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What is the treatment?. Treatment of Retinoblastoma. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team. It is important to the patient’s family about the possible late effects caused by some treatments.
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Treatment of Retinoblastoma • Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team. • It is important to the patient’s family about the possible late effects caused by some treatments. • Late effects of cancer treatment: • Physical problems; changes in mood, feelings, thinking, learning or memory; second cancers • May be treated or controlled http://www.enotalone.com/article/7563.html
Six Types of Standard Treatment • Chemotherapy • Radiation therapy • External beam radiation therapy (EBRT) • Radioactive isotope plaques
Six Types of Standard Treatment • Chemotherapy • Radiation therapy • External beam radiation therapy (EBRT) • Indications: • For eyes with significant vitreous seeding • For children who have progression of disease while undergoing chemoreduction • For tumors extending up to or beyond the cut margin of the optic nerve of an enucleated eye • Advantages: incidence of local control is high and retinal late effects are minimal • Disadvantages: cessation of bone growth, 6-fold increase in development of cancer in the patient’s lifetime • Radioactive isotope plaques
Six Types of Standard Treatment • Chemotherapy • Radiation therapy • External beam radiation therapy (EBRT) • Radioactive isotope plaques • Advantage: locally directed treatment to the tumor, minimizing radiation to the normal tissue • Disadvantage: incomplete treatment, high dose to local sclera, significantly less irradiation for anterior lesions, and difficulty placing posterior plaques
Six Types of Standard Treatment • Enucleation • Surgery to remove the eye and part of the optic nerve. This is done if the tumor is large and there is little or no chance that vision can be saved. The patient will be fitted for an artificial eye after this surgery. • Cryotherapy • Uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ; Can be used primarily for small anteriorly located tumors • Photocoagulation • A procedure that uses laser light to destroy blood vessels to the tumor, causing the tumor cells to die; Can be used as primary therapy for small posteriorly located tumors • Thermotherapy • Use of heat to destroy cancer cells. Thermotherapy may be given using a laser beam aimed through the dilated pupil or onto the outside of the eyeball, or using ultrasound, microwaves, or infrared radiation
For the Patient • Chemotherapy- initial • Enucleation- if unsuccessful
Medical • Chemotherapy • Preservation of normal vision • Primary neoadjuvant chemotherapy or chemoreduction has been the most significant recent advance in the treatment of retinoblastoma. • Prophylactic chemotherapy is recommended if a tumor is in the optic nerve past the lamina cribrosa because these cases have a poor survival prognosis. • Use of neoadjuvant chemotherapy has the advantage of limiting the necessity for EBRT and reducing the possibility of EBRT-related complications.
Surgical • Enucleation • Enucleation is performed when there is no chance of preserving useful vision in an eye. • Treatment of choice for large retinoblastomas • Indicated for: patients who present with total retinal detachments and/or the posterior segment is full of the tumor, in which case it is clear the patient cannot retain any form of useful vision.