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.