{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T03:39:57Z","timestamp":1791430797454,"version":"4.3.3"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T00:00:00Z","timestamp":1605225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T00:00:00Z","timestamp":1605225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eye"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>We aimed to study the clinical state and prognosis of patients with unilateral retinoblastoma who were being treated at a paediatric comprehensive cancer centre in a limited-resource country, to assess the different phases of treatment and the success of different, more complex real-life models.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Subjects<\/jats:title>\n                <jats:p>In this retrospective study, we created a snapshot of our retinoblastoma database for the period between 2007 and 2015. Patients whose data were included in the study were followed up until 2016. Out of a total of 744 screened patients, we included data of 248 patients who had been diagnosed with unilateral retinoblastoma.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>As classified as per the International Retinoblastoma Classification, 1 patient presented with group A, 21 with group B, 39 with group C, 104 with group D and 83 with group E retinoblastoma. Chemotherapy was the initial line of treatment in 115 patients and enucleation in 133 others. Later, 141 patients (56.9%) required further management. Patients had a mean ocular survival time of 20.8 months. Nine patients developed extraocular disease at a later stage of management: five after upfront enucleation and four after neoadjuvant chemotherapy. Mean overall survival time stood at 90.2 months. Four and three deaths were recorded in groups D and E, respectively. A single patient died in the initial chemotherapy arm, while six passed away in the initial enucleation arm.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Our study highlights the importance of initial chemotherapy and close follow-up after enucleation of classes D and E affected eyes even in absence of germline mutations.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1038\/s41433-020-01275-2","type":"journal-article","created":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T19:02:51Z","timestamp":1605294171000},"page":"2564-2572","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Unilateral retinoblastoma; natural history and an age-based protocol in 248 patients"],"prefix":"10.1038","volume":"35","author":[{"given":"Hossam","family":"El Zomor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radwa","family":"Nour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas","family":"Saad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hala","family":"Taha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah E.","family":"Shelil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel","family":"Aleieldin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Saad Zaghloul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0930-4583","authenticated-orcid":false,"given":"Ahmad S.","family":"Alfaar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,13]]},"reference":[{"key":"1275_CR1","doi-asserted-by":"publisher","first-page":"1432","DOI":"10.1136\/bjo.2009.168062","volume":"94","author":"S Canturk","year":"2010","unstructured":"Canturk S, Qaddoumi I, Khetan V, Ma Z, Furmanchuk A, Antoneli CBG, et al. Survival of retinoblastoma in less-developed countries impact of socioeconomic and health-related indicators. Br J Ophthalmol. 2010;94:1432\u20136.","journal-title":"Br J Ophthalmol"},{"key":"1275_CR2","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1073\/pnas.68.4.820","volume":"68","author":"AG Knudson","year":"1971","unstructured":"Knudson AG. Mutation and cancer: statistical study of retinoblastoma. Proc Natl Acad Sci USA. 1971;68:820\u20133.","journal-title":"Proc Natl Acad Sci USA"},{"key":"1275_CR3","doi-asserted-by":"publisher","first-page":"S9","DOI":"10.3129\/i09-194","volume":"44","author":"Canadian Retinoblastoma Society.","year":"2009","unstructured":"Canadian Retinoblastoma Society. National retinoblastoma strategy Canadian guidelines for care. Can J Ophthalmol. 2009;44:S9\u201347.","journal-title":"Can J Ophthalmol"},{"key":"1275_CR4","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1002\/pbc.20606","volume":"47","author":"G Chantada","year":"2006","unstructured":"Chantada G, Antoneli CBG, Grundy R, Schvartzman E, Popovic MB, Rodr\u0131 C, et al. A proposal for an international retinoblastoma staging system. Pediatr Blood Cancer. 2006;47:801\u20135.","journal-title":"Pediatr Blood Cancer"},{"key":"1275_CR5","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.5858\/133.8.1199","volume":"133","author":"X Sastre","year":"2009","unstructured":"Sastre X, Chantada GL, Doz F, Wilson MW, de Davila MTG, Rodr\u00edguez-Galindo C, et al. Proceedings of the consensus meetings from the International Retinoblastoma Staging Working Group on the pathology guidelines for the examination of enucleated eyes and evaluation of prognostic risk factors in retinoblastoma. Arch Pathol Lab Med. 2009;133:1199\u2013202.","journal-title":"Arch Pathol Lab Med"},{"key":"1275_CR6","doi-asserted-by":"publisher","first-page":"2883","DOI":"10.1200\/JCO.18.01808","volume":"37","author":"P Ch\u00e9vez-Barrios","year":"2019","unstructured":"Ch\u00e9vez-Barrios P, Eagle RC, Krailo M, Piao J, Albert DM, Gao Y, et al. Study of unilateral retinoblastoma with and without histopathologic high-risk features and the role of adjuvant chemotherapy: a Children\u2019s Oncology Group study. J Clin Oncol. 2019;37:2883\u201391.","journal-title":"J Clin Oncol"},{"key":"1275_CR7","doi-asserted-by":"publisher","first-page":"287","DOI":"10.3109\/13816810.2015.1016241","volume":"36","author":"H ElZomor","year":"2015","unstructured":"ElZomor H, Taha H, Aleieldin A, Nour R, Zaghloul MS, Fawzi M, et al. High risk retinoblastoma: prevalence and success of treatment in developing countries. Ophthalmic Genet. 2015;36:287\u20139.","journal-title":"Ophthalmic Genet"},{"key":"1275_CR8","doi-asserted-by":"publisher","first-page":"10506","DOI":"10.1200\/JCO.2017.35.15_suppl.10506","volume":"35","author":"IJ Dunkel","year":"2017","unstructured":"Dunkel IJ, Krailo MD, Chantada GL, Banerjee A, Abouelnaga S, Buchsbaum J, et al. Intensive multi-modality therapy for extra-ocular retinoblastoma (RB): A Children\u2019s Oncology Group (COG) trial (ARET0321). J Clin Oncol. 2017;35:10506.","journal-title":"J Clin Oncol"},{"key":"1275_CR9","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","volume":"42","author":"PA Harris","year":"2009","unstructured":"Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42:377\u201381.","journal-title":"J Biomed Inf"},{"key":"1275_CR10","unstructured":"IBM Corp. IBM SPSS statistics for windows, version 24.0. Armonk, NY: IBM Corp.; 2018."},{"key":"1275_CR11","unstructured":"Klein JP, Moeschberger ML. Survival analysis: techniques for censored and truncated data. New York, NY: Springer; 2010."},{"key":"1275_CR12","doi-asserted-by":"crossref","unstructured":"Bunin GR, Orjuela M. Retinoblastoma: epidemiologic aspects. In: Singh AD, Murphree AL, Damato BE, editors. Clinical ophthalmic oncology. Berlin, Heidelberg: Springer Berlin Heidelberg; 2015. p. 39\u201350.","DOI":"10.1007\/978-3-662-43451-2_4"},{"key":"1275_CR13","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1086\/345651","volume":"72","author":"S Richter","year":"2003","unstructured":"Richter S, Vandezande K, Chen N, Zhang K, Sutherland J, Anderson J, et al. Sensitive and efficient detection of RB1 gene mutations enhances care for families with retinoblastoma. Am J Hum Genet. 2003;72:253\u201369.","journal-title":"Am J Hum Genet"},{"key":"1275_CR14","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.ejca.2005.07.027","volume":"42","author":"B Brichard","year":"2006","unstructured":"Brichard B, Heusterspreute M, De Potter P, Chantrain C, Vermylen C, Sibille C, et al. Unilateral retinoblastoma, lack of familial history and older age does not exclude germline RB1 gene mutation. Eur J Cancer. 2006;42:65\u201372.","journal-title":"Eur J Cancer"},{"key":"1275_CR15","doi-asserted-by":"publisher","first-page":"e26394","DOI":"10.1002\/pbc.26394","volume":"64","author":"DL Friedman","year":"2017","unstructured":"Friedman DL, Krailo M, Villaluna D, Gombos D, Langholz B, Jubran R, et al. Systemic neoadjuvant chemotherapy for group B intraocular retinoblastoma (ARET0331): a report from the Children\u2019s Oncology Group. Pediatr Blood Cancer. 2017;64;e26394.","journal-title":"Pediatr Blood Cancer"},{"key":"1275_CR16","doi-asserted-by":"crossref","unstructured":"Berry JL, Jubran R, Kim JW, Wong K, Bababeygy SR, Almarzouki H, et al. Long-term outcomes of group D eyes in bilateral retinoblastoma patients treated with chemoreduction and low-dose IMRT salvage. Pediatr Blood Cancer. 2013;60:688\u201393.","DOI":"10.1002\/pbc.24303"},{"key":"1275_CR17","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1007\/s11940-007-0015-4","volume":"9","author":"C Rodriguez-Galindo","year":"2007","unstructured":"Rodriguez-Galindo C, Chantada GL, Haik BG, Wilson MW. Treatment of retinoblastoma: current status and future perspectives. Curr Treat Options Neurol. 2007;9:294\u2013307.","journal-title":"Curr Treat Options Neurol"},{"key":"1275_CR18","doi-asserted-by":"publisher","unstructured":"Rao R, Honavar SG, Reddy VP. Preservation of retinoblastoma group E eyes with neovascular glaucoma using intravenous chemotherapy: risk factors and outcomes. Br J Ophthalmol. 2019. https:\/\/doi.org\/10.1136\/bjophthalmol-2018-313442.","DOI":"10.1136\/bjophthalmol-2018-313442"},{"key":"1275_CR19","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1016\/S0002-9394(02)01348-X","volume":"133","author":"CL Shields","year":"2002","unstructured":"Shields CL, Honavar SG, Meadows AT, Shields JA, Demirci H, Singh A, et al. Chemoreduction plus focal therapy for retinoblastoma: factors predictive of need for treatment with external beam radiotherapy or enucleation. Am J Ophthalmol. 2002;133:657\u201364.","journal-title":"Am J Ophthalmol"},{"key":"1275_CR20","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1016\/j.ophtha.2007.11.009","volume":"115","author":"LL Rouic","year":"2008","unstructured":"Rouic LL, Aerts I, L\u00e9vy-Gabriel C, Dendale R, Sastre X, Esteve M, et al. Conservative treatments of intraocular retinoblastoma. Ophthalmology. 2008;115:1405\u201310.e2.","journal-title":"Ophthalmology."},{"key":"1275_CR21","doi-asserted-by":"publisher","first-page":"2276","DOI":"10.1016\/j.ophtha.2006.06.018","volume":"113","author":"CL Shields","year":"2006","unstructured":"Shields CL, Mashayekhi A, Au AK, Czyz C, Leahey A, Meadows AT, et al. The International Classification of Retinoblastoma predicts chemoreduction success. Ophthalmology. 2006;113:2276\u201380.","journal-title":"Ophthalmology."},{"key":"1275_CR22","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1002\/mpo.1355","volume":"38","author":"B Brichard","year":"2002","unstructured":"Brichard B, De Bruycker JJ, De Potter P, Neven B, Vermylen C, Cornu G. Combined chemotherapy and local treatment in the management of intraocular retinoblastoma. Med Pediatr Oncol. 2002;38:411\u20135.","journal-title":"Med Pediatr Oncol"},{"key":"1275_CR23","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1001\/archopht.1996.01100140539004","volume":"114","author":"JE Kingston","year":"1996","unstructured":"Kingston JE, Hungerford JL, Madreperla SA, Plowman PN. Results of combined chemotherapy and radiotherapy for advanced intraocular retinoblastoma. Arch Ophthalmol. 1996;114:1339\u201343.","journal-title":"Arch Ophthalmol"},{"key":"1275_CR24","doi-asserted-by":"publisher","first-page":"1653","DOI":"10.1001\/archopht.120.12.1653","volume":"120","author":"CL Shields","year":"2002","unstructured":"Shields CL, Honavar SG, Meadows AT, Shields JA, Demirci H, Naduvilath TJ. Chemoreduction for unilateral retinoblastoma. Arch Ophthalmol. 2002;120:1653\u20138.","journal-title":"Arch Ophthalmol"},{"key":"1275_CR25","doi-asserted-by":"publisher","first-page":"e0146582","DOI":"10.1371\/journal.pone.0146582","volume":"11","author":"DH Abramson","year":"2016","unstructured":"Abramson DH, Daniels AB, Marr BP, Francis JH, Brodie SE, Dunkel IJ, et al. Intra-arterial chemotherapy (ophthalmic artery chemosurgery) for group D retinoblastoma. PLoS ONE. 2016;11:e0146582.","journal-title":"PLoS ONE"},{"key":"1275_CR26","doi-asserted-by":"publisher","first-page":"191","DOI":"10.3109\/13816819209105167","volume":"13","author":"DH Abramson","year":"1992","unstructured":"Abramson DH, Servodidio CA. Retinoblastoma in the first year of life. Ophthalmic Paediatr Genet. 1992;13:191\u2013203.","journal-title":"Ophthalmic Paediatr Genet"},{"key":"1275_CR27","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1136\/bjo.87.3.327","volume":"87","author":"E Bellaton","year":"2003","unstructured":"Bellaton E, Bertozzi AI, Behar C, Chastagner P, Brisse H, Sainte-Rose C, et al. Neoadjuvant chemotherapy for extensive unilateral retinoblastoma. Br J Ophthalmol. 2003;87:327\u20139.","journal-title":"Br J Ophthalmol"},{"key":"1275_CR28","doi-asserted-by":"publisher","first-page":"2875","DOI":"10.1200\/JCO.18.00141","volume":"37","author":"S Luna-Fineman","year":"2019","unstructured":"Luna-Fineman S, Chantada G, Alejos A, Amador G, Barnoya M, Castellanos ME, et al. Delayed enucleation with neoadjuvant chemotherapy in advanced intraocular unilateral retinoblastoma: AHOPCA II, a prospective, multi-institutional protocol in Central America. J Clin Oncol. 2019;37:2875\u201382.","journal-title":"J Clin Oncol"},{"key":"1275_CR29","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1200\/JCO.2010.32.5332","volume":"29","author":"J Zhao","year":"2011","unstructured":"Zhao J, Dimaras H, Massey C, Xu X, Huang D, Li B, et al. Pre-enucleation chemotherapy for eyes severely affected by retinoblastoma masks risk of tumor extension and increases death from metastasis. J Clin Oncol. 2011;29:845\u201351.","journal-title":"J Clin Oncol"},{"key":"1275_CR30","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.ajo.2004.04.032","volume":"138","author":"CL Shields","year":"2004","unstructured":"Shields CL, Mashayekhi A, Cater J, Shelil A, Meadows AT, Shields JA. Chemoreduction for retinoblastoma. Analysis of tumor control and risks for recurrence in 457 tumors. Am J Ophthalmol. 2004;138:329\u201337.","journal-title":"Am J Ophthalmol"},{"key":"1275_CR31","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1001\/archopht.120.4.460","volume":"120","author":"CL Shields","year":"2002","unstructured":"Shields CL, Honavar SG, Shields JA, Demirci H, Meadows AT, Naduvilath TJ, et al. Factors predictive of recurrence of retinal tumors, vitreous seeds, and subretinal seeds following chemoreduction for retinoblastoma. Arch Ophthalmol. 2002;120:460\u20134.","journal-title":"Arch Ophthalmol"},{"key":"1275_CR32","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1001\/jamaoncol.2019.6716","volume":"6","author":"ID Fabian","year":"2020","unstructured":"Global Retinoblastoma Study Group, Fabian ID, Abdallah E, Abdullahi SU, Abdulqader RA, Adamou Boubacar S, et al. Global retinoblastoma presentation and analysis by national income level. JAMA Oncol. 2020;6:685.","journal-title":"JAMA Oncol"},{"key":"1275_CR33","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1097\/IAE.0000000000001962","volume":"39","author":"S Kaliki","year":"2019","unstructured":"Kaliki S, Patel A, Iram S, Ramappa G, Mohamed A, Palkonda VAR. RETINOBLASTOMA IN INDIA: clinical presentation and outcome in 1,457 patients (2,074 Eyes). Retina. 2019;39:379\u201391.","journal-title":"Retina."}],"container-title":["Eye"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41433-020-01275-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41433-020-01275-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41433-020-01275-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T09:11:12Z","timestamp":1629364272000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41433-020-01275-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,13]]},"references-count":33,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["1275"],"URL":"https:\/\/doi.org\/10.1038\/s41433-020-01275-2","relation":{},"ISSN":["0950-222X","1476-5454"],"issn-type":[{"value":"0950-222X","type":"print"},{"value":"1476-5454","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,13]]},"assertion":[{"value":"28 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2020","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2020","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2020","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}