Survival outcomes and globe salvage rates of retinoblastoma in India - A systematic review.

Purpose: The World Health Organization (WHO) CURE-ALL initiative highlights retinoblastoma (RB) as an index cancer, prompting Indian centers to collaborate for better RB outcomes. The current study is a systematic review of published RB survival outcomes from India till date, thereby providing a crucial roadmap for ongoing efforts.

Methods: The PubMed and Google Scholar databases were searched till April 2024. The reference lists of selected articles were also searched manually for additional studies. Non-Indian articles, multicentric studies, case reviews, duplicates, and studies not mentioning outcomes were excluded. Fifteen eligible studies were shortlisted for review.

Results: The total number of patients was 4147. Median age at diagnosis was between 24-36 months of age. Median lag time from symptom onset to diagnosis varied between 3-12 months. The overall globe salvage rates ranged from 13% to 54.7%, with early intraocular disease having greater rates of vision preservation. A higher proportion of vision salvage (>50%) was found in recently concluded studies, mainly due to the use of intra-arterial chemotherapy after 2019. The pooled 5-year overall survival (OS) was 78.7%. Reported relapse rates ranged from 7% to 36%. Treatment abandonment rates varied between 10% to 58%.

Conclusion: Our review shows globe salvage rates for RB in India match other low-middle-income countries, but 5-year OS is lower than in developed nations. The relapse rates are similar to the global rates. Proposed measures to optimize RB outcomes include parental counseling for early recognition, efforts to limit treatment abandonment, and improving access to specialized treatment.