Retinoblastoma medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The priorities in the treatment of retinoblastoma are to preserve life, preserve globe and preserve vision, in that specific order. Minimizing side effects and complications of treatment are also of paramount importance in these very young patients. Enucleation remains the definitive treatment of intraocular retinoblastoma, particularly in the majority of patients who present with unilateral disease.Treatment modalities that may be successful in globe salvage include systemic chemotherapy with focal consolidation, intra-arterial chemotherapy, and for small tumors, focally destructive therapy (cryopexy, laser photocoagulation, hyperthermia and plaque irradiation).<ref>http://eyewiki.org/Retinoblastoma#General_treatment</ref> | |||
==Medical therapy== | ==Medical therapy== | ||
Until recently the only treatment was to remove the affected eyeball before the cancer spread. Chemotherapy is the treatment of choice for most unilateral cases. However with locally advanced disease external beam radiation may be needed and if both eyes are involved [[enucleation]] may be the only option. Affected children in developing countries present with advanced features and usually die of metastatic spread. In its initial stages, retinoblastoma is very similar to [[Coats disease]], a non-cancerous retina disease. Coats' Disease should be ruled out before enucleation is done. A mis-diagnosis of Retinoblastoma accounts for the greatest number of Coats' disease eyes being enucleated. | Until recently the only treatment was to remove the affected eyeball before the cancer spread. Chemotherapy is the treatment of choice for most unilateral cases. However with locally advanced disease external beam radiation may be needed and if both eyes are involved [[enucleation]] may be the only option. Affected children in developing countries present with advanced features and usually die of metastatic spread. In its initial stages, retinoblastoma is very similar to [[Coats disease]], a non-cancerous retina disease. Coats' Disease should be ruled out before enucleation is done. A mis-diagnosis of Retinoblastoma accounts for the greatest number of Coats' disease eyes being enucleated. | ||
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Local therapies include- | Local therapies include- | ||
[[Laser therapy]] (Uses infrared laser light to precisely destroy the blood vessels surrounding a tumor.) | * [[Laser therapy]] (Uses infrared laser light to precisely destroy the blood vessels surrounding a tumor.) | ||
* [[Cryotherapy]] (use of a cold gas which is injected into the affected part of the retina to shrink the tumor.) | * [[Cryotherapy]] (use of a cold gas which is injected into the affected part of the retina to shrink the tumor.) | ||
* [[Thermotherapy]] (A relatively new technique used mainly in new testing. It uses the principle that if heat is applied to the affected area, a tumor will sustain more damage than healthy cells because healthy cells can cool themselves better using healthy surrounding blood vessels. If this technique is not immediately successful it may increase the efficacy of other treatments such as chemotherapy and focused radiation plaques.) | * [[Thermotherapy]] (A relatively new technique used mainly in new testing. It uses the principle that if heat is applied to the affected area, a tumor will sustain more damage than healthy cells because healthy cells can cool themselves better using healthy surrounding blood vessels. If this technique is not immediately successful it may increase the efficacy of other treatments such as chemotherapy and focused radiation plaques.) | ||
Revision as of 20:00, 1 September 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
The priorities in the treatment of retinoblastoma are to preserve life, preserve globe and preserve vision, in that specific order. Minimizing side effects and complications of treatment are also of paramount importance in these very young patients. Enucleation remains the definitive treatment of intraocular retinoblastoma, particularly in the majority of patients who present with unilateral disease.Treatment modalities that may be successful in globe salvage include systemic chemotherapy with focal consolidation, intra-arterial chemotherapy, and for small tumors, focally destructive therapy (cryopexy, laser photocoagulation, hyperthermia and plaque irradiation).[1]
Medical therapy
Until recently the only treatment was to remove the affected eyeball before the cancer spread. Chemotherapy is the treatment of choice for most unilateral cases. However with locally advanced disease external beam radiation may be needed and if both eyes are involved enucleation may be the only option. Affected children in developing countries present with advanced features and usually die of metastatic spread. In its initial stages, retinoblastoma is very similar to Coats disease, a non-cancerous retina disease. Coats' Disease should be ruled out before enucleation is done. A mis-diagnosis of Retinoblastoma accounts for the greatest number of Coats' disease eyes being enucleated.
Many children with bilateral retinoblastoma can be treated with a preservation attempt. Tumor chemoreduction with carboplatin and other drugs may reduce the tumor volume making them amenable to local therapies [2]
Local therapies include-
- Laser therapy (Uses infrared laser light to precisely destroy the blood vessels surrounding a tumor.)
- Cryotherapy (use of a cold gas which is injected into the affected part of the retina to shrink the tumor.)
- Thermotherapy (A relatively new technique used mainly in new testing. It uses the principle that if heat is applied to the affected area, a tumor will sustain more damage than healthy cells because healthy cells can cool themselves better using healthy surrounding blood vessels. If this technique is not immediately successful it may increase the efficacy of other treatments such as chemotherapy and focused radiation plaques.)
- Radiotherapy (Generally used as a last resort, radiotherapy was previously the treatment of choice before the above mentioned treatments were developed. Radiotherapy destroys cancerous growths using gamma radiation but it carries with it many drawbacks, including:-
- Possibility of secondary cancerous growths which present themselves months or years later.
- Destruction of healthy cells in the area surrounding the treated tumor.
- Bone deformation due to the destruction of the growth plates mainly in the area of the temple.)
It is important that children with retinoblastoma are treated in specialist centers.
Brachytherapy with beta-emitting eye applicators have also been a successful major treatment. BEBIG (GmbH-Berlin-Germany) produces various kinds of ruthenium ophthalmic applicators for treating retinoblastoma.
References
- ↑ http://eyewiki.org/Retinoblastoma#General_treatment
- ↑ Dunkel IJ, Lee TC, Shi W, Beaverson KL, Novetsky D, Lyden D, Finlay JL, McCormick B, Abramson DH. "A phase II trial of carboplatin for intraocular retinoblastoma". Pediatr Blood Cancer. PMID 17301956.