Retinoblastoma surgery: Difference between revisions
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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]]. | ||
==Surgery== | ==Surgery== | ||
Enucleation is indicated for: | 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> | ||
* | <br> | ||
* | This method indicated for: | ||
* | *Unilateral or bilateral group E disease | ||
*Unilateral group D disease | |||
*Maintenance of tumor activity in a blind eye after treatment for primary tumor | |||
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> | 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]]. Six weeks after the conjunctiva has healed, a prosthesis can be fitted by an ocularist. | 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. | ||
Revision as of 03:57, 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]
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.
Surgery
Enucleation is the most commonly applied method for the treatment of retinoblastoma.[1]
This method indicated for:
- Unilateral or bilateral group E disease
- Unilateral group D disease
- Maintenance of tumor activity in a blind eye after treatment for primary tumor
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
- ↑ Kim, Jonathan W.; Murphree, A. Linn; Singh, Arun D. (2015). "Retinoblastoma: Treatment Options": 89–107. doi:10.1007/978-3-662-43451-2_9.
- ↑ 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.