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*Presence or absence of [[vitreous]] or subretinal seeds
*Presence or absence of [[vitreous]] or subretinal seeds
*Age of the patient
*Age of the patient
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. <ref name="pmid18757474">{{cite journal |vauthors=Kim JW, Kathpalia V, Dunkel IJ, Wong RK, Riedel E, Abramson DH |title=Orbital recurrence of retinoblastoma following enucleation |journal=Br J Ophthalmol |volume=93 |issue=4 |pages=463–7 |date=April 2009 |pmid=18757474 |doi=10.1136/bjo.2008.138453 |url=}}</ref>
*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.<ref name="pmid23674091">{{cite journal |vauthors=MacCarthy A, Bayne AM, Brownbill PA, Bunch KJ, Diggens NL, Draper GJ, Hawkins MM, Jenkinson HC, Kingston JE, Stiller CA, Vincent TJ, Murphy MF |title=Second and subsequent tumors among 1927 retinoblastoma patients diagnosed in Britain 1951-2004 |journal=Br. J. Cancer |volume=108 |issue=12 |pages=2455–63 |date=June 2013 |pmid=23674091 |pmc=3694232 |doi=10.1038/bjc.2013.228 |url=}}</ref>
*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===
Systemic [[chemotherapy]] has become the forefront of treatment in the past decade, in search of [[Eyeball|globe]] preserving measures and to avoid the [[adverse effects]] of [[radiation 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>
Systemic [[chemotherapy]] has become the forefront of treatment in the past decade, in search of [[Eyeball|globe]] preserving measures and to avoid the [[adverse effects]] of [[radiation 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>
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==References==
==References==
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{{reflist|2}}
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Revision as of 04:05, 19 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]

  • Tumor size
  • Tumor location
  • Presence or absence of vitreous or subretinal seeds
  • Age of the patient

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:

Chemotherapy regimen
The most common chemotherapy regimen for retinoblastoma is the combination of the followings:[4][5][6]

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 for one day and be repeated every (21-28) days
    • Etoposide 5 mg/kg IV q24h for two days be repeated (21-28) days
    • Vincristine 0.05 mg/kg IV q24h for one day and be repeated every (21-28) days
  • High dose regimen:
    • Carboplatin 28 mg/kg IV q24h for one day and be repeated every (21-28) days
    • Etoposide 12 mg/kg IV q24h for two days and be repeated every (21-28) days
    • Vincristine 0.05 mg/kg IV q24h for one day and be repeated every (21-28) days
  • The above afromentioned dosage is recommended for orbital retinoblastoma and is subject to change for other type of tumor spread.

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[7]
Unilateral retinoblastoma
Bilateral retinoblastoma
Cavitary retinoblastoma
Progressive or recurrent intraocular retinoblastoma
Treatment options for Extraocular tumor[7]
Orbital and locoregional retinoblastoma
CNS disease
Trilateral retinoblastoma
Extracranial metastatic retinoblastoma
Progressive or recurrent extraocular retinoblastoma

References

  1. ↑ Retinoblastoma Treatment. National Cancer Institute(2015) http://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq#section/_53 Accessed on October 13, 2015
  2. ↑ 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.
  3. ↑ Venkatramani, Rajkumar; Jubran, Rima Fuad (2015). "Retinoblastoma: Intravenous Chemotherapy": 119–127. doi:10.1007/978-3-662-43451-2_11.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 7.0 7.1 "Retinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute".
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