Therapeutic Options for Retinoblastoma

Abstract

In the past 10 years, the management strategy for retinoblastoma has significantly changed, shifting toward local chemotherapy and away from systemic chemotherapy. Innovations in the field of molecular biology and the development of targeted therapies have led to improvements in survival rates and ocular salvage for this disease. However, the need still exists to further assess the long-term effects of such directional changes in Therapy.

Human neural progenitor cells decrease photoreceptor degeneration, normalize opsin distribution and support synapse structure in cultured porcine retina

“…Focal therapy is used to locally treat small tumors in cases where there is no vitreous seeding. These include photocoagulation, cryotherapy, thermotherapy and brachytherapy (110,111). Photocoagulation employs the use of a diode laser, cryotherapy uses freeze-thaw cycles, thermotherapy uses infra-red, ultrasound or microwaves and brachytherapy uses radiation with custom designed plaques (111).…”

“…These include photocoagulation, cryotherapy, thermotherapy and brachytherapy (110,111). Photocoagulation employs the use of a diode laser, cryotherapy uses freeze-thaw cycles, thermotherapy uses infra-red, ultrasound or microwaves and brachytherapy uses radiation with custom designed plaques (111). Larger tumors are treated with chemotherapy to reduce tumor size usually using three classes of drugs: DNA alkylating agents (e.g.…”

“…To avoid the risk of disease dissemination, patients with unilateral retinoblastoma usually undergo enucleation. However, in case of bilateral patients, the worst affected eye is enucleated and the remaining eye is salvaged so that the child can at least retain vision (103,110,111). Although these current treatment regimens have been used successfully to treat many retinoblastoma patients, they are not devoid of side effects.…”

Risk of metastasis and orbital recurrence in advanced retinoblastoma eyes treated with systemic chemoreduction versus primary enucleation

“…Group E eyes are described as eyes that have been destroyed anatomically or functionally by tumor1, and according to the IIRC, primary enucleation was recommended for these eyes. However, in certain clinical situations, such as bilateral advanced disease, salvage may be attempted for Group E eyes . Furthermore, with the advent of new treatment modalities such as intra‐arterial chemotherapy, we now have more options in our armamentarium for the treatment of advanced retinoblastoma eyes.…”

“…However, in certain clinical situations, such as bilateral advanced disease, salvage may be attempted for Group E eyes. 4 of new treatment modalities such as intra-arterial chemotherapy, we now have more options in our armamentarium for the treatment of advanced retinoblastoma eyes. The salvage rate for Group D eyes treated with intra-arterial chemotherapy has been reported to range from 36% to 100%, 6 with several large series demonstrating that 78% 7 to 94% of the treated eyes avoid enucleation or radiation.…”