Retinoblastoma medical therapy
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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] Sahar Memar Montazerin, M.D.[3]
Overview
Medical therapy for intraocular tumors
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]
Treatment modalities which are currently available for retinoblastoma include:
Enucleation of the eye
- This option is the first line treatment of the majority of the cases. [3]
- Indications:
- Large tumors filling the vitreous for which there is little or no likelihood of restoring vision
- Extension to the anterior chamber
- In the presence of neovascular glaucoma
External beam radiotherapy
- This type of therapy is not recommended as first-line treatment of primary intra-ocular retinoblastoma due to the high risk of secondary malignancies following radiation in patients carrying RB1 gene mutation.[4]
- This therapy may be helpful in the salvage of the remaining eye which is resistant to another kind of therapies.
Brachytherapy
Brachytherapy involves the placement of a radioactive implant (plaque), usually on the sclera adjacent to the base of a tumor. It is used as the primary treatment or, more frequently, in patients with small tumors or in those who had failed initial therapy including previous EBR therapy.
Thermotherapy
Thermotherapy involves the application of heat directly to the tumor, usually in the form of infrared radiation. It is also used for small tumors.
Laser photocoagulation
Laser photocoagulation is recommended only for small posterior tumors. An argon or diode laser or a xenon arc is used to coagulate all the blood supply to the tumor.
Cryotherapy
Cryotherapy induces damage to the vascular endothelium with secondary thrombosis and infarction of the tumor tissue by rapidly freezing it. Cryotherapy may be used as primary therapy for small peripheral tumors or small recurrent tumors previously treated with other methods.
Systemic chemotherapy
Systemic chemotherapy has become forefront of treatment in the past decade, in search of globe preserving measures and to avoid the adverse effects of EBR therapy. The common indications for chemotherapy for intraocular retinoblastoma include:
- Large tumors
- Tumors that cannot be treated with local therapies alone
- Bilateral tumors
- Invasion into the choroid, optic nerve, sclera, orbit, or anterior chamber
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[5] | |
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| 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[5] | |
| 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.
- ↑ Kim JW, Kathpalia V, Dunkel IJ, Wong RK, Riedel E, Abramson DH (April 2009). "Orbital recurrence of retinoblastoma following enucleation". Br J Ophthalmol. 93 (4): 463–7. doi:10.1136/bjo.2008.138453. PMID 18757474.
- ↑ MacCarthy A, Bayne AM, Brownbill PA, Bunch KJ, Diggens NL, Draper GJ, Hawkins MM, Jenkinson HC, Kingston JE, Stiller CA, Vincent TJ, Murphy MF (June 2013). "Second and subsequent tumors among 1927 retinoblastoma patients diagnosed in Britain 1951-2004". Br. J. Cancer. 108 (12): 2455–63. doi:10.1038/bjc.2013.228. PMC 3694232. PMID 23674091.
- ↑ 5.0 5.1 "Retinoblastoma Treatment (PDQ®)—Health Professional Version - National Cancer Institute".