapy agents were administered by trained paramedical staff to groups of patients at the same time. Survival before and after the introduction of chemotherapy was monitored. Between 2006 and 2013 a total of 270 patients with retinoblastoma were included, 181 treated prior to chemotherapy and 89 after (beginning in 2009). We had 94% follow-up and 249 had histological verification of diagnosis.Results Using a proportional hazards model adjusted for age, sex and laterality, children treated after chemotherapy was introduced had a 37% lower risk of dying (HR 0.63, 95% CI 0.41 to 0.99) compared with children treated before. Prior to the introduction of chemotherapy only 15% of children who survived bilateral disease retained vision after treatment compared with 71% after chemotherapy.Conclusions The introduction of chemotherapy proved safe and cost-effective in non-specialist hands and was associated with significant improvements in survival and, among bilateral cases, in preserving vision.