Centralized Multidisciplinary Retinoblastoma Care Closes the Outcome Gap: Survival and Globe Salvage for 1000 Eyes from 601 Patients.

Abstract

Retinoblastoma (RB) outcomes in low- and middle-income countries remain inferior to those achieved in high-income countries, largely due to delayed diagnosis, limited access to specialized care, and fragmented treatment systems. The aim of this study is to evaluate the long-term impact of a two-decade strategy based on centralized multidisciplinary care, structured capacity building, and a telemedicine-supported international twinning partnership in reducing disparities in retinoblastoma (RB) outcomes in a resource-limited setting. Retrospective, single-center cohort study. 601 children with RB (1000 affected eyes) treated at King Hussein Cancer Center (KHCC) between March 2003 and December 2025. Demographic characteristics, tumor classification, treatment modalities, globe salvage, metastasis, secondary malignancies, and survival outcomes were reviewed. Overall survival was estimated using the Kaplan-Meier method. Globe salvage rate, rates of metastasis and secondary malignancy, and 5-year overall survival. Of 601 children, 314 (52%) were male, 399 (66%) had bilateral disease, and 346 (58%) were non-Jordanian, referred from 15 countries. Of 1000 affected eyes, 120 (12%) were enucleated before referral; among the remaining eyes, 7 (0.7%) had extraocular disease, and by International Classification, 52 (5.2%) were Group A, 134 (13%) Group B, 204 (20%) Group C, 391 (39%) Group D, and 92 (9.2%) Group E. Of 880 eyes treated at KHCC, primary enucleation was performed in 157 (18%), and conservative eye-salvage therapy was attempted in 723 (82%). Among the 723 eyes that underwent eye-salvaging treatment, systemic chemotherapy was administered in 713 (99%), transpupillary thermo therapy (TTT) in all 723 (100%), cryotherapy in 248 (34%), intra-arterial chemotherapy in 34 (4.7%; 11 primary and 23 secondary), intravitreal chemotherapy in 43 (5.9%), subtenon chemotherapy in 24 (3.3%), and iodine-125 plaque brachytherapy in 23 (3.2%). Ten Group A eyes in 10 patients were treated with TTT and/or cryotherapy alone without systemic chemotherapy. Overall eye salvage rate was 61% (538/880); among conservatively treated eyes, salvage rate was 74.4% (538/723), ranging from 98% (Group A) to 17% (Group E). At median follow-up of 120 months, metastasis occurred in 26 patients (4.3%) and secondary malignancy in 7 (1.2%). Estimated 5-year overall survival was 96% (95% CI, 94%-98%). A centralized multidisciplinary RB program integrating telemedicine, international collaboration, and advanced globe-salvage therapies achieved survival and eye-preservation outcomes comparable to high-income settings despite resource constraints. Over two decades, KHCC evolved into a major regional referral center, offering a scalable model for reducing global disparities in RB care. None.