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Tumor Discovery Primarily enucleated RB patient’s analysis

than American children. In the present study, HRFs at 66.6%, India at 48%, and Nepal (10-year survival) at
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of the anterior segment included the involvement of 24%. 7,23 In Africa, 5-year survival rates are 60% in Uganda
the anterior chamber (19.2%), iris (15.4%), trabecular (low-income), 53% in Senegal (lower-middle-income),
meshwork (11.5%), Schlemm’s canal (11.5%), and ciliary and 46% in Namibia (upper-middle-income). 7,23 The
body (16.7%). Ciliary body and iris involvement in our overall survival rate in our study was 69.23%, based on
study was higher than that reported by Kaliki et al. and a follow-up period of 6 months to 12 years. According to
Yaqoob et al. (3.7% each and 4.7% each, respectively) the Global Retinoblastoma Outcome Study, the survival
but lower than the rates observed by Yahaya et al. (28% rate in low-income countries is 40% compared with
and 21.5%). 8,33,34 These studies did not mention about the 77% in lower-middleincome and 79% in upper-middle-
invasion of the anterior chamber, trabecular meshwork, income countries. 7
or Schlemm’s canal. In addition, we observed scleral Bangladesh, a lower-middle-income country, has a
invasion in 15.4% of cases, extrascleral invasion in 6.4%, survival rate of 69.3%, which is below the estimated rate of
and orbital invasion in 3.9%. Studies from the Indian 77% for similar-income countries. Approximately 27% of
subcontinent reported scleral invasion rates between study children died, with 23% due to metastasis, possibly
4.9% and 14% and extrascleral invasion from 1.6% to linked to delayed presentation, multiple HRFs, and
11.8%, whereas a study from Uganda found a scleral treatment refusal. The Global Retinoblastoma Outcome
invasion rate of 22.7%. 8,35 In comparison studies with Study reported metastasis rates by economic status: 24%
American and Indian RB patients, these rates were 1% in low-income, 51.4% in lower-middle-income, 16.9%
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and 2%, respectively. Of the 78 patients, 38.4% (n = 30) in upper-middle–income, and 2.1% in high-income
received adjuvant treatment; approximately 33% received countries. Authors attributed lower metastasis rates in
vincristine, etoposide, and carboplatin chemotherapy, low-income countries to underreporting and higher
and 5.1% received both chemotherapy and external rates in lower-middle-income countries to delayed
beam radiotherapy (EBRT). In 3.8% of cases, the parents presentation and numerous histopathological HRFs. In
8
refused any treatment.
this study, the mortality rate due to RB alone was 23.07%,
A significant global burden (43%) of RB cases exists with additional deaths (3.8%) due to other causes. In
in six Asia-Pacific countries: China, India, Indonesia, a 3-year study of RB outcomes, mortality rates were
Pakistan, Philippines, and Bangladesh. Mortality rates reported as 29.7% in low-income, 52.3% in lower-middle-
15
for this cancer vary by continent: the highest rates are income, 16.9% in upper-middle–income, and only 1.1%
observed in Africa (70%) and Asia (40%) compared in high-income countries. 8
with North America (3%) and Europe (5%). Increased In this retrospective analysis, 21 patients died, 3 were
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mortality in Africa and Asia is attributed to factors such lost to follow-up, and the remaining patients were either in
as economic challenges, illiteracy, lack of awareness, regular or irregular follow-up, with periods ranging from
shortages of trained medical personnel, limited treatment 6 months to 12 years. Counseling on the disease’s nature
facilities, and cultural beliefs. Survival rates also correlate proved effective for tumor recurrence detection, initiating
with a country’s income level, as socioeconomic
conditions affect the likelihood of seeking medical prompt treatment, sibling screening, and raising awareness
attention. Early presentation and improved treatment among patients’ families and neighbors.
facilities have notably increased survival rates in higher- This study was conducted at a tertiary eye care center in
income countries. For example, a 2002 study reported a Bangladesh, which is a lower-middle-income country with
5-year survival rate of 87% in the United States, and a a high population density. Limited healthcare infrastructure
2021 study found a 4- – 8-year survival rate of 99%. In and personnel hinder the availability of ophthalmic services
Europe, the 5-year survival rate was 95% in a 2002 study nationwide. Complete RB treatment is available at only two
and 100% in a 2017 study, while Japan reported a 10-year tertiary eye care centers, with some secondary hospitals
survival rate of 95%. These high rates apply to only 10% offering only enucleation services. Most healthcare centers
7
of patients with RB worldwide, primarily those in high- lack trained personnel for histopathological assessment
income countries. However, 80% of patients with RB and RB treatment, potentially contributing to the
worldwide live in low- and middle-income countries in underreporting of metastasis and survival rates. This study
5
Asia, Africa, and Latin America. In Asia, 5-year survival mainly focused on the presence of a high HRF (84.6%),
rates vary by income level: 89% in Taiwan (high income), underscoring the need for early case detection and lag
86% in China (upper-middle-income), and 37% in time reduction. Recently, multidisciplinary management
Indonesia (middle-income). Lower-middle-income Asian for RB has been recommended to preserve life and vision,
countries have similarly variable rates, with Uzbekistan although such a model is challenging in low- and lower-

Volume 3 Issue 4 (2024) 8 doi: 10.36922/td.4336