ATV Trail Ride in the Ganaraska Forest. July 2002. Riders of all skill levels - even those with no experience - can tour Ontario's Ganaraska Forest on all-terrain vehicles in August with a package that includes lessons and equipment.
Retinoblastoma - pediatric eye cancer - is best treated by removing the eye promptly, not trying to save a child's vision with chemotherapy, new research shows.
In fact, children who undergo chemotherapy have a sharply higher risk of death because the treatment tends to mask the spread of cancer into the brain.
"We have to think about saving the whole child, not just the eye," Brenda Gallie, an ophthalmologist at Toronto's Hospital for Sick Children and principal investigator of the study, said in an interview.
She said parents often resist enucleation - surgical removal of the eye - and many physicians believe that shrinking the cancerous tumour with drugs can save vision and make surgery easier if it is necessary later, but the data demonstrate that removing the eye is clearly the best option.
"All chemotherapy does is cause a delay that gives the tumour a chance to grow toward the brain," Dr. Gallie said.
Conversely, she said, "if you do it right and remove the tumour promptly, this is a cancer where death is 100-per-cent preventable."
Dr. Gallie stressed that these findings apply to cases of severe retinoblastoma - meaning that the tumour is large or the cancer is threatening to spread to the brain. Smaller tumours can still be treated effectively with chemotherapy, and vision can often be saved.
The new study, published online on Monday in the Journal of Clinical Oncology, consisted of a retrospective analysis of 100 eyes removed from children with retinoblastoma who were treated at Tongren Hospital in Beijing. Of the total, 45 were treated with enucleation and 55 with chemotherapy.
There were no deaths in the patients who had an eye removed soon after diagnosis. However, five of the patients who had chemotherapy first - which delayed surgical removal of the eye by about three months - died. That is a death rate of 17 per cent.
Dr. Gallie noted that enucleation has long been the standard treatment in Canada, but that is not the case everywhere in the world. Many children undergo chemotherapy, but only after surgery. They are also fitted with artificial eyes.
Retinoblastoma used to be treated with radiation, until researchers realized that the side effects of radiation were killing more children than the cancer itself. Chemotherapy then became a popular treatment, based largely on anecdotal evidence, which has largely been discredited by the new study.
"Our hope is that clinicians around the world read this paper and understand its importance," Dr. Gallie said.
Retinoblastoma is a relatively rare disease that affects about one in every 15,000 children globally. The rarity makes it difficult do to research comparing treatment options; the study was done in China because of the large number of cases.
About 25 new cases occur in Canada annually and about 20 cases are treated at the Hospital for Sick Children. Retinoblastoma has a strong genetic link, so is often seen in several generations of the same family. Survivors also have a much higher risk of developing other cancers later in life.
Jeff Healey is the Canada's best-known survivor of retinoblastoma. He underwent a double enucleation at the age of eight months. But he learned to play guitar at the age of 3 and went on to become a world-renowned artist. Mr. Healey died of lung cancer in 2008 at the age of 41. One of his three children also developed cancer of the eye.
Retinoblastoma is difficult to detect. In more than 70 per cent of cases, the first sign of disease is when a photograph of the child reveals a white glow in the eye - known as cat eye - where red eye would normally appear.
Editor's Note: The original version of this article did not specify that these findings apply to cases of severe retinoblastoma. Smaller tumours can still be treated effectively with chemotherapy.