Retinoblastoma surgery: Difference between revisions

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{{Retinoblastoma}}
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==Overview==
==Overview==
The feasibility of surgery depends on the tumor size, tumor location, and presence or absence of [[vitreous]] or subretinal seeds at diagnosis. When the retinoblastoma is too large to be treated by other treatment modalities, [[surgery]] may be used. In these situations, [[enucleation]] may help to prevent [[metastasis]].  
There are different modalities of treatment available for retinoblastoma. The feasibility of each strategy depends on the [[Cancer staging|stage]] of retinoblastoma at the time of [[diagnosis]].
==Surgery==
==Surgery==
Enucleation is indicated for:
 
*Group E tumor
* [[Enucleation]] is the most commonly applied method for the treatment of retinoblastoma.<ref name="KimMurphree2015">{{cite journal|last1=Kim|first1=Jonathan W.|last2=Murphree|first2=A. Linn|last3=Singh|first3=Arun D.|title=Retinoblastoma: Treatment Options|year=2015|pages=89–107|doi=10.1007/978-3-662-43451-2_9}}</ref>
*Advanced group D tumors may require enucleation, particularly in the setting of unilateral disease
* This method is [[Indication (medicine)|indicated]] for:
*Poor visual potential and have failed previous "globe-conserving" approaches
 
*Secondary [[glaucoma]]
**Unilateral or [[bilateral]] group E [[disease]]
*Poor view to the [[fundus]] with presumed active [[tumor]]
**Unilateral group D [[disease]]
*[[Anterior chamber]] invasion
**Maintenance of [[tumor]] activity in a [[Blindness|blind]] [[eye]] after treatment for [[primary tumor]]
Potential complications of enucleation include scleral perforation with seeding of [[tumor]] cells into the orbit.
Adjuvant systemic [[chemotherapy]] or [[brachytherapy]] may be considered in patients with high-risk features to prevent metastatic disease (eg, [[ciliary body]], [[iris]], massive scleral or choroidal infiltration, and invasion of the [[optic nerve]] posterior to the lamina cribrosa). Adjuvant chemotherapy may reduce the development of contralateral or intracranial [[tumors]] ([[PNET]]) in  children with a germline [[mutation]]. When there is a positive optic nerve margin or extrascleral/trans-scleral extension, [[external beam radiotherapy]] should be considered.<ref name="pmid12096963">{{cite journal| author=Honavar SG, Singh AD, Shields CL, Meadows AT, Demirci H, Cater J et al.| title=Postenucleation adjuvant therapy in high-risk retinoblastoma. | journal=Arch Ophthalmol | year= 2002 | volume= 120 | issue= 7 | pages= 923-31 | pmid=12096963 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12096963  }} </ref> Although somewhat controversial, adjuvant chemotherapy may reduce the development of contralateral or intracranial tumors (PNET) in the child with a germline mutation. <ref name="pmid22084213">{{cite journal| author=Kaliki S, Shields CL, Shah SU, Eagle RC, Shields JA, Leahey A| title=Postenucleation adjuvant chemotherapy with vincristine, etoposide, and carboplatin for the treatment of high-risk retinoblastoma. | journal=Arch Ophthalmol | year= 2011 | volume= 129 | issue= 11 | pages= 1422-7 | pmid=22084213 | doi=10.1001/archophthalmol.2011.289 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22084213  }} </ref> An orbital implant (typically [[hydroxyapatite]] or porous polyethylene) is placed at the time of enucleation. After Approximately after six weeks when the conjunctiva has healed, a prosthesis can be fitted by an ocularist.


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Disease]]
[[Category:Medicine]]
[[Category:Ophthalmology]]
[[Category:Oncology]]
[[Category:Hereditary cancers]]
[[Category:Up-To-Date]]
[[Category:Surgery]]

Latest revision as of 23:59, 29 July 2020

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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

There are different modalities of treatment available for retinoblastoma. The feasibility of each strategy depends on the stage of retinoblastoma at the time of diagnosis.

Surgery

  • Enucleation is the most commonly applied method for the treatment of retinoblastoma.[1]
  • This method is indicated for:

References

  1. ↑ Kim, Jonathan W.; Murphree, A. Linn; Singh, Arun D. (2015). "Retinoblastoma: Treatment Options": 89–107. doi:10.1007/978-3-662-43451-2_9.
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