The Whole Child with Retinoblastoma

Professor Brenda L Gallie

Meeting:  2012 RANZCO


Date: 26 Nov 2012


Session Time: 10:30 am - 11:00 am

Untreated retinoblastoma damages vision, spreads out of the eye, and ultimately kills the child. Cure is easy if the cancer is stopped while the tumour is contained by the eye and very difficult after it has escaped from the eye.

Poverty underlies high global mortality, through lack of awareness, medical expertise, resources, and family support. When retinoblastoma first shows, cure by removal of the eye is widely available and affordable with cure rate > 98%. Despite huge resources, new, widely advocated approaches to save eyes with retinoblastoma, may instead be failing the whole child. Systemic chemotherapy to make subsequent surgery safer, may result in the opposite. Most startling is the global sweep of intra-arterial chemotherapy, widely publicized to treat every eye despite no safety and efficacy data. Children curable by simple enucleation, who develop extraocular disease after repeated intra-arterial chemotherapy, can only be found on parents’ blogs.

The Internet brings to parents facing retinoblastoma everywhere the concept that their duty is to save the eye, blinding them to the potential of the whole child, even without seeing eyes. This can lead to delays, bankruptcy, failure of followup, and death of the curable child. Where do our responsibilities as Ophthalmologists lie?