Retinoblastoma medical therapy
Retinoblastoma medical therapy On the Web
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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 priority of retinoblastoma treatment is to:
- The exact course of treatment will depend upon 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:
- 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.
- The common indications for systemic chemotherapy include:
- Unilateral intraocular retinoblastoma with high risk features
- 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
- The most common chemotherapy regimen for retinoblastoma is the combination of the following:
- This combination may be used with different dose of medication and frequency depending upon the stage of the tumor.
- Usually, the treatment regimen is comprised of either three sessions of high dose regimen or six sessions of low dose regimen.
- Low dose regimen:
- High dose regimen:
- The above mentioned dosage is recommended for orbital retinoblastoma and is subject to change for other types of tumor presentation.
- Chemotherapeutic drugs are administered locally via a thin catheter threaded through the groin, aorta, and the neck directly into the optic vessels.
- 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:
- This method is indicated for intraocular retinoblastoma and one of the following factors:
- This method is suitable for treating tumors with the following characteristics:
Management Options of Retinoblastoma
|Treatment options for Intraocular tumor|
|Progressive or recurrent intraocular retinoblastoma|
|Treatment options for Extraocular tumor|
|Orbital and locoregional retinoblastoma|
|Extracranial metastatic retinoblastoma|
|Progressive or recurrent extraocular retinoblastoma|
- Retinoblastoma Treatment. National Cancer Institute(2015) http://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq#section/_53 Accessed on October 13, 2015
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