Retinoblastoma medical therapy: Difference between revisions
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===[[Laser photocoagulation|Laser Photocoagulation]]=== | ===[[Laser photocoagulation|Laser Photocoagulation]]=== | ||
*This method is [[Indication (medicine)|indicated]] for intraocular retinoblastoma and one of the following factors: | *This method is [[Indication (medicine)|indicated]] for intraocular retinoblastoma and one of the following factors: | ||
**[[Consolidation (medicine)|Consolidation]] of large [[Tumor|tumors]] after systemic [[chemotherapy]] | **[[Consolidation (medicine)|Consolidation]] of large [[Tumor|tumors]] after [[systemic]] [[chemotherapy]] | ||
**For the treatment of small peripheral or posterior tumors as the sole [[modality]] | **For the treatment of small peripheral or [[Anatomical terms of location|posterior]] [[Tumor|tumors]] as the sole [[modality]] | ||
**For the eradication of small [[tumor]] recurrences following [[chemotherapy]] and/or [[radiotherapy]] | **For the eradication of small [[tumor]] recurrences following [[chemotherapy]] and/or [[radiotherapy]] | ||
*This method is suitable for treating [[tumors]] with the following characteristics: | *This method is suitable for treating [[tumors]] with the following characteristics: | ||
**3.0 mm or less in diameter | **3.0 mm or less in [[diameter]] | ||
**2.0 mm or less in thickness | **2.0 mm or less in thickness | ||
**Without seeding into the adjacent [[vitreous]] | **Without seeding into the adjacent [[vitreous]] | ||
===[[Cryotherapy]]=== | ===[[Cryotherapy]]=== | ||
*[[Indication (medicine)|Indications]]: | *[[Indication (medicine)|Indications]]: | ||
**[[Tumors]] not | **[[Tumors]] not larger than 3 mm in [[diameter]], with no evidence of seeding, and located [[Anatomical terms of location|anterior]] to the equator | ||
**Primary treatment | **Primary treatment | ||
**[[Consolidation (medicine)|Consolidation]] treatment | **[[Consolidation (medicine)|Consolidation]] treatment | ||
| Line 101: | Line 101: | ||
! colspan="2" |Treatment options for Intraocular [[tumor]]<ref name="urlRetinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq#_13 |title=Retinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref> | ! colspan="2" |Treatment options for Intraocular [[tumor]]<ref name="urlRetinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq#_13 |title=Retinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref> | ||
|- | |- | ||
!Unilateral retinoblastoma | |||
| | | | ||
* [[Enucleation]] followed by [[chemotherapy]] | *[[Enucleation]] followed by [[chemotherapy]] | ||
*Conservative ocular salvage approaches: | *Conservative [[ocular]] salvage approaches: | ||
**Chemoreduction with either systemic or [[ophthalmic artery]] infusion [[chemotherapy]] with or without [[intravitreal]] [[chemotherapy]] | **Chemoreduction with either [[systemic]] or [[ophthalmic artery]] [[infusion]] [[chemotherapy]] with or without [[intravitreal]] [[chemotherapy]] | ||
**Local treatments ([[cryotherapy]], [[thermotherapy]], and plaque [[radiation therapy]]) | **Local treatments ([[cryotherapy]], [[thermotherapy]], and plaque [[radiation therapy]]) | ||
|- | |- | ||
!Bilateral retinoblastoma | |||
| | | | ||
* [[Enucleation]] for large intraocular [[tumors]], followed by risk-adapted [[chemotherapy]] when the eye and [[vision]] cannot be saved | *[[Enucleation]] for large intraocular [[tumors]], followed by risk-adapted [[chemotherapy]] when the [[eye]] and [[vision]] cannot be saved | ||
* Conservative ocular salvage approaches when the eye and [[vision]] can be saved: | * Conservative [[ocular]] salvage approaches when the [[eye]] and [[vision]] can be saved: | ||
**Chemoreduction with either systemic or [[ophthalmic artery]] infusion [[chemotherapy]] with or without [[intravitreal]] [[chemotherapy]] | **Chemoreduction with either [[systemic]] or [[ophthalmic artery]] [[infusion]] [[chemotherapy]] with or without [[intravitreal]] [[chemotherapy]] | ||
**Local treatments ([[cryotherapy]], [[thermotherapy]], and plaque [[radiation therapy]]) | **Local treatments ([[cryotherapy]], [[thermotherapy]], and plaque [[radiation therapy]]) | ||
**[[External beam radiotherapy|EBRT]] | **[[External beam radiotherapy|EBRT]] | ||
|- | |- | ||
!Cavitary retinoblastoma | |||
| | | | ||
* Systemic and/or intra-arterial [[chemotherapy]] | *[[Systemic]] and/or [[Intra-arterial Chemotherapy for Retinoblastoma|intra-arterial]] [[chemotherapy]] | ||
|- | |- | ||
!Progressive or recurrent intraocular retinoblastoma | |||
| | | | ||
* [[Enucleation]] | *[[Enucleation]] | ||
* [[Radiation therapy]] ([[External beam radiation therapy|EBRT]] or plaque [[radiation therapy]]) | *[[Radiation therapy]] ([[External beam radiation therapy|EBRT]] or plaque [[radiation therapy]]) | ||
* Local treatments ([[cryotherapy]] or [[thermotherapy]]) | * Local treatments ([[cryotherapy]] or [[thermotherapy]]) | ||
* Salvage [[chemotherapy]] (systemic or [[Intra-arterial Chemotherapy for Retinoblastoma|intra-arterial]]) | *[[Salvage therapy|Salvage]] [[chemotherapy]] ([[systemic]] or [[Intra-arterial Chemotherapy for Retinoblastoma|intra-arterial]]) | ||
* [[Intravitreal]] [[chemotherapy]] | *[[Intravitreal]] [[chemotherapy]] | ||
|+ | |+ | ||
! colspan="2" |Treatment options for Extraocular [[tumor]]<ref name="urlRetinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq#_13 |title=Retinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref> | ! colspan="2" |Treatment options for Extraocular [[tumor]]<ref name="urlRetinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq#_13 |title=Retinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref> | ||
|- | |- | ||
![[Orbit (anatomy)|Orbital]] and locoregional retinoblastoma | |||
| | | | ||
* [[Chemotherapy]] | * [[Chemotherapy]] | ||
* [[Radiation therapy]] | * [[Radiation therapy]] | ||
|- | |- | ||
![[CNS disease]] | |||
| | | | ||
* Systemic [[chemotherapy]] and [[CNS]]-directed [[therapy]] | *[[Systemic]] [[chemotherapy]] and [[CNS]]-directed [[therapy]] | ||
* Systemic [[chemotherapy]] followed by myeloablative [[chemotherapy]] and [[stem cell]] rescue | *[[Systemic]] [[chemotherapy]] followed by myeloablative [[chemotherapy]] and [[stem cell]] rescue | ||
|- | |- | ||
!Trilateral retinoblastoma | |||
| | | | ||
* Systemic [[chemotherapy]] followed by [[surgery]] and myeloablative [[chemotherapy]] with [[stem cell]] rescue | *[[Systemic]] [[chemotherapy]] followed by [[surgery]] and myeloablative [[chemotherapy]] with [[stem cell]] rescue | ||
* Systemic [[chemotherapy]] followed by [[surgery]] and [[radiation therapy]] | *[[Systemic]] [[chemotherapy]] followed by [[surgery]] and [[radiation therapy]] | ||
|- | |- | ||
![[Extracranial]] [[metastatic]] retinoblastoma | |||
| | | | ||
* Systemic [[chemotherapy]] followed by myeloablative [[chemotherapy]] with [[stem cell]] rescue and [[radiation therapy]] | *[[Systemic]] [[chemotherapy]] followed by myeloablative [[chemotherapy]] with [[stem cell]] rescue and [[radiation therapy]] | ||
|- | |- | ||
!Progressive or recurrent extraocular retinoblastoma | |||
| | | | ||
* Systemic [[chemotherapy]] and [[radiation therapy]] for [[orbital disease]] | *[[Systemic]] [[chemotherapy]] and [[radiation therapy]] for [[orbital disease]] | ||
* Systemic [[chemotherapy]] followed by myeloablative [[chemotherapy]] with [[stem cell]] rescue, and [[radiation therapy]] for extra-[[Orbital Disease|orbital]] [[disease]] | *[[Systemic]] [[chemotherapy]] followed by myeloablative [[chemotherapy]] with [[stem cell]] rescue, and [[radiation therapy]] for extra-[[Orbital Disease|orbital]] [[disease]] | ||
|} | |} | ||
| Line 161: | Line 161: | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
Latest revision as of 23:59, 29 July 2020
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Retinoblastoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Retinoblastoma medical therapy On the Web |
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American Roentgen Ray Society Images of Retinoblastoma medical therapy |
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Risk calculators and risk factors for Retinoblastoma medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Simrat Sarai, M.D. [3]
Overview
The optimal therapy for retinoblastoma depends on the stage at diagnosis. Systemic chemotherapy via carboplatin, etoposide, and vincristine (CEV) is the most common regimen used to treat retinoblastoma.
Medical Therapy
- The priority of retinoblastoma treatment is to:[1]
- Save the life of the child
- Preserve vision
- Minimize complications or side effects of treatment
- The exact course of treatment will depend upon 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]
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 radiation therapy.[3]
- The common indications for systemic chemotherapy include:
- Unilateral intraocular retinoblastoma with high risk features
- 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 following:[4][5][6]
- This combination may be used with different dose of medication and frequency depending upon the stage of the tumor.
- Usually, the treatment regimen is 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 for one day and repeated every (21 - 28) days
- Etoposide 5 mg/kg IV q24h for two days and repeated (21 - 28) days
- Vincristine 0.05 mg/kg IV q24h for one day and repeated every (21 - 28) days
- High dose regimen:
- Carboplatin 28 mg/kg IV q24h for one day and repeated every (21 - 28) days
- Etoposide 12 mg/kg IV q24h for two days and repeated every (21 - 28) days
- Vincristine 0.05 mg/kg IV q24h for one day and repeated every (21 - 28) days
- The above mentioned dosage is recommended for orbital retinoblastoma and is subject to change for other types of tumor presentation.
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.
Other Interventions
- Other treatment modalities which are currently available for retinoblastoma include:[7]
External Beam Radiotherapy (EBRT)
- The feasibility of external beam radiotherapy depends on the stage of retinoblastoma at the time of diagnosis.
- The globe preservation rate with this method varies according to the stage of the tumor at the time of diagnosis:
- Groups I–II eyes: 95%
- Groups IV and V eyes: 50%
- This method is indicated as salvage therapy for seeding following unsuccessful chemotherapy, however, the decision to use this method of treatment must be made on a case by case basis.
- The dose to target tumor cells of retina ranges from 3,600 to 4,500 cGy administered in 180 - 200 cGy daily fractions 5 times/week.
- Contraindications of EBRT:
- Children less than 1 year of age (due to the risk of secondary malignancies)
- Eyes with dismal visual potential
Brachytherapy
- Indications:
- Primary treatment
- Residual tumor following photocoagulation/thermotherapy/thermo-chemotherapy/cryotherapy
- Tumor recurrence
- Tumor size less than 15 mm in diameter
- Contraindication:
Thermotherapy
- Indications:
- Tumors not larger than 3 mm in diameter with no evidence of seeding, and located posterior to the equator
- Primary treatment
- Consolidation treatment
- Tumor recurrence
Thermo-chemotherapy
- Indications:
- Tumors not larger than 12 mm in diameter with no evidence of seeding, and located posterior to the equator
- Consolidation treatment
Laser Photocoagulation
- This method is indicated for intraocular retinoblastoma and one of the following factors:
- Consolidation of large tumors after systemic chemotherapy
- For the treatment of small peripheral or posterior tumors as the sole modality
- For the eradication of small tumor recurrences following chemotherapy and/or radiotherapy
- This method is suitable for treating tumors with the following characteristics:
Cryotherapy
- Indications:
- Tumors not larger than 3 mm in diameter, with no evidence of seeding, and located anterior to the equator
- Primary treatment
- Consolidation treatment
- Tumor recurrence
Management Options of Retinoblastoma
| Treatment options for Intraocular tumor[8] | |
|---|---|
| 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[8] | |
| 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.
- ↑ 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.
- ↑ Kim, Jonathan W.; Murphree, A. Linn; Singh, Arun D. (2015). "Retinoblastoma: Treatment Options": 89–107. doi:10.1007/978-3-662-43451-2_9.
- ↑ 8.0 8.1 "Retinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute".