Retinoblastoma surgery: Difference between revisions
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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]]. | 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]]. | ||
===Management options of Retinoblastoma=== | |||
:* | |||
{| class="wikitable" | |||
|+ | |||
! 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> | |||
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|Unilateral retinoblastoma | |||
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* Enucleation followed by chemotherapy | |||
*Conservative ocular salvage approaches: | |||
**Chemoreduction with either systemic or ophthalmic artery infusion chemotherapy with or without intravitreal chemotherapy | |||
**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 | |||
* 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 | |||
**Local treatments (cryotherapy, thermotherapy, and plaque radiation therapy) | |||
**EBRT | |||
|- | |||
|Cavitary retinoblastoma | |||
| | |||
* Systemic and/or intra-arterial chemotherapy | |||
|- | |||
|Progressive or recurrent intraocular retinoblastoma | |||
| | |||
* Enucleation | |||
* Radiation therapy (EBRT or plaque radiation therapy) | |||
* Local treatments (cryotherapy or thermotherapy) | |||
* Salvage chemotherapy (systemic or intra-arterial) | |||
* 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> | |||
|- | |||
|Orbital and locoregional retinoblastoma | |||
| | |||
* Chemotherapy | |||
* Radiation therapy | |||
|- | |||
|CNS disease | |||
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* Systemic chemotherapy and CNS-directed therapy | |||
* 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 radiation therapy | |||
|- | |||
|Extracranial metastatic retinoblastoma | |||
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* Systemic chemotherapy followed by myeloablative chemotherapy with stem cell rescue and radiation therapy | |||
|- | |||
|Progressive or recurrent extraocular retinoblastoma | |||
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* Systemic chemotherapy and radiation therapy for orbital disease | |||
* Systemic chemotherapy followed by myeloablative chemotherapy with stem cell rescue, and radiation therapy for extraorbital disease | |||
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==Surgery== | ==Surgery== | ||
Enucleation is indicated for: | Enucleation is indicated for: | ||
Revision as of 15:21, 3 May 2019
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Retinoblastoma Microchapters |
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Treatment |
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Retinoblastoma surgery On the Web |
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American Roentgen Ray Society Images of Retinoblastoma surgery |
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Risk calculators and risk factors for Retinoblastoma surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
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.
Management options of Retinoblastoma
| Treatment options for Intraocular tumor[1] | |
|---|---|
| Unilateral retinoblastoma |
|
| Bilateral retinoblastoma |
|
| Cavitary retinoblastoma |
|
| Progressive or recurrent intraocular retinoblastoma |
|
| Treatment options for Extraocular tumor[1] | |
| Orbital and locoregional retinoblastoma |
|
| CNS disease |
|
| Trilateral retinoblastoma |
|
| Extracranial metastatic retinoblastoma |
|
| Progressive or recurrent extraocular retinoblastoma |
|
Surgery
Enucleation is indicated for:
- Group E tumor
- Advanced group D tumors may require enucleation, particularly in the setting of unilateral disease
- Poor visual potential and have failed previous "globe-conserving" approaches
- Secondary glaucoma
- Poor view to the fundus with presumed active tumor
- Anterior chamber invasion
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.[2] Although somewhat controversial, adjuvant chemotherapy may reduce the development of contralateral or intracranial tumors (PNET) in the child with a germline mutation.[3] An orbital implant (typically hydroxyapatite or porous polyethylene) is placed at the time of enucleation. Six weeks after the conjunctiva has healed, a prosthesis can be fitted by an ocularist.
References
- ↑ 1.0 1.1 "Retinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute".
- ↑ Honavar SG, Singh AD, Shields CL, Meadows AT, Demirci H, Cater J; et al. (2002). "Postenucleation adjuvant therapy in high-risk retinoblastoma". Arch Ophthalmol. 120 (7): 923–31. PMID 12096963.
- ↑ Kaliki S, Shields CL, Shah SU, Eagle RC, Shields JA, Leahey A (2011). "Postenucleation adjuvant chemotherapy with vincristine, etoposide, and carboplatin for the treatment of high-risk retinoblastoma". Arch Ophthalmol. 129 (11): 1422–7. doi:10.1001/archophthalmol.2011.289. PMID 22084213.