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| __NOTOC__ | | __NOTOC__ |
| {{Retinoblastoma}} | | {{Retinoblastoma}} |
| {{CMG}}{{AE}}{{Simrat}} | | {{CMG}}; {{AE}} {{Sahar}} {{Simrat}} |
| ==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:
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| *Group E tumor, based on International classification for Retinoblastoma. Group E tumors are large tumors (>50 percent of globe volume) with limited to no visual potential, painful eyes, and/or tumors that extend into the [[optic nerve]].
| | * [[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: |
| *[[Enucleation]] is also the preferred treatment in eyes that have poor visual potential and have failed previous "globe-conserving" approaches. | | |
| *Enucleation is often performed if the eye has any one of the following:
| | **Unilateral or [[bilateral]] group E [[disease]] |
| **Secondary [[glaucoma]]
| | **Unilateral group D [[disease]] |
| **Poor view to the [[fundus]] with presumed active [[tumor]]
| | **Maintenance of [[tumor]] activity in a [[Blindness|blind]] [[eye]] after treatment for [[primary tumor]] |
| **[[Anterior chamber]] invasion
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| Potential complications of enucleation include scleral perforation with seeding of [[tumor]] cells into the orbit.
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| 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.
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| ==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]] |
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