Retinoblastoma medical therapy: Difference between revisions
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The optimal therapy for [[retinoblastoma]] depends on the stage at diagnosis. Systemic [[chemotherapy]] via [[carboplatin]], [[etoposide]], and [[vincristine]] (CEV) is the most common regimen used to treat [[retinoblastoma]]. | The optimal therapy for [[retinoblastoma]] depends on the stage at diagnosis. Systemic [[chemotherapy]] via [[carboplatin]], [[etoposide]], and [[vincristine]] (CEV) is the most common regimen used to treat [[retinoblastoma]]. | ||
==Medical | ==Medical Therapy== | ||
The priority of [[retinoblastoma]] treatment is:<ref name="NIH">Retinoblastoma Treatment. National Cancer Institute(2015) http://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq#section/_53 Accessed on October 13, 2015</ref> | The priority of [[retinoblastoma]] treatment is:<ref name="NIH">Retinoblastoma Treatment. National Cancer Institute(2015) http://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq#section/_53 Accessed on October 13, 2015</ref> | ||
*Save the life of the child | *Save the life of the child | ||
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* Systemic [[chemotherapy]] followed by myeloablative [[chemotherapy]] with [[stem cell]] rescue, and [[radiation therapy]] for extra-[[Orbital Disease|orbital]] [[disease]] | * Systemic [[chemotherapy]] followed by myeloablative [[chemotherapy]] with [[stem cell]] rescue, and [[radiation therapy]] for extra-[[Orbital Disease|orbital]] [[disease]] | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 18:26, 14 June 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
The optimal therapy for retinoblastoma depends on the stage at diagnosis. Systemic chemotherapy via carboplatin, etoposide, and vincristine (CEV) is the most common regimen used to treat retinoblastoma.
Medical Therapy
The priority of retinoblastoma treatment is:[1]
- Save the life of the child
- Preserve vision
- Minimize complications or side effects of treatment.
The exact course of treatment will depend on the individual case and will be decided by the ophthalmologist in discussion with the pediatric oncologist. Children with the involvement of both eyes at diagnosis usually require multimodality therapy (chemotherapy and local therapies).
The choice of therapy depends upon several factors such as:[2]
Systemic chemotherapy
Systemic chemotherapy has become the forefront of treatment in the past decade, in search of globe preserving measures and to avoid the adverse effects of radiation therapy.[3]
The common indications for systemic chemotherapy include:
- Unilateral intraocular retinoblastoma with high risk feature
- Bilateral intraocular retinoblastoma
- Prophylaxis against metastasis following enucleation in the presence of histopathologic high-risk features
- Extraocular retinoblastoma with local and/or regional spread
- Metastatic retinoblastoma with or without CNS involvement
- Trilateral retinoblastoma
Chemotherapy regimen
The most common chemotherapy regimen for retinoblastoma is the combination of the followings:[4][5][6]
This combination may be used with different dose of medication and frequency depending on the stage of the tumor.
- Usually, treatment regimen comprised of either three sessions of high dose regimen or six sessions of low dose regimen.
- Low dose regimen:
- Carboplatin 18.6 mg/kg IV q24h for one day and be repeated every (21-28) days
- Etoposide 5 mg/kg IV q24h for two days be repeated (21-28) days
- Vincristine 0.05 mg/kg IV q24h for one day and be repeated every (21-28) days
- High dose regimen:
- Carboplatin 28 mg/kg IV q24h for one day and be repeated every (21-28) days
- Etoposide 12 mg/kg IV q24h for two days and be repeated every (21-28) days
- Vincristine 0.05 mg/kg IV q24h for one day and be repeated every (21-28) days
- The above afromentioned dosage is recommended for orbital retinoblastoma and is subject to change for other type of tumor spread.
Intra-arterial chemotherapy
Chemotherapeutic drugs are administered locally via a thin catheter threaded through the groin, aorta, and the neck directly into the optic vessels.
Management options of Retinoblastoma
| Treatment options for Intraocular tumor[7] | |
|---|---|
| Unilateral retinoblastoma |
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| Bilateral retinoblastoma |
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| Cavitary retinoblastoma |
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| Progressive or recurrent intraocular retinoblastoma |
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| Treatment options for Extraocular tumor[7] | |
| Orbital and locoregional retinoblastoma | |
| CNS disease |
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| Trilateral retinoblastoma |
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| Extracranial metastatic retinoblastoma |
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| Progressive or recurrent extraocular retinoblastoma |
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References
- ↑ Retinoblastoma Treatment. National Cancer Institute(2015) http://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq#section/_53 Accessed on October 13, 2015
- ↑ Shields CL, Shields JA (1999). "Recent developments in the management of retinoblastoma". J Pediatr Ophthalmol Strabismus. 36 (1): 8–18, quiz 35-6. PMID 9972509.
- ↑ Venkatramani, Rajkumar; Jubran, Rima Fuad (2015). "Retinoblastoma: Intravenous Chemotherapy": 119–127. doi:10.1007/978-3-662-43451-2_11.
- ↑ Rodriguez-Galindo, Carlos; Wilson, Matthew W.; Haik, Barrett G.; Merchant, Thomas E.; Billups, Catherine A.; Shah, Nirali; Cain, Alvida; Langston, James; Lipson, Mindy; Kun, Larry E.; Pratt, Charles B. (2003). "Treatment of Intraocular Retinoblastoma With Vincristine and Carboplatin". Journal of Clinical Oncology. 21 (10): 2019–2025. doi:10.1200/JCO.2003.09.103. ISSN 0732-183X.
- ↑ Gallie BL, Budning A, DeBoer G, Thiessen JJ, Koren G, Verjee Z, Ling V, Chan HS (November 1996). "Chemotherapy with focal therapy can cure intraocular retinoblastoma without radiotherapy". Arch. Ophthalmol. 114 (11): 1321–8. PMID 8906022.
- ↑ Dunkel IJ, Lee TC, Shi W, Beaverson KL, Novetsky D, Lyden D, Finlay JL, McCormick B, Abramson DH (October 2007). "A phase II trial of carboplatin for intraocular retinoblastoma". Pediatr Blood Cancer. 49 (5): 643–8. doi:10.1002/pbc.21163. PMID 17301956.
- ↑ 7.0 7.1 "Retinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute".