A new study out of The Hospital for Sick Children (SickKids), Princess Margaret Hospital (PMH) and Beijing Tongren Hospital shows children treated with chemotherapy before surgery had a higher risk of death because chemotherapy delayed removal of the eye with advanced disease and masked the spread of the disease into the brain. The research is published in the January 31 advance online edition of the Journal of Clinical Oncology.
At SickKids, a worldwide leader in the diagnosis and treatment of retinoblastoma, the standard of care for advanced disease is surgical removal of the eye, with a mortality rate of only one per cent. However, this is not the standard of care in every centre globally; some opt to first treat patients with chemotherapy in an attempt to save the eye.
In the largest study of its kind, researchers performed a retrospective analysis of 100 eyes removed from retinoblastoma patients at Beijing Tongren Hospital from May 2006 to October 2008. Next to India, China has the most new cases of retinoblastoma in the world, mainly due to its large population size.
They found that there were no deaths in the patients who had their eye removed promptly after diagnosis. However, of the patients who had chemotherapy that delayed the surgical removal of the eye to more than three months after diagnosis, nearly 17 per cent died. The authors state that while chemotherapy could give the illusion of effectively shrinking the initial tumour, the true extent of the spread of the disease at a microscopic level was masked. By the time the cancer was detected, it had metastasized to the brain and other parts of the body.
“We are thinking about saving the whole child – not just the eye,” says Dr. Brenda Gallie, principal investigator of the study, Ophthalmologist at SickKids and Senior Scientist at the Campbell Family Institute for Cancer Research, Ontario Cancer Institute at PMH. “In children with advanced disease in whom chemotherapy delayed removal of the eye, there was an increased risk of death. Our research reinforces the importance of removing a severely affected eye without delay; often when only one eye is affected, early surgery is the only necessary treatment,” adds Gallie, who is also Professor in the Department of Ophthalmology and Vision Sciences at the University of Toronto.
Retinoblastoma is a rare disease that affects approximately one in every 15,000 live births around the world. Less than 25 new cases occur in Canada every year and approximately 20 cases are treated at SickKids. This cancer can be inherited and is difficult to detect. In more than 70 per cent of cases, the first sign of disease is when a photo of the child reveals a white glow in the eye – known as cat eye – where red eye would normally appear.
The study is supported by the Ontario Ministry of Health and Long-Term Care, Kalmar Family Trust, the Canadian Retinoblastoma Society and SickKids Foundation.
About The Hospital for Sick Children
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision for Healthier Children. A Better World. For more information, please visit www.sickkids.ca.
About Princess Margaret Hospital
Princess Margaret Hospital and its research arm Ontario Cancer Institute, which includes the Campbell Family Cancer Research Institute, have achieved an international reputation as global leaders in the fight against cancer. Princess Margaret Hospital is a member of the University Health Network, which also includes Toronto General Hospital and Toronto Western Hospital. All three are research hospitals affiliated with the University of Toronto. For more information, go to www.uhn.ca.
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The Hospital for Sick Children
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