Hossam Elzomor1,2, Hala Taha3, Radwa Nour4, Adel Aleieldin5,6, M Saad Zaghloul2,7, Ibrahim Qaddoumi8, Ahmad S Alfaar4,9. 1. a Pediatric Oncology Department , Children's Cancer Hospital Egypt , Cairo , Egypt. 2. b Egyptian National Cancer Institute, Cairo University , Cairo , Egypt. 3. c Pathology Department , Children's Cancer Hospital Egypt , Cairo , Egypt. 4. d Research Department , Children's Cancer Hospital Egypt , Cairo , Egypt. 5. e Ophthalmology Unit , Children's Cancer Hospital Egypt , Cairo , Egypt. 6. f Research Institute of Ophthalmology , Giza , Egypt. 7. g Radiation Oncology Department , Children's Cancer Hospital Egypt , Cairo , Egypt. 8. h Department of Oncology , St. Jude Children's Research Hospital , Memphis , Tennessee , USA. 9. i Ophthalmology Department , Charité, Universitätsmedizin Berlin , Berlin , Germany.
Abstract
BACKGROUND: Retinoblastoma poses a substantial burden in developing countries. We conducted this study to assess the effect of implementing a multidisciplinary approach and standardized protocols for treating pediatric patients with retinoblastoma at the Children's Cancer Hospital Egypt (CCHE). MATERIALS AND METHODS: In January 2011, the CCHE implemented standardized protocols for the diagnosis, treatment, and reporting of retinoblastoma cases. The hospital also introduced a new retinoblastoma management algorithm and data analysis system. In this study, we compared the pathologic features, tumor invasiveness, reporting, and survival of 276 pediatric patients who underwent enucleations of 290 eyes before or after the implementation of the retinoblastoma protocols. RESULTS: Time to enucleation (indicating time needed for decision taking) decreased significantly within the neoadjuvant chemotherapy group for intraocular disease after January 2011 (68.7 ± 48 weeks vs. 47.3 ± 28.3 weeks; p < 0.05). Mean optic nerve stump length increased from 5.6 mm in the earlier period to 7.2 mm in the later period (p = 0.004). The overall quality of pathology reporting also improved during the later period. The probability of 3-year survival was significantly higher for patients during the later period (94.2% vs. 79.2%; p = 0.018). CONCLUSIONS: The implementation of standardized protocols and a multidisciplinary approach improved reporting; discrepancies in disease classification and the amount of missing data were reduced; and quality measures and prognostic capabilities of the team were substantially improved. Such established data-driven practice supports faster decision making to enucleate diseased eyes and save patients' lives through providing measurable indicators.
BACKGROUND:Retinoblastoma poses a substantial burden in developing countries. We conducted this study to assess the effect of implementing a multidisciplinary approach and standardized protocols for treating pediatric patients with retinoblastoma at the Children's Cancer Hospital Egypt (CCHE). MATERIALS AND METHODS: In January 2011, the CCHE implemented standardized protocols for the diagnosis, treatment, and reporting of retinoblastoma cases. The hospital also introduced a new retinoblastoma management algorithm and data analysis system. In this study, we compared the pathologic features, tumor invasiveness, reporting, and survival of 276 pediatric patients who underwent enucleations of 290 eyes before or after the implementation of the retinoblastoma protocols. RESULTS: Time to enucleation (indicating time needed for decision taking) decreased significantly within the neoadjuvant chemotherapy group for intraocular disease after January 2011 (68.7 ± 48 weeks vs. 47.3 ± 28.3 weeks; p < 0.05). Mean optic nerve stump length increased from 5.6 mm in the earlier period to 7.2 mm in the later period (p = 0.004). The overall quality of pathology reporting also improved during the later period. The probability of 3-year survival was significantly higher for patients during the later period (94.2% vs. 79.2%; p = 0.018). CONCLUSIONS: The implementation of standardized protocols and a multidisciplinary approach improved reporting; discrepancies in disease classification and the amount of missing data were reduced; and quality measures and prognostic capabilities of the team were substantially improved. Such established data-driven practice supports faster decision making to enucleate diseased eyes and save patients' lives through providing measurable indicators.
Authors: Michala Burges; Ibrahim Qaddoumi; Rachel C Brennan; Lisa Krull; Natasha Sahr; Carlos Rodriguez-Galindo; Sima Jeha; Matthew W Wilson Journal: JCO Glob Oncol Date: 2020-10
Authors: Mohammad H Abu-Arja; Nicolás Rojas Del Río; Andres Morales La Madrid; Alvaro Lassaletta; Scott L Coven; Rosa Moreno; Miguel Valero; Veronica Perez; Felipe Espinoza; Eduardo Fernandez; José Santander; Juan Tordecilla; Veronica Oyarce; Katherine Kopp; Ute Bartels; Ibrahim Qaddoumi; Jonathan L Finlay; Adrián Cáceres; Mauricio Reyes; Ximena Espinoza; Diana S Osorio Journal: JCO Glob Oncol Date: 2021-03