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Updated: Sep 20, 2026
Aqueous Humor as a Liquid Biopsy for Retinoblastoma: Clear Corneal Paracentesis and Genomic Analysis
Published on: September 7, 2021
Centralized Multidisciplinary Retinoblastoma Care Closes the Outcome Gap: Survival and Globe Salvage for 1000 Eyes
Yacoub A Yousef1, Hadeel Halalsheh2, Mona Mohammad1
1Departments of Surgery/Ophthalmology.
Purpose:
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.
Design:
Retrospective, single-center cohort study.
Subjects:
601 children with RB (1000 affected eyes) treated at King Hussein Cancer Center (KHCC) between March 2003 and December 2025.
Methods:
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.
Main Outcome Measures:
Globe salvage rate, rates of metastasis and secondary malignancy, and 5-year overall survival.
Results:
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%).
Conclusions:
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.
Funding:
None.
