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Long-term retinoblastoma follow-up with or without general anaesthesia
Ruchika Batra1, Joseph Abbott, Helen Jenkinson
1Birmingham Children's Hospital, Birmingham, UK.
Insights
Examination without general anesthesia (EWA) is safe for children with retinoblastoma, reducing risks and resource use. This practice allows for effective monitoring as the risk of tumor recurrence declines with age.
Area of Science:
- Ophthalmology
- Pediatric Oncology
Background:
- Children with retinoblastoma require frequent monitoring for tumor recurrence.
- Examinations under anesthesia (EUA) are effective but pose risks and resource burdens.
- Transitioning to examination without anesthesia (EWA) is common practice for older children, but safety data is lacking.
Purpose of the Study:
- To evaluate the safety and feasibility of commencing examination without anesthesia (EWA) in children treated for retinoblastoma.
- To identify factors influencing the safe transition to EWA.
Main Methods:
- Retrospective review of 128 sequential retinoblastoma patients over 10 years.
- Analysis of 113 eyes from 84 children, focusing on age at diagnosis, follow-up duration, and age of conversion to EWA.
- Assessment of tumor activity detected during EWA.
Main Results:
- EWA commenced at a mean age of 53 months, varying based on child cooperation and disease activity.
- One case of tumor activity detected via EWA at 86 months, successfully treated.
- No increased risk of undetected tumor growth observed with EWA.
Conclusions:
- Examination without anesthesia (EWA) appears safe for monitoring retinoblastoma patients.
- Factors such as child cooperation and disease activity are crucial for determining the appropriate age to initiate EWA.
- EWA can be a safe and effective alternative to EUA in select pediatric retinoblastoma patients.
Background:
Children with treated retinoblastoma undergo frequent examinations to monitor for recurrent or new tumours. Examinations under anaesthesia allow a more complete examination in younger children, however they are stressful for the family, subject the child to medical risk and consume resources. The risk of recurrent or new tumours declines with age and it is common practice to examine older children without general anaesthesia. There are no studies on the safety and cost effectiveness of this practice, or guidelines on when examination without anaesthesia (EWA) can be safely commenced.
Procedure:
Retrospective case note review of 128 sequential patients treated for retinoblastoma in a national referral centre over 10 years.
Results:
Following exclusions, 113 eyes of 84 children were analysed. The mean age at diagnosis was 20 months (range birth to 71 months). There were 55 unilateral and 29 bilateral cases. The mean follow-up was 77.7 months (range 12-178 months). EWA was commenced at a mean age of 53 months (range 12-98 months). The age of conversion to EWA was largely dependent on child cooperation and disease activity. Tumour activity was detected on EWA in one child at the age of 86 months, 9 months after the last active treatment and treated successfully.
Conclusions:
Examination without general anaesthesia does not appear to expose children to an increased risk of undetected tumour growth. This study highlights the important factors to be considered when deciding a safe time to commence EWA.