Commentary: The challenges of treating retinoblastoma in India.

The mode of retinoblastoma treatment has evolved from being primary external beam radiotherapy (EBRT) which was popular till mid-1990s to intravenous chemotherapy (IVC) till 2006 and, currently, to intra-arterial chemotherapy (IAC) and intraocular chemotherapy. In this issue, Camp et al.[1] have written a very informative article of how this treatment has evolved over the years and have compared the pre-chemotherapy and chemotherapy outcomes in the management of neonatal retinoblastomas. A sense of the cost of each treatment in the United States of America (USA) has also been beautifully elicited in this article. Unfortunately, even the most well-to-do families from India cannot afford the treatment in USA. India has the highest burden of retinoblastoma in the world with 1486 (18.3%) predicted cases of the total global burden of 8099 per year.[2] Unfortunately, most of these patients come from lower socioeconomic status who can neither afford to pay from their pockets nor have insurance cover. Although few state governments and, now recently, even the central government is providing insurance cover for the poor, it is not enough to cover the latest treatment like IAC, though the cost of IAC in India is 1/20th or less compared to that of USA. In spite of all the latest treatment modalities being available in India (including IAC), unfortunately uniform treatment at par with the West cannot be given to all due to socioeconomic, literary, and cultural differences.[3] Hence, treatment for each case in India is based not only on the classification or the stage of the disease but it has to be based also on the overall financial status, literacy level, cultural background, and travel distance of every family. Despite all these barriers, most retinoblastoma centers in India do an excellent job of having an overall survival rate very close to or even at par with the Western centers.