The pattern of retinoblastoma at Queen Elizabeth Central Hospital, Malawi

Abstract

Background Retinoblastoma is the most common intraocular tumour in childhood. Whilst survival in the developed world is over 95%. the case is not true for the developing world. The determination of the burden of disease. its pattern of presentation and management and its outcomes may be a platform for mobilizing resources for its management. s Aims The aim of the study was to determine the pattern of presentation and modes of treatment of retinoblastoma patients seen at Queen Elizabeth Central Hospital. Malawi between January 2004 and December 2009. Methods This was a descriptive retrospective case series of retinoblastoma patients who presented at QECH. Blantyre. Malawi from 1st January 2005 t031 Sl December 2009. Medical . records and histopathology records were retrieved. Details of the demographic characteristics. clinical presentation, investigations done. and management of the patients with retinoblastoma were extracted and entered into preformed questionnaires and later were analysed using SPSS 17.1 statistical package. Results There were 105 patients with a clinical diagnosis of retinoblastoma. 33 patients had just a clinical diagnosis whereas 43 out of 76 patients who'had specimens sent for histology were confirmed to be retinoblastoma. 8 patients were excluded from analysis because of missing clinical records. leaving 68 files for analysis. Males constituted 57<10(Ir'39) and females 43% (n=29). Bilateral retinoblastoma constituted 17.6% (n=12). The mean age at presentation for bilateral disease was 19.9 (+/-6.5) months and for unilateral disease was 37.2 (\-/- 7.8) months. White reflex (n=54; 79.4%) and eye swelling (n=32: 47.1 %) were the most common presenting complaints. whereas leukocoria (n=45: 66.2%) and proptosis (n"'"21: 30.9%) were the most common clinical findings. Imaging studies were not routinely employed in the diagnosis of retinoblastoma; USS (n=10: 14.70/,0)and CT scan (n=8; 11.8%). Enucleaction was the most common surgical intervention (n~36, 52.9%) followed by exenteration (n=ll; 16.2%). Chemotherapy was rarely used (n=6; 8.8%) and all received monotherapy. Conclusion Retinoblastoma patients in Malawi present to hospital with advanced disease and management options for retinoblastoma are limited Recommendation There is a need to improve public awareness so patients can present early to hospital. The incorporation of the treatment guidelines for retinoblastoma in the Malawi's Essential Health Package is recommended.