Twenty-Year Collaboration Between North American and South American Retinoblastoma Programs

Retinoblastoma is a highly curable neoplasm in the developed world. In less-developed countries, however, survival figures are lower mostly because of delayed diagnosis and poor treatment compliance. During the past decades, in middleincome countries, disease-free survival of children with retinoblastoma has improved gradually, but there are many challenges related with advanced disease at diagnosis that introduce specific considerations for management. In that setting, children present with more advanced intraocular disease that frequently needs enucleation and systemic treatment to prevent extraocular dissemination; occasionally, they present with metastatic disease that needs high-dose therapy. Unlike many other pediatric malignancies, medical evidence needed for the treatment of these children is not available from cooperative groups from higher-income countries (HICs), simply because this condition is virtually nonexistent in HICs and because limited results have been reported by cooperative groups. Thus, evidence is left to be generated in less-developed countries. In addition, eye-conservative treatment is a challenge in this setting, not only because more patients present with more advanced disease but also because of the relatively low availability of sophisticated therapies and training of specialized personnel to use local treatments.