NEOADJUVANT CHEMOTHERAPY AND ENUCLEATION ACCEPTANCE IN ADVANCED RETINOBLASTOMA: A PROSPECTIVE STUDY IN A LOW-RESOURCE SETTING

Background: In low- and middle-income countries (LMICs), retinoblastoma (RB) frequently presents at advanced stages, with parental refusal of enucleation posing a major treatment challenge. Neoadjuvant chemotherapy (NACT) may reduce tumor burden and improve enucleation acceptance. Methods: This prospective observational study was conducted at a tertiary cancer center in India (Dec 2023–Dec 2024). Eleven children (1 month –5 years old) with unilateral Group E RB (ICRB classification) who initially refused upfront enucleation were included. Patients received three cycles of NACT (Vincristine, Etoposide, Carboplatin). Tumor burden reduction was assessed via MRI-based volume measurements before and after NACT. Statistical tests included Chi-square tests, Mann-Whitney U tests, and ttests. Results: Mean tumor burden reduction was 76.3% (±12.5%) (range: 52–91%, p < 0.0001). Parental enucleation acceptance increased from 0% to 90.9% following chemotherapy and structured counseling.No significant association was found between gender and eye involvement (p = 0.39) or age differences between genders (p = 0.55).Conclusion: NACT significantly reduced tumor burden and improved parental acceptance of enucleation in unilateral Group E RB. These findings suggest that pre-enucleation chemotherapy, combined with structured counseling, may enhance treatment adherence in LMICs.Larger multi-center studies are needed to validate these results.