Abstract
Objective
The primary aim of this study was to identify the frequency of death, metastasis,
enucleation, and use of external beam radiation therapy (EBRT) among retinoblastoma
patients. The secondary aim was to determine whether any events were associated with
suboptimal clinical management to identify areas for clinical care improvement.
Methods
Patients diagnosed with retinoblastoma between January 1, 2000, and December 31, 2015,
at The Hospital for Sick Children were included. Medical records of eligible patients
underwent a comprehensive 2-part review. First, a chart review collected diagnostic
details, treatment course, and occurrence of 4 events: death, metastasis, use of EBRT,
and enucleation. Next, events were reviewed in detail, and a multidisciplinary committee
reached consensus on cases managed suboptimally.
Results
The study included 209 patients (292 eyes). There were 8 deaths, 11 metastases, 177
enucleations (143 primary, 34 secondary), and 8 uses of EBRT. Thirteen patients were
reviewed by the multidisciplinary committee, which confirmed that 5 of these patients
had events associated with suboptimal clinical management. Three patients developed
metastases leading to death (misdiagnosis and mismanagement of trilateral retinoblastoma
[1], parental refusal of enucleation [1], and inaccurate histopathology after primary
enucleation [1]). One patient developed extraocular extension related to scleral invasion
following aggressive focal therapy. One patient underwent secondary enucleation for
a Group B eye related to mismanagement of a treatment complication.
Discussion
Deaths, metastases, and enucleations with documented instances of suboptimal care
highlighted a need to enhance medical team and patient communication, histopathology
interpretation, laser treatment guidelines, and trilateral retinoblastoma management.
Routine clinical audit of retinoblastoma management can identify areas for clinical
practice change.
Résumé
Objectif
Notre étude avait pour objectif principal d'identifier la fréquence des décès, de
l'apparition de métastases, des énucléations et du recours à la radiothérapie externe
(EBRT) dans le rétinoblastome. Notre objectif secondaire visait à identifier des événements
associés à une prise en charge clinique sous-optimale afin de cerner des zones d'amélioration
des soins cliniques.
Méthodes
L’étude regroupait des patients qui ont reçu un diagnostic de rétinoblastome entre
le 1er janvier 2000 et le 31 décembre 2015 à l'Hôpital pour enfants malades (SickKids) de
Toronto, en Ontario. Les dossiers médicaux des patients admissibles ont fait l'objet
d'un examen exhaustif en 2 parties. On a commencé par extraire les détails liés au
diagnostic, au traitement et à la survenue de 4 événements: décès, métastases, recours
à l'EBRT et énucléation. Par la suite, après avoir examiné chaque événement en détail,
un comité multidisciplinaire est parvenu à un consensus sur les cas dont la prise
en charge n'avait pas été optimale.
Résultats
L’étude regroupait 209 patients (292 yeux). On a répertorié 8 décès, 11 métastases,
177 énucléations (143 primaires et 34 secondaires) et 8 recours à l'EBRT. Le comité
multidisciplinaire a passé en revue le dossier de 13 patients et a confirmé que 5
de ces patients avaient subi des événements découlant d'une prise en charge clinique
sous-optimale. Ainsi, 3 patients ont présenté des métastases qui ont mené à leur décès
(diagnostic erroné et mauvaise prise en charge d'un rétinoblastome trilatéral [1],
refus de l’énucléation par un parent [1] et résultats erronés de l'examen histopathologique
après l’énucléation primaire [1]). Par ailleurs, 1 patient a présenté une extension
extraoculaire associée à un envahissement scléral à la suite d'un traitement focal
énergique; et 1 patient a dû subir une énucléation secondaire de l’œil dont la tumeur
était classée Groupe B en raison de la prise en charge inappropriée d'une complication
thérapeutique.
Discussion
Les décès, l'apparition de métastases et les énucléations s'accompagnant de données
probantes qui mettent en relief une prise en charge sous-optimale soulignent le besoin
d'améliorer la communication entre l’équipe de soins et les patients, l'interprétation
des résultats de l'examen histopathologique, les lignes directrices du traitement
au laser et la prise en charge du rétinoblastome trilatéral. La vérification clinique
régulière de la prise en charge du rétinoblastome permettra de faire ressortir les
aspects de la pratique clinique qui peuvent bénéficier d'une amélioration.
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Article Info
Publication History
Published online: May 30, 2021
Identification
Copyright
© 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
