Retinoblastoma medical therapy: Difference between revisions
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[[Cryotherapy]] induces damage to the vascular endothelium with secondary [[thrombosis]] and infarction of the tumor tissue by rapidly freezing it. Cryotherapy may be used as primary therapy for small peripheral tumors or small recurrent tumors previously treated with other methods. | [[Cryotherapy]] induces damage to the vascular endothelium with secondary [[thrombosis]] and infarction of the tumor tissue by rapidly freezing it. Cryotherapy may be used as primary therapy for small peripheral tumors or small recurrent tumors previously treated with other methods. | ||
===Systemic chemotherapy=== | ===Systemic chemotherapy=== | ||
Systemic [[chemotherapy]] has become the forefront of treatment in the past decade, in search of globe preserving measures and to avoid the adverse effects of EBR therapy. | Systemic [[chemotherapy]] has become the forefront of treatment in the past decade, in search of globe preserving measures and to avoid the adverse effects of EBR therapy.<ref name="VenkatramaniJubran2015">{{cite journal|last1=Venkatramani|first1=Rajkumar|last2=Jubran|first2=Rima Fuad|title=Retinoblastoma: Intravenous Chemotherapy|year=2015|pages=119–127|doi=10.1007/978-3-662-43451-2_11}}</ref><br> | ||
The common indications for systemic chemotherapy include: | The common indications for systemic chemotherapy include: | ||
*Unilateral intraocular retinoblastoma with high risk feature | *Unilateral intraocular retinoblastoma with high risk feature | ||
Revision as of 17:54, 16 May 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Sahar Memar Montazerin, M.D.[3]
Overview
Medical therapy for intraocular tumors
The priority of retinoblastoma treatment is:[1]
- Save the life of the child
- Preserve vision
- Minimize complications or side effects of treatment.
The exact course of treatment will depend on the individual case and will be decided by the ophthalmologist in discussion with the pediatric oncologist. Children with the involvement of both eyes at diagnosis usually require multimodality therapy (chemotherapy and local therapies).
The choice of therapy depends upon several factors such as:[2]
Treatment modalities which are currently available for retinoblastoma include:
Enucleation of the eye
- This option is the first line treatment of the majority of the cases. [3]
- Indications:
- Large tumors filling the vitreous for which there is little or no likelihood of restoring vision
- Extension to the anterior chamber
- In the presence of neovascular glaucoma
External beam radiotherapy
- This type of therapy is not recommended as first-line treatment of primary intra-ocular retinoblastoma due to the high risk of secondary malignancies following radiation in patients carrying RB1 gene mutation.[4]
- This therapy may be helpful in the salvage of the remaining eye which is resistant to another kind of therapies.
Brachytherapy
Brachytherapy involves the placement of a radioactive implant (plaque), usually on the sclera adjacent to the base of a tumor. It is used as the primary treatment or, more frequently, in patients with small tumors or in those who had failed initial therapy including previous EBR therapy.
Thermotherapy
Thermotherapy involves the application of heat directly to the tumor, usually in the form of infrared radiation. It is also used for small tumors.
Laser photocoagulation
Laser photocoagulation is recommended only for small posterior tumors. An argon or diode laser or a xenon arc is used to coagulate all the blood supply to the tumor.
Cryotherapy
Cryotherapy induces damage to the vascular endothelium with secondary thrombosis and infarction of the tumor tissue by rapidly freezing it. Cryotherapy may be used as primary therapy for small peripheral tumors or small recurrent tumors previously treated with other methods.
Systemic chemotherapy
Systemic chemotherapy has become the forefront of treatment in the past decade, in search of globe preserving measures and to avoid the adverse effects of EBR therapy.[5]
The common indications for systemic chemotherapy include:
- Unilateral intraocular retinoblastoma with high risk feature
- Bilateral intraocular retinoblastoma
- Prophylaxis against metastasis following enucleation in the presence of histopathologic high-risk features
- Extraocular retinoblastoma with local and/or regional spread
- Metastatic retinoblastoma with or without CNS involvement
- Trilateral retinoblastoma
Chemotherapy regimen
The most common chemotherapy regimen for retinoblastoma is the combination of the followings:[6][7][8]
- Carboplatin
- Etoposide
- Vincristine
This combination may be used with different dose of medication and frequency depending on the stage of the tumor.
- Usually, treatment regimen comprised of either three sessions of high dose regimen or six sessions of low dose regimen.
- Low dose regimen:
- Carboplatin 18.6 mg/kg IV q24h every (21-28) days
- Etoposide 10 mg/kg IV q24h (21-28) days
- Vincristine 0.05 mg/kg IV q24h (21-28) days
- High dose regimen:
- Carboplatin 28 mg/kg IV q24h (21-28) days
- Etoposide 12 mg/kg IV q24h (21-28) days
- Vincristine 0.05 mg/kg IV q24h (21-28) days
Intra-arterial chemotherapy
Chemotherapeutic drugs are administered locally via a thin catheter threaded through the groin, aorta, and the neck directly into the optic vessels.
Management options of Retinoblastoma
| Treatment options for Intraocular tumor[9] | |
|---|---|
| Unilateral retinoblastoma |
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| Bilateral retinoblastoma |
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| Cavitary retinoblastoma |
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| Progressive or recurrent intraocular retinoblastoma |
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| Treatment options for Extraocular tumor[9] | |
| Orbital and locoregional retinoblastoma | |
| CNS disease |
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| Trilateral retinoblastoma |
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| Extracranial metastatic retinoblastoma |
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| Progressive or recurrent extraocular retinoblastoma |
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References
- ↑ Retinoblastoma Treatment. National Cancer Institute(2015) http://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq#section/_53 Accessed on October 13, 2015
- ↑ Shields CL, Shields JA (1999). "Recent developments in the management of retinoblastoma". J Pediatr Ophthalmol Strabismus. 36 (1): 8–18, quiz 35-6. PMID 9972509.
- ↑ Kim JW, Kathpalia V, Dunkel IJ, Wong RK, Riedel E, Abramson DH (April 2009). "Orbital recurrence of retinoblastoma following enucleation". Br J Ophthalmol. 93 (4): 463–7. doi:10.1136/bjo.2008.138453. PMID 18757474.
- ↑ MacCarthy A, Bayne AM, Brownbill PA, Bunch KJ, Diggens NL, Draper GJ, Hawkins MM, Jenkinson HC, Kingston JE, Stiller CA, Vincent TJ, Murphy MF (June 2013). "Second and subsequent tumors among 1927 retinoblastoma patients diagnosed in Britain 1951-2004". Br. J. Cancer. 108 (12): 2455–63. doi:10.1038/bjc.2013.228. PMC 3694232. PMID 23674091.
- ↑ Venkatramani, Rajkumar; Jubran, Rima Fuad (2015). "Retinoblastoma: Intravenous Chemotherapy": 119–127. doi:10.1007/978-3-662-43451-2_11.
- ↑ Rodriguez-Galindo, Carlos; Wilson, Matthew W.; Haik, Barrett G.; Merchant, Thomas E.; Billups, Catherine A.; Shah, Nirali; Cain, Alvida; Langston, James; Lipson, Mindy; Kun, Larry E.; Pratt, Charles B. (2003). "Treatment of Intraocular Retinoblastoma With Vincristine and Carboplatin". Journal of Clinical Oncology. 21 (10): 2019–2025. doi:10.1200/JCO.2003.09.103. ISSN 0732-183X.
- ↑ Gallie BL, Budning A, DeBoer G, Thiessen JJ, Koren G, Verjee Z, Ling V, Chan HS (November 1996). "Chemotherapy with focal therapy can cure intraocular retinoblastoma without radiotherapy". Arch. Ophthalmol. 114 (11): 1321–8. PMID 8906022.
- ↑ Dunkel IJ, Lee TC, Shi W, Beaverson KL, Novetsky D, Lyden D, Finlay JL, McCormick B, Abramson DH (October 2007). "A phase II trial of carboplatin for intraocular retinoblastoma". Pediatr Blood Cancer. 49 (5): 643–8. doi:10.1002/pbc.21163. PMID 17301956.
- ↑ 9.0 9.1 "Retinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute".