Retinoblastoma surgery: Difference between revisions
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{{CMG}}; {{AE}} {{Sahar}} {{Simrat}} | {{CMG}}; {{AE}} {{Sahar}} {{Simrat}} | ||
==Overview== | ==Overview== | ||
There are different modalities of treatment available for the treatment of retinoblastoma. The feasibility of each strategy depends on the stage of retinoblastoma at the time of diagnosis. | There are different modalities of treatment available for the treatment of [[retinoblastoma]]. The feasibility of each strategy depends on the stage of [[retinoblastoma]] at the time of [[diagnosis]]. | ||
==Surgery== | ==Surgery== | ||
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> | [[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> | <br> | ||
This method is indicated for: | This method is [[Indication|indicated]] for: | ||
*Unilateral or bilateral group E disease | *Unilateral or [[bilateral]] group E [[disease]] | ||
*Unilateral group D disease | *Unilateral group D [[disease]] | ||
*Maintenance of tumor activity in a blind eye after treatment for primary tumor | *Maintenance of [[tumor]] activity in a blind eye after treatment for primary [[tumor]] | ||
==Other interventions== | ==Other interventions== | ||
Other treatment modalities which are currently available for retinoblastoma include:<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> | Other treatment [[Modality|modalities]] which are currently available for [[retinoblastoma]] include:<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> | ||
===External beam radiotherapy=== | ===[[External beam radiotherapy]]=== | ||
The feasibility of external beam radiotherapy depends on the stage of retinoblastoma at the time of diagnosis.<br> | The feasibility of [[external beam radiotherapy]] depends on the stage of [[retinoblastoma]] at the time of [[diagnosis]].<br> | ||
The globe preservation rate with this method varies according to the stage of the tumor at the time of diagnosis: | The globe preservation rate with this method varies according to the stage of the [[tumor]] at the time of [[diagnosis]]: | ||
Groups I–II eyes:95% | Groups I–II eyes:95% | ||
Groups IV and V eyes:50% | Groups IV and V eyes:50% | ||
This method is indicated as salvage therapy for seeding following unsuccessful chemotherapy, however, the decision to use this method of treatment must be made on a case by case basis.<br> | |||
The dose to target | This method is [[Indication (medicine)|indicated]] as salvage therapy for seeding following unsuccessful [[chemotherapy]], however, the decision to use this method of treatment must be made on a case by case basis.<br> | ||
Contraindications of EBRT: | The dose to target tumor cells of [[retina]] ranges from 3,600 to 4,500 cGy administered in 180–200 cGy daily fractions 5 times/week.<br> | ||
*Children less than 1 year of age due to the risk secondary malignancies | [[Contraindications]] of [[External beam radiotherapy|EBRT]]: | ||
*Children less than 1 year of age due to the risk secondary [[malignancies]] | |||
*For eyes with dismal visual potential | *For eyes with dismal visual potential | ||
*In primary therapy of retinoblastoma | *In primary therapy of [[retinoblastoma]] | ||
===Brachytherapy=== | ===[[Brachytherapy]]=== | ||
Indications: | [[Indication (medicine)|Indications]]: | ||
*Primary treatment | *Primary treatment | ||
*Residual tumor following photocoagulation/thermotherapy/thermo-chemotherapy/cryotherapy | *Residual tumor following [[Laser therapy|photocoagulation]]/[[thermotherapy]]/thermo-chemotherapy/[[cryotherapy]] | ||
*Tumor recurrence | *[[Tumor]] recurrence | ||
*Tumor less than 15 mm in diameter | *[[Tumor]] less than 15 mm in diameter | ||
Contraindication: | [[Contraindication]]: | ||
*Presence of diffuse vitreous seeding | *Presence of diffuse [[vitreous]] seeding | ||
===Thermotherapy=== | ===[[Thermotherapy]]=== | ||
*Tumors not more than 3 mm in diameter, with no and traction, retinal vascular occlusion evidence of seeding, and located posterior to the equator | *[[Tumor|Tumors]] not more than 3 mm in diameter, with no and traction, [[retinal]] vascular occlusion evidence of seeding, and located posterior to the equator | ||
*Primary treatment | *Primary treatment | ||
*Consolidation treatment | *[[Consolidation (medicine)|Consolidation]] treatment | ||
*Tumor recurrence | *[[Tumor]] recurrence | ||
===Thermochemotherapy=== | ===Thermochemotherapy=== | ||
Indications: | [[Indication (medicine)|Indications]]: | ||
*Tumors not more than 12 mm in diameter with no evidence of seeding, and located posterior to the equator | *[[Tumors]] not more than 12 mm in diameter with no evidence of seeding, and located posterior to the equator | ||
*Consolidation treatment | *[[Consolidation (medicine)|Consolidation]] treatment | ||
===Laser photocoagulation=== | ===Laser photocoagulation=== | ||
This method is indicated for intraocular retinoblastoma and one of the following factors: | This method is [[Indication (medicine)|indicated]] for intraocular [[retinoblastoma]] and one of the following factors: | ||
*Consolidation of large tumors after systemic chemotherapy | *[[Consolidation (medicine)|Consolidation]] of large [[Tumor|tumors]] after systemic [[chemotherapy]] | ||
*For the treatment of small peripheral or posterior tumors as the sole modality | *For the treatment of small peripheral or posterior tumors as the sole [[modality]] | ||
*For the eradication of small tumor recurrences following chemotherapy and/or radiotherapy | *For the eradication of small [[tumor]] recurrences following [[chemotherapy]] and/or [[radiotherapy]] | ||
This method is suitable for treating tumors with the following characteristics: | This method is suitable for treating [[tumors]] with the following characteristics: | ||
* 3.0 mm or less in diameter | * 3.0 mm or less in diameter | ||
* 2.0 mm or less in thickness | * 2.0 mm or less in thickness | ||
*Without seeding into the adjacent vitreous | *Without seeding into the adjacent [[vitreous]] | ||
===Cryotherapy=== | ===[[Cryotherapy]]=== | ||
Indications: | [[Indication (medicine)|Indications]]: | ||
*Tumors not more than 3 mm in diameter with no evidence of seeding, and located anterior to the equator | *[[Tumors]] not more than 3 mm in diameter with no evidence of seeding, and located anterior to the equator | ||
*Primary treatment | *Primary treatment | ||
*Consolidation treatment | *[[Consolidation (medicine)|Consolidation]] treatment | ||
*Tumor recurrence | *[[Tumor]] recurrence | ||
==References== | ==References== | ||
Revision as of 16:34, 19 May 2019
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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 the treatment of 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:
- Unilateral or bilateral group E disease
- Unilateral group D disease
- Maintenance of tumor activity in a blind eye after treatment for primary tumor
Other interventions
Other treatment modalities which are currently available for retinoblastoma include:[1]
External beam radiotherapy
The feasibility of external beam radiotherapy depends on the stage of retinoblastoma at the time of diagnosis.
The globe preservation rate with this method varies according to the stage of the tumor at the time of diagnosis:
Groups I–II eyes:95%
Groups IV and V eyes:50%
This method is indicated as salvage therapy for seeding following unsuccessful chemotherapy, however, the decision to use this method of treatment must be made on a case by case basis.
The dose to target tumor cells of retina ranges from 3,600 to 4,500 cGy administered in 180–200 cGy daily fractions 5 times/week.
Contraindications of EBRT:
- Children less than 1 year of age due to the risk secondary malignancies
- For eyes with dismal visual potential
- In primary therapy of retinoblastoma
Brachytherapy
- Primary treatment
- Residual tumor following photocoagulation/thermotherapy/thermo-chemotherapy/cryotherapy
- Tumor recurrence
- Tumor less than 15 mm in diameter
- Presence of diffuse vitreous seeding
Thermotherapy
- Tumors not more than 3 mm in diameter, with no and traction, retinal vascular occlusion evidence of seeding, and located posterior to the equator
- Primary treatment
- Consolidation treatment
- Tumor recurrence
Thermochemotherapy
- Tumors not more than 12 mm in diameter with no evidence of seeding, and located posterior to the equator
- Consolidation treatment
Laser photocoagulation
This method is indicated for intraocular retinoblastoma and one of the following factors:
- Consolidation of large tumors after systemic chemotherapy
- For the treatment of small peripheral or posterior tumors as the sole modality
- For the eradication of small tumor recurrences following chemotherapy and/or radiotherapy
This method is suitable for treating tumors with the following characteristics:
- 3.0 mm or less in diameter
- 2.0 mm or less in thickness
- Without seeding into the adjacent vitreous
Cryotherapy
- Tumors not more than 3 mm in diameter with no evidence of seeding, and located anterior to the equator
- Primary treatment
- Consolidation treatment
- Tumor recurrence
References
- ↑ 1.0 1.1 Kim, Jonathan W.; Murphree, A. Linn; Singh, Arun D. (2015). "Retinoblastoma: Treatment Options": 89–107. doi:10.1007/978-3-662-43451-2_9.