Calculators & Tools

Retinoblastoma — Toronto Stage

Post-enucleation staging of retinoblastoma.

1 What is the Retinoblastoma — Toronto Stage?

The Retinoblastoma — Toronto Stage is a oncology scoring tool used in paediatric practice. Post-enucleation staging of retinoblastoma. It scores 1 criteria and interprets the total across 5 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in oncology
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 1 criteria: Extent of disease. Totals are then banded: 1 stage or more - Stage 0: stage 0 - eye-preserving therapy (systemic/intra-arterial chemotherapy, focal therapy). Excellent survival in high-income settings; 2 stage or more - Stage I: stage I - completely resected after enucleation. Usually no adjuvant therapy unless high-risk histology; 3 stage or more - Stage II: stage II - microscopic residual disease. Adjuvant chemotherapy indicated; 4 stage or more - Stage III: stage III - regional extension. Intensive chemotherapy plus orbital radiotherapy; 5 stage or more - Stage IV: stage IV - metastatic. High-dose chemotherapy with stem-cell rescue; CNS disease carries a very poor prognosis.
  • Source: Gupta S, Aitken JF, Bartels U et al. Paediatric cancer stage in population-based cancer registries: the Toronto consensus principles and guidelines. Lancet Oncol 2016;17:e163-72.

4 Frequently asked questions

How many criteria does the Retinoblastoma — Toronto Stage use?

1. They are Extent of disease.

What do the bands of the Retinoblastoma — Toronto Stage mean?

The total is interpreted as: 1 stage or more - Stage 0: stage 0 - eye-preserving therapy (systemic/intra-arterial chemotherapy, focal therapy). Excellent survival in high-income settings; 2 stage or more - Stage I: stage I - completely resected after enucleation. Usually no adjuvant therapy unless high-risk histology; 3 stage or more - Stage II: stage II - microscopic residual disease. Adjuvant chemotherapy indicated; 4 stage or more - Stage III: stage III - regional extension. Intensive chemotherapy plus orbital radiotherapy; 5 stage or more - Stage IV: stage IV - metastatic. High-dose chemotherapy with stem-cell rescue; CNS disease carries a very poor prognosis.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Source: Gupta S, Aitken JF, Bartels U et al. Paediatric cancer stage in population-based cancer registries: the Toronto consensus principles and guidelines. Lancet Oncol 2016;17:e163-72.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.