Materiały źródłowe

• #1 Retinoblastoma Treatment – NCI

  https://www.cancer.gov/types/retinoblastoma/patient/retinoblastoma-treatment-pdq

  Retinoblastoma is a disease in which malignant (cancer) cells form in the tissues of the retina. […] Treatment for retinoblastoma depends on whether it is intraocular (within the eye) or extraocular (outside the eye). […] Six types of standard treatment are used: Cryotherapy, Thermotherapy, Chemotherapy, Radiation therapy, High-dose chemotherapy with stem cell rescue, Surgery (enucleation). […] Children with retinoblastoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. […] Treatment for retinoblastoma may cause side effects. […] New types of treatment are being tested in clinical trials. […] Treatment of progressive or recurrent intraocular retinoblastoma may include external-beam radiation therapy or plaque radiotherapy, cryotherapy, thermotherapy, systemic chemotherapy or ophthalmic artery infusion chemotherapy, intravitreal chemotherapy, surgery (enucleation), or a clinical trial of targeted therapy with an oncolytic virus that targets the RB1 gene and is injected into the tumor.

• #2 Treating Retinoblastoma | Treating Children’s Eye Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/retinoblastoma/treating.html

  If your child has been diagnosed with retinoblastoma, your child’s treatment team will discuss the options with you. Its important to weigh the benefits of each treatment option against the possible risks and side effects. […] The main types of treatment for retinoblastoma are: Surgery (Enucleation) for Retinoblastoma, Radiation Therapy for Retinoblastoma, Laser Therapy (Photocoagulation or Thermotherapy) for Retinoblastoma, Cryotherapy for Retinoblastoma, Chemotherapy for Retinoblastoma. […] Sometimes more than one type of treatment may be used. The treatment options are based on the extent (stage) of the cancer and other factors. […] The goals of treatment for retinoblastoma are: To get rid of the cancer and save the childs life, To save the eye if possible, To preserve as much vision as possible, To limit the risk of side effects later in life that can be caused by treatment, particularly second cancers in children with hereditary retinoblastoma.

• #3 Retinoblastoma Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq

  Retinoblastoma is a pediatric cancer that requires careful integration of multidisciplinary care. Treatment of retinoblastoma aims to save the patient’s life and preserve useful vision. For patients presenting with extraocular retinoblastoma, treatment with systemic chemotherapy and radiation therapy is likely to be curative. However, extraorbital disease requires intensive chemotherapy and may include consolidation with high-dose chemotherapy and autologous hematopoietic stem cell rescue with or without radiation therapy. While a large proportion of patients with systemic extracentral nervous system (CNS) metastases can be cured, the prognosis for patients with intracranial disease is dismal. […] Treatment planning by a multidisciplinary team of cancer specialists including a pediatric oncologist, ophthalmologist, and radiation oncologist with experience treating ocular tumors of childhood is required to optimize treatment outcomes.

• #4 Retinoblastoma – EyeWiki

  https://eyewiki.org/Retinoblastoma

  Retinoblastoma is an intraocular malignancy with primitive neuroendocrine origins that primarily affects young children. […] 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 many patients who present with unilateral disease. However, the loss of an eye is associated with significant social stigma in certain cultures. In addition, bilateral enucleation is a devastating option for bilaterally affected patients. Treatment modalities that may be successful in globe salvage include systemic chemotherapy with focal consolidation, intra-arterial chemotherapy, intravitreal chemotherapy, and focally destructive therapy (cryopexy, laser photocoagulation, hyperthermia and plaque irradiation).

• #5 Retinoblastoma Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq

  The goals of therapy include the following: Eradicate the disease to save the patient’s life. Preserve as much vision as possible. Decrease risk of late sequelae from treatment, particularly subsequent neoplasms (SNs). […] Treatment of retinoblastoma depends on the intraocular and extraocular disease burden, disease laterality, germline RB1 gene status, and the potential for preserving vision. For patients presenting with intraocular disease, particularly those with bilateral eye involvement, a conservative approach consisting of tumor reduction with intravenous or intra-arterial chemotherapy (ophthalmic artery chemotherapy), coupled with aggressive local therapy, may result in high ocular salvage rates. […] A risk-adapted, judicious combination of the following therapeutic options should be considered: Enucleation. Local treatment (cryotherapy, laser therapy, and brachytherapy). Systemic chemotherapy. Intra-arterial chemotherapy (ophthalmic artery infusion of chemotherapy). Intravitreal chemotherapy. Intracameral chemotherapy. Radiation therapy (external-beam radiation therapy [EBRT], brachytherapy).

• #6 5 Innovative Retinoblastoma Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/retinoblastoma/retinoblastoma-treatment.html

  Doctors who treat retinoblastoma will tell you they have three goals, in order: Save the life. Save the eye. Save the vision. To achieve these goals, they may use the following treatments. […] Retinoblastoma chemotherapy is delivered in one of the following ways: Intra-arterial: A catheter is inserted into a blood vessel near the groin and then steered through the body up to the eye, where chemo is directly delivered. This avoids exposing the patient to systemic chemotherapy. Under certain circumstances, this is the preferred technique for delivering chemotherapy medications. […] High dose chemotherapy with stem cell rescue: This is a form of intravenous chemotherapy. It is an option for patients whose cancer has spread beyond the eye into areas like the liver or central nervous system. These patients are given a very powerful dose of chemotherapy to kill cancer cells.

• #7 Retinoblastoma Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq

  Retinoblastoma is a pediatric cancer that requires careful integration of multidisciplinary care. Treatment of retinoblastoma aims to save the patient’s life and preserve useful vision. For patients presenting with extraocular retinoblastoma, treatment with systemic chemotherapy and radiation therapy is likely to be curative. However, extraorbital disease requires intensive chemotherapy and may include consolidation with high-dose chemotherapy and autologous hematopoietic stem cell rescue with or without radiation therapy. While a large proportion of patients with systemic extracentral nervous system (CNS) metastases can be cured, the prognosis for patients with intracranial disease is dismal. […] Treatment planning by a multidisciplinary team of cancer specialists including a pediatric oncologist, ophthalmologist, and radiation oncologist with experience treating ocular tumors of childhood is required to optimize treatment outcomes.

• #8 Treating Retinoblastoma | Treating Children’s Eye Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/retinoblastoma/treating.html

  Overall, more than 9 in 10 children with retinoblastoma are cured. The chances of long-term survival are much better if the tumor has not spread outside the eye. […] Retinoblastoma is rare, so not many doctors other than those in specialty eye hospitals and major childrens cancer centers have much experience treating it. […] Children with retinoblastoma are treated by a team of doctors that often includes: A pediatric ophthalmologist, An ocular oncologist, A pediatric oncologist, A radiation oncologist. […] Once the cancer is found and the needed tests have been done, the cancer care team will discuss treatment options with you. Its important to discuss all of the options as well as their possible side effects with your childs doctors to help you make an informed decision. […] If your child has retinoblastoma, be sure they are treated at a childrens cancer center that has expertise in treating children with this rare form of cancer.

• #9 Retinoblastoma Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq

  The goals of therapy include the following: Eradicate the disease to save the patient’s life. Preserve as much vision as possible. Decrease risk of late sequelae from treatment, particularly subsequent neoplasms (SNs). […] Treatment of retinoblastoma depends on the intraocular and extraocular disease burden, disease laterality, germline RB1 gene status, and the potential for preserving vision. For patients presenting with intraocular disease, particularly those with bilateral eye involvement, a conservative approach consisting of tumor reduction with intravenous or intra-arterial chemotherapy (ophthalmic artery chemotherapy), coupled with aggressive local therapy, may result in high ocular salvage rates. […] A risk-adapted, judicious combination of the following therapeutic options should be considered: Enucleation. Local treatment (cryotherapy, laser therapy, and brachytherapy). Systemic chemotherapy. Intra-arterial chemotherapy (ophthalmic artery infusion of chemotherapy). Intravitreal chemotherapy. Intracameral chemotherapy. Radiation therapy (external-beam radiation therapy [EBRT], brachytherapy).

• #10 Retinoblastoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retinoblastoma/diagnosis-treatment/drc-20351013

  Common retinoblastoma treatments include chemotherapy, cold therapy and laser therapy. Radiation therapy may be another option. Surgery to remove the eye can treat retinoblastoma, but it’s only used in certain situations. […] Which treatment is best for your child’s retinoblastoma depends on several factors. These factors include the size and location of the cancer, and whether cancer has spread beyond the eye. Your healthcare team also considers your child’s overall health and your own preferences. […] Chemotherapy treats cancer with strong medicines. It’s often the first treatment for retinoblastoma. Other treatments might be needed after chemotherapy to kill any cancer cells that remain. […] Cold therapy, also called cryotherapy, uses extreme cold to damage cancer cells. It’s typically used after chemotherapy to kill any cancer cells that are left. For very small retinoblastomas, cryotherapy might be the only treatment needed.

• #11 Treating Retinoblastoma | Treating Children’s Eye Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/retinoblastoma/treating.html

  If your child has been diagnosed with retinoblastoma, your child’s treatment team will discuss the options with you. Its important to weigh the benefits of each treatment option against the possible risks and side effects. […] The main types of treatment for retinoblastoma are: Surgery (Enucleation) for Retinoblastoma, Radiation Therapy for Retinoblastoma, Laser Therapy (Photocoagulation or Thermotherapy) for Retinoblastoma, Cryotherapy for Retinoblastoma, Chemotherapy for Retinoblastoma. […] Sometimes more than one type of treatment may be used. The treatment options are based on the extent (stage) of the cancer and other factors. […] The goals of treatment for retinoblastoma are: To get rid of the cancer and save the childs life, To save the eye if possible, To preserve as much vision as possible, To limit the risk of side effects later in life that can be caused by treatment, particularly second cancers in children with hereditary retinoblastoma.

• #12 Retinoblastoma Treatment – NCI

  https://www.cancer.gov/types/retinoblastoma/patient/retinoblastoma-treatment-pdq

  Retinoblastoma is a disease in which malignant (cancer) cells form in the tissues of the retina. […] Treatment for retinoblastoma depends on whether it is intraocular (within the eye) or extraocular (outside the eye). […] Six types of standard treatment are used: Cryotherapy, Thermotherapy, Chemotherapy, Radiation therapy, High-dose chemotherapy with stem cell rescue, Surgery (enucleation). […] Children with retinoblastoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. […] Treatment for retinoblastoma may cause side effects. […] New types of treatment are being tested in clinical trials. […] Treatment of progressive or recurrent intraocular retinoblastoma may include external-beam radiation therapy or plaque radiotherapy, cryotherapy, thermotherapy, systemic chemotherapy or ophthalmic artery infusion chemotherapy, intravitreal chemotherapy, surgery (enucleation), or a clinical trial of targeted therapy with an oncolytic virus that targets the RB1 gene and is injected into the tumor.

• #13 Retinoblastoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retinoblastoma/diagnosis-treatment/drc-20351013

  Common retinoblastoma treatments include chemotherapy, cold therapy and laser therapy. Radiation therapy may be another option. Surgery to remove the eye can treat retinoblastoma, but it’s only used in certain situations. […] Which treatment is best for your child’s retinoblastoma depends on several factors. These factors include the size and location of the cancer, and whether cancer has spread beyond the eye. Your healthcare team also considers your child’s overall health and your own preferences. […] Chemotherapy treats cancer with strong medicines. It’s often the first treatment for retinoblastoma. Other treatments might be needed after chemotherapy to kill any cancer cells that remain. […] Cold therapy, also called cryotherapy, uses extreme cold to damage cancer cells. It’s typically used after chemotherapy to kill any cancer cells that are left. For very small retinoblastomas, cryotherapy might be the only treatment needed.

• #14 Chemotherapy for Retinoblastoma | American Cancer Society

  https://www.cancer.org/cancer/types/retinoblastoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of anti-cancer drugs to treat cancer. Chemo can be given in different ways to treat retinoblastoma. […] Systemic chemo is given in cycles, with each treatment followed by a rest period to give the body time to recover. Each chemo cycle typically lasts for a few weeks, and the total length of treatment is often several months. […] Some of the chemo drugs used to treat retinoblastoma include: Carboplatin, Cisplatin, Vincristine, Etoposide, Cyclophosphamide, Topotecan, Doxorubicin. […] Sometimes instead of systemic chemotherapy, the chemo is injected directly into the ophthalmic artery, the main artery that supplies blood to the eye. […] Because the chemo is put directly into the artery feeding the eye, doctors can use much smaller doses of chemo drugs (less than 10% of the doses used for systemic chemo). Therefore, there are fewer side effects from the chemo.

• #15 Chemotherapy for Retinoblastoma | American Cancer Society

  https://www.cancer.org/cancer/types/retinoblastoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of anti-cancer drugs to treat cancer. Chemo can be given in different ways to treat retinoblastoma. […] Systemic chemo is given in cycles, with each treatment followed by a rest period to give the body time to recover. Each chemo cycle typically lasts for a few weeks, and the total length of treatment is often several months. […] Some of the chemo drugs used to treat retinoblastoma include: Carboplatin, Cisplatin, Vincristine, Etoposide, Cyclophosphamide, Topotecan, Doxorubicin. […] Sometimes instead of systemic chemotherapy, the chemo is injected directly into the ophthalmic artery, the main artery that supplies blood to the eye. […] Because the chemo is put directly into the artery feeding the eye, doctors can use much smaller doses of chemo drugs (less than 10% of the doses used for systemic chemo). Therefore, there are fewer side effects from the chemo.

• #16 Retinoblastoma Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/1222849-treatment

  Primary neoadjuvant chemotherapy or chemoreduction has been the most significant recent advance in the treatment of retinoblastoma. This is typically the principle mode of treatment for eyes in intraocular groups C and D. However, our understanding of dose, duration, and end points are still evolving with this relatively new treatment modality. […] Use of neoadjuvant chemotherapy has the advantage of limiting the necessity for EBRT and reducing the possibility of EBRT-related complications. […] Current studies completed by the Retinoblastoma Study Group show the promising use of chemotherapy (carboplatin, vincristine sulfate, and etoposide phosphate) as a primary mode of treatment in reducing tumor bulk, followed by various forms of local approaches (radiotherapy [external beam or plaque], cryotherapy, thermotherapy, and photocoagulation) that can be used for final tumor control.

• #17 Retinoblastoma | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/r/retinoblastoma

  If the exam shows a large amount of disease in one eye, treatment may include removal of that eye. […] If both eyes are involved, current treatment approaches make every effort to try to save at least one eye. […] Treatment depends on the size and location of the tumor and whether the tumor has spread. […] Several types of treatment are available. These include surgery, chemotherapy, cryotherapy and laser therapy, and radiation. […] Surgery and chemotherapy are the most common treatments for retinoblastoma. […] Cryotherapy and laser therapy are used for small tumors, less than 6mm in size. […] When surgery is finished, your child may be given chemotherapy to destroy any remaining traces of disease. […] Some of the chemotherapy medicines may be Carboplatin, Etoposide, Vincristine, Cyclophosphamide, Ifosfamide, doxorubicin and Topotecan.

• #18 Retinoblastoma – Diagnosis & Disease Information

  https://www.cancertherapyadvisor.com/ddi/retinoblastoma/

  Intravenous chemotherapy is typically the first-line treatment for retinoblastoma, particularly for patients with bilateral or familial retinoblastoma and for young patients for whom intra-arterial chemotherapy may not be feasible. The most common treatment regimen consists of vincristine, etoposide, and carboplatin over 6 to 9 monthly cycles. Intravenous chemotherapy is effective in reducing tumor size and preventing metastasis, and also has a lower risk of leading to secondary cancers and the development of pineoblastoma. […] Enucleation is recommended for patients with large or progressive tumor masses (group E patients), particularly unilateral retinoblastoma, that are not responsive to conventional treatments. This treatment prevents cancer spread and alleviates disease-related symptoms, particularly when preserving or correcting vision is not possible.

• #19 Chemotherapy for Retinoblastoma | American Cancer Society

  https://www.cancer.org/cancer/types/retinoblastoma/treating/chemotherapy.html

  In this newer approach, a tiny needle is used to inject a chemo drug (typically melphalan or topotecan) directly into the vitreous humor, the jelly-like substance inside the eye. […] Chemo can be used as the first treatment to shrink some tumors that have not spread outside the eye. This is called chemoreduction. […] Systemic chemo is also used to treat children whose retinoblastoma has spread outside the eye, a much more critical situation. […] The side effects of chemo depend on the types and doses of drugs used, and how long they are given. […] Much lower doses of chemo are used in this approach, so the side effects tend to be limited to the eye area. […] As with intra-arterial chemo, the side effects from this newer technique seem to be limited to the eye and nearby areas. Each treatment might damage the retina slightly, which might affect vision.

• #20 Treatment of Retinoblastoma: What Is the Latest and What Is the Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9010858/

  Despite the changing paradigm of retinoblastoma treatment from systemic to OAC and IVi chemotherapy, eyes that relapse or that are initially refractory to conventional therapy are still difficult to treat with currently available drug options and most undergo enucleation. Thus, drug discovery in retinoblastoma is of paramount importance. Recent studies have used innovative multi-omics technology to identify deregulated pathways that could be targeted via novel treatment strategies in retinoblastoma. […] The aim in developing OAC was to deliver the drug directly into the artery that irrigates the ocular tissues to increase local bioavailability while minimizing systemic exposure. […] Intra-arterial delivery of chemotherapy was first achieved 70 years ago by Reese, who delivered a nitrogen mustard derivative to the eye by puncturing the internal carotid artery and injecting the drug into that artery. […] Key outcomes of the widespread adoption of OAC include: Eliminating the use of EBRT, which has decreased the incidence of second, non-ocular tumors and thereby improved long-term survival. […] Drastically increasing the rate of eye salvage. At MSKCC, this rate has increased from 5 to 95%.

• #21 Retinoblastoma Treatment | Retinoblastoma | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/retinoblastoma/retinoblastoma-treatment/

  Intra-arterial chemotherapy (IAC) is a method for directly delivering chemotherapy to the eye. IAC has revolutionized the treatment of retinoblastoma and increased our ability to save eyes and reduce side effects. […] IAC is highly effective in treating retinoblastoma through Group D, and it can save the eyes of a significant percentage of Group E patients, all of whom previously would have undergone enucleation (removal of the eye). […] This procedure is performed by the ocular oncologist during the examination and while the patient is under anesthesia. It is most often used as a supplement to systemic or intra-arterial chemotherapy for treating vitreous tumor seeds. […] External beam radiation therapy (EBRT), in which a large machine outside the body delivers high-powered beams of radiation, was commonly used for treating retinoblastoma until the 1990s. However, EBRT has been largely replaced by chemotherapy due to the concerns of secondary cancers, arrested bone growth, and other side effects of radiation.

• #22 Chemotherapy for Retinoblastoma | American Cancer Society

  https://www.cancer.org/cancer/types/retinoblastoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of anti-cancer drugs to treat cancer. Chemo can be given in different ways to treat retinoblastoma. […] Systemic chemo is given in cycles, with each treatment followed by a rest period to give the body time to recover. Each chemo cycle typically lasts for a few weeks, and the total length of treatment is often several months. […] Some of the chemo drugs used to treat retinoblastoma include: Carboplatin, Cisplatin, Vincristine, Etoposide, Cyclophosphamide, Topotecan, Doxorubicin. […] Sometimes instead of systemic chemotherapy, the chemo is injected directly into the ophthalmic artery, the main artery that supplies blood to the eye. […] Because the chemo is put directly into the artery feeding the eye, doctors can use much smaller doses of chemo drugs (less than 10% of the doses used for systemic chemo). Therefore, there are fewer side effects from the chemo.

• #23 Childhood Retinoblastoma | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-retinoblastoma

  Retinoblastoma is a rare childhood cancer of the eye. It starts in the retina, the nerve tissue in the back of the eye that is sensitive to light. When retinoblastoma stays in the eye, more than 95 percent of cases result in a cure. […] Through our Retinoblastoma Program, children with retinoblastomas receive coordinated care from a team of oncologists, ophthalmologists, interventional radiologists, and other specialists with expertise in retinoblastoma. […] We offer a full range of treatment options for retinoblastoma, including intra-arterial chemotherapy. This recently developed therapy can provide the most effective retinoblastoma treatment with the fewest side effects. […] Intra-arterial chemotherapy is a relatively newer treatment for retinoblastoma in which the chemotherapy is injected directly into the main blood vessel of the eye (the ophthalmic artery). This treatment was designed to minimize the amount of contact the chemotherapy has with the rest of your child’s body so as to reduce side effects.

• #24 Retinoblastoma Treatment | Retinoblastoma | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/retinoblastoma/retinoblastoma-treatment/

  Intra-arterial chemotherapy (IAC) is a method for directly delivering chemotherapy to the eye. IAC has revolutionized the treatment of retinoblastoma and increased our ability to save eyes and reduce side effects. […] IAC is highly effective in treating retinoblastoma through Group D, and it can save the eyes of a significant percentage of Group E patients, all of whom previously would have undergone enucleation (removal of the eye). […] This procedure is performed by the ocular oncologist during the examination and while the patient is under anesthesia. It is most often used as a supplement to systemic or intra-arterial chemotherapy for treating vitreous tumor seeds. […] External beam radiation therapy (EBRT), in which a large machine outside the body delivers high-powered beams of radiation, was commonly used for treating retinoblastoma until the 1990s. However, EBRT has been largely replaced by chemotherapy due to the concerns of secondary cancers, arrested bone growth, and other side effects of radiation.

• #25 Treatment of Retinoblastoma: What Is the Latest and What Is the Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9010858/

  Despite the changing paradigm of retinoblastoma treatment from systemic to OAC and IVi chemotherapy, eyes that relapse or that are initially refractory to conventional therapy are still difficult to treat with currently available drug options and most undergo enucleation. Thus, drug discovery in retinoblastoma is of paramount importance. Recent studies have used innovative multi-omics technology to identify deregulated pathways that could be targeted via novel treatment strategies in retinoblastoma. […] The aim in developing OAC was to deliver the drug directly into the artery that irrigates the ocular tissues to increase local bioavailability while minimizing systemic exposure. […] Intra-arterial delivery of chemotherapy was first achieved 70 years ago by Reese, who delivered a nitrogen mustard derivative to the eye by puncturing the internal carotid artery and injecting the drug into that artery. […] Key outcomes of the widespread adoption of OAC include: Eliminating the use of EBRT, which has decreased the incidence of second, non-ocular tumors and thereby improved long-term survival. […] Drastically increasing the rate of eye salvage. At MSKCC, this rate has increased from 5 to 95%.

• #26 Intra-arterial chemotherapy delivers most precise treatment for retinoblastoma | Cancer | Eyes and Vision | Pediatrics | UT Southwestern Medical Center

  https://utswmed.org/medblog/retinoblastoma-treatments/

  Intra-arterial chemotherapy delivers most precise treatment for retinoblastoma. The team had the expertise to offer his family a leading-edge treatment called intra-arterial chemotherapy (IAC), which is only offered at a handful of hospitals in the country. Today, UT Southwestern offers intra-arterial chemotherapy (IAC), a much more precise method of delivering a higher concentration of chemotherapy drugs directly to a retinoblastoma tumor through the artery that goes directly into the eye. IAC is over 90% successful in saving the eye, compared with 40%-50% success using systemic chemotherapy. In Group E, IAC can save 30%-40% of patients’ eyes, when before the rate was next to zero. This allows us to save the eyes of more children with locally advanced retinoblastoma. Using our advanced treatment protocol, most patients will need no more than three IAC treatments. Mastering IAC has brought us one step closer to saving eyes and lives of children with retinoblastoma.

• #27 Intra Arterial Chemotherapy for Retinoblastoma | Children’s Hospital of Philadelphia

  https://www.chop.edu/treatments/intra-arterial-chemotherapy-iac-retinoblastoma

  Retinoblastoma is a rare childhood cancer that originates in the layer of nerve tissue that coats the back of the eye (the retina). Intra-arterial chemotherapy (IAC) is a method of delivering concentrated doses of cancer-killing medicine directly to the affected area of the eye. […] In most cases, three IAC treatments are administered, spaced four weeks apart. The patient is then monitored to see that the cancerous cells have been eliminated and that they do not return. […] We believe that IAC is most effective in cases where the retinoblastoma is in one eye (unilateral), and there is no indication of cancer beyond that eye. It is used in newly diagnosed cases when the cancer is found in one eye, and as a second-line treatment, after other treatment methods have been used. […] With IAC and other treatments, the survival rate for children in the United States with retinoblastoma is close to 100 percent, and the majority of those children retain both eyes with vision.

• #28

  https://journals.lww.com/ijo/fulltext/2020/68110/modern_treatment_of_retinoblastoma__a_2020_review.9.aspx

  The treatment of choice for retinoblastoma depends largely on the International Classification of Retinoblastoma (ICRB) staging, the presence or absence of extraocular clinical factors, germline testing results, the family psychosocial situation, and available institutional resources. […] Current indications for IVC include patients with bilateral disease, confirmed germline mutation, family history of retinoblastoma, or cases with suspected optic nerve or choroidal invasion. […] Given the success of IAC for globe salvage in advanced cases and refractory tumors, this treatment modality has become more widely used over the past decade. […] Main indications for IAC include both first-line and globe salvage therapies. […] Despite localized delivery of chemotherapeutic agents, systemic toxicity has been observed following IAC.

• #29 Treatment of Retinoblastoma: What Is the Latest and What Is the Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9010858/

  Vitreous seeding may occur in eyes with endophytic features or after conservative therapy. Until the advent of OAC in combination with IVi, vitreous seeding was extremely difficult to control with systemic chemotherapy or EBRT, and thus most of those eyes were enucleated. […] Importantly, melphalan was undetectable in plasma, probably explaining the lack of hematologic toxicity associated with IVi chemotherapy. […] In summary, retinoblastoma treatment has evolved over the last century, resulting in a striking change in the treatment paradigm of this ocular tumor. Advances in the knowledge of its tumor biology and drug response and the development of new routes of drug delivery promise to lead to additional new, more effective, and less toxic therapies in retinoblastoma.

• #30 Personalized medicine and retinoblastoma treatment

  https://www.retina-specialist.com/article/personalized-medicine-and-retinoblastoma-treatment

  Sequential intravenous chemotherapy followed by intra-arterial chemotherapy (bridge chemotherapy) for young infants with retinoblastoma may be considered when cannulation of the ophthalmic artery isn’t possible. […] The significant tumoricidal effects reported with intra-arterial melphalan generated enthusiasm to study intravitreal delivery for vitreous seeding. […] A recent bi-institutional cohort study evaluated the vitreous seed response after 475 intravitreal melphalan injections. […] The risk of tumor dissemination after intravitreal injection was evaluated in a 2013 study of 304 patients following therapeutic intravitreal melphalan injections for RB. […] Data regarding toxicity of intravitreal melphalan continues to be limited. […] Effective intravitreal combination of melphalan and topotecan has also recently been reported in nine eyes.

• #31 Treatment of Retinoblastoma: What Is the Latest and What Is the Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9010858/

  Vitreous seeding may occur in eyes with endophytic features or after conservative therapy. Until the advent of OAC in combination with IVi, vitreous seeding was extremely difficult to control with systemic chemotherapy or EBRT, and thus most of those eyes were enucleated. […] Importantly, melphalan was undetectable in plasma, probably explaining the lack of hematologic toxicity associated with IVi chemotherapy. […] In summary, retinoblastoma treatment has evolved over the last century, resulting in a striking change in the treatment paradigm of this ocular tumor. Advances in the knowledge of its tumor biology and drug response and the development of new routes of drug delivery promise to lead to additional new, more effective, and less toxic therapies in retinoblastoma.

• #32 Retinoblastoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retinoblastoma/diagnosis-treatment/drc-20351013

  Common retinoblastoma treatments include chemotherapy, cold therapy and laser therapy. Radiation therapy may be another option. Surgery to remove the eye can treat retinoblastoma, but it’s only used in certain situations. […] Which treatment is best for your child’s retinoblastoma depends on several factors. These factors include the size and location of the cancer, and whether cancer has spread beyond the eye. Your healthcare team also considers your child’s overall health and your own preferences. […] Chemotherapy treats cancer with strong medicines. It’s often the first treatment for retinoblastoma. Other treatments might be needed after chemotherapy to kill any cancer cells that remain. […] Cold therapy, also called cryotherapy, uses extreme cold to damage cancer cells. It’s typically used after chemotherapy to kill any cancer cells that are left. For very small retinoblastomas, cryotherapy might be the only treatment needed.

• #33 Treatment for Retinoblastoma | National Eye Institute

  https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinoblastoma/treatment-retinoblastoma

  Retinoblastoma can cause blindness, and it can even be life-threatening. The good news is that treatment can help prevent vision loss and stop the cancer from spreading. […] Your child may need to get more than 1 type of treatment at the same time. Treatments for retinoblastoma can have mild or serious side effects. Talk with your childs doctors about the risks and benefits of their treatment plan and what you can expect. […] Chemotherapy is the most common treatment for retinoblastoma. Its often the first treatment doctors try, and it may help your child avoid surgery. […] During cryotherapy, doctors place a very cold tool called a freezing pen (probe) on the surface of the eye. Using this pen, doctors freeze and thaw the tumor cells several times to kill them. This helps keep the tumor cells from spreading outside of the eye.

• #34 Retinoblastoma | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/r/retinoblastoma

  If the exam shows a large amount of disease in one eye, treatment may include removal of that eye. […] If both eyes are involved, current treatment approaches make every effort to try to save at least one eye. […] Treatment depends on the size and location of the tumor and whether the tumor has spread. […] Several types of treatment are available. These include surgery, chemotherapy, cryotherapy and laser therapy, and radiation. […] Surgery and chemotherapy are the most common treatments for retinoblastoma. […] Cryotherapy and laser therapy are used for small tumors, less than 6mm in size. […] When surgery is finished, your child may be given chemotherapy to destroy any remaining traces of disease. […] Some of the chemotherapy medicines may be Carboplatin, Etoposide, Vincristine, Cyclophosphamide, Ifosfamide, doxorubicin and Topotecan.

• #35 Treatment | Alex’s Lemonade Stand Foundation for Childhood Cancer

  https://www.alexslemonade.org/childhood-cancer/guides/childhood-cancer/chapter-5-retinoblastoma/treatment

  Cryotherapy, a freezing treatment, is used to treat small primary tumors or new tumors that develop on the anterior (front part) of the retina. It is most successful if used to treat tumors up to 5 mm in diameter and 3 mm in thickness, and it may have to be repeated numerous times to eliminate all the tumor cells. It is often used in combination with chemotherapy and can also be used after radiation therapy. […] Laser thermotherapy (also known as transpupillary thermal therapy or TTT) is a method of delivering heat directly to the surface of the tumor using infrared radiation and a diode laser. It is used to treat tumors smaller than 3 mm in size. Like cryotherapy, it can be combined with chemotherapy or radiation therapy to treat larger tumors. […] Laser photocoagulation is another method for treating small tumors. It is used to treat small tumors located at the back of the retina that are not close to the optic nerve or blood vessels.

• #36 Retinoblastoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retinoblastoma/diagnosis-treatment/drc-20351013

  Common retinoblastoma treatments include chemotherapy, cold therapy and laser therapy. Radiation therapy may be another option. Surgery to remove the eye can treat retinoblastoma, but it’s only used in certain situations. […] Which treatment is best for your child’s retinoblastoma depends on several factors. These factors include the size and location of the cancer, and whether cancer has spread beyond the eye. Your healthcare team also considers your child’s overall health and your own preferences. […] Chemotherapy treats cancer with strong medicines. It’s often the first treatment for retinoblastoma. Other treatments might be needed after chemotherapy to kill any cancer cells that remain. […] Cold therapy, also called cryotherapy, uses extreme cold to damage cancer cells. It’s typically used after chemotherapy to kill any cancer cells that are left. For very small retinoblastomas, cryotherapy might be the only treatment needed.

• #37 Childhood Retinoblastoma | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-retinoblastoma

  Cryotherapy (sometimes called cryosurgery) applies extreme cold directly to the tumor and is used to treat small tumors or tumors that develop outside of the original tumor. […] Thermotherapy is a method of delivering heat to the eye using ultrasound, microwaves, or infrared radiation. […] Photocoagulation, also called light coagulation, is another method for treating small tumors. […] Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to destroy cancer cells. […] Beyond treatment, we continue to care for your child through our pediatric survivorship programs. Services include annual visits to our clinic to manage disease complications and screen for recurrence, and counseling services ranging from psychological to nutritional support. […] New types of treatment are being tested through clinical trials. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may then become the standard treatment. […] Retinoblastoma has one of the highest cure rates of all childhood cancers. Nine out of every 10 children will survive well into adulthood.

• #38 Treatment for Retinoblastoma | National Eye Institute

  https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinoblastoma/treatment-retinoblastoma

  Retinoblastoma can cause blindness, and it can even be life-threatening. The good news is that treatment can help prevent vision loss and stop the cancer from spreading. […] Your child may need to get more than 1 type of treatment at the same time. Treatments for retinoblastoma can have mild or serious side effects. Talk with your childs doctors about the risks and benefits of their treatment plan and what you can expect. […] Chemotherapy is the most common treatment for retinoblastoma. Its often the first treatment doctors try, and it may help your child avoid surgery. […] During cryotherapy, doctors place a very cold tool called a freezing pen (probe) on the surface of the eye. Using this pen, doctors freeze and thaw the tumor cells several times to kill them. This helps keep the tumor cells from spreading outside of the eye.

• #39 Retinoblastoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retinoblastoma/diagnosis-treatment/drc-20351013

  Common retinoblastoma treatments include chemotherapy, cold therapy and laser therapy. Radiation therapy may be another option. Surgery to remove the eye can treat retinoblastoma, but it’s only used in certain situations. […] Which treatment is best for your child’s retinoblastoma depends on several factors. These factors include the size and location of the cancer, and whether cancer has spread beyond the eye. Your healthcare team also considers your child’s overall health and your own preferences. […] Chemotherapy treats cancer with strong medicines. It’s often the first treatment for retinoblastoma. Other treatments might be needed after chemotherapy to kill any cancer cells that remain. […] Cold therapy, also called cryotherapy, uses extreme cold to damage cancer cells. It’s typically used after chemotherapy to kill any cancer cells that are left. For very small retinoblastomas, cryotherapy might be the only treatment needed.

• #40 Retinoblastoma Treatment – NCI

  https://www.cancer.gov/types/retinoblastoma/patient/retinoblastoma-treatment-pdq

  Retinoblastoma is a disease in which malignant (cancer) cells form in the tissues of the retina. […] Treatment for retinoblastoma depends on whether it is intraocular (within the eye) or extraocular (outside the eye). […] Six types of standard treatment are used: Cryotherapy, Thermotherapy, Chemotherapy, Radiation therapy, High-dose chemotherapy with stem cell rescue, Surgery (enucleation). […] Children with retinoblastoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. […] Treatment for retinoblastoma may cause side effects. […] New types of treatment are being tested in clinical trials. […] Treatment of progressive or recurrent intraocular retinoblastoma may include external-beam radiation therapy or plaque radiotherapy, cryotherapy, thermotherapy, systemic chemotherapy or ophthalmic artery infusion chemotherapy, intravitreal chemotherapy, surgery (enucleation), or a clinical trial of targeted therapy with an oncolytic virus that targets the RB1 gene and is injected into the tumor.

• #41 Retinoblastoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retinoblastoma/diagnosis-treatment/drc-20351013

  Laser therapy uses a laser light to heat up and damage the cancer cells. The medical term for this procedure is transpupillary thermotherapy. It’s typically used after chemotherapy to kill any cancer cells that are left. For very small retinoblastomas, laser therapy might be the only treatment needed. Treatments are typically repeated every few weeks until there are no signs of active cancer in the eye. […] Radiation therapy treats cancer with powerful energy. Types of radiation therapy used in treating retinoblastoma include: […] When other treatments haven’t worked or when the retinoblastoma is too large to be treated by other methods, surgery to remove the eye may be used. In these situations, eye removal may help prevent the spread of cancer to other parts of the body. […] Clinical trials are studies to test new treatments and new ways of using existing treatments. While clinical trials give your child a chance to try the latest in retinoblastoma treatments, they can’t guarantee a cure.

• #42 Retinoblastoma | Duke Health

  https://www.dukehealth.org/pediatric-treatments/childhood-cancer/retinoblastoma

  Thermotherapy (transpupillary thermotherapy, or TTT) uses an infrared-light laser to destroy cancer cells. There is less damage to surrounding blood vessels because the temperature of the laser isn’t as high as with other types of laser therapy. […] When your child is diagnosed with retinoblastoma, immediate treatment is our priority. We see your child at Duke within a day or two and begin treatment within a week to 10 days, depending on the tests needed to determine the best treatment strategy. Our team evaluates the results and creates a personalized care plan for your child. […] Our ocular oncologist (eye cancer specialist) works closely with pediatricians and pediatric specialists in ophthalmology, cancer, neurosurgery, anesthesiology, and nursing. We offer complete care for your child’s cancer and long-term follow up after treatment is completed.

• #43 Retinoblastoma | Duke Health

  https://www.dukehealth.org/pediatric-treatments/childhood-cancer/retinoblastoma

  Thermotherapy (transpupillary thermotherapy, or TTT) uses an infrared-light laser to destroy cancer cells. There is less damage to surrounding blood vessels because the temperature of the laser isn’t as high as with other types of laser therapy. […] When your child is diagnosed with retinoblastoma, immediate treatment is our priority. We see your child at Duke within a day or two and begin treatment within a week to 10 days, depending on the tests needed to determine the best treatment strategy. Our team evaluates the results and creates a personalized care plan for your child. […] Our ocular oncologist (eye cancer specialist) works closely with pediatricians and pediatric specialists in ophthalmology, cancer, neurosurgery, anesthesiology, and nursing. We offer complete care for your child’s cancer and long-term follow up after treatment is completed.

• #44 Treatment for Retinoblastoma | National Eye Institute

  https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinoblastoma/treatment-retinoblastoma

  Doctors can use different lasers to heat and kill cancer cells directly or to destroy the blood vessels in the eye that are feeding the tumor. […] Radiation therapy uses x-rays to kill cancer cells. […] In some cases, doctors may recommend surgery to get rid of the tumor by removing the eye completely.

• #45 Retinoblastoma: Symptoms, causes, treatment, and more

  https://www.webmd.com/cancer/what-is-retinoblastoma

  Laser Therapy: A different kind of laser targets and destroys the blood vessels that supply the tumor. This works for small tumors in the back of the eye. […] Radiation: There are two kinds of radiation therapy. For small tumors, a surgeon can sew a disc that has radioactive material inside it onto the eyeball near the tumor. Your child stays in the hospital a few days while it works, and then the disc is removed. Older technology uses a machine to focus beams of radiation on the tumor. This usually is used only if other strategies don’t work. […] Surgery: If the tumor is very large by the time it’s found, it may not be possible to save the child’s vision. In these cases, the eye may be removed.

• #46 Retinoblastoma: Symptoms, causes, treatment, and more

  https://www.webmd.com/cancer/what-is-retinoblastoma

  Laser Therapy: A different kind of laser targets and destroys the blood vessels that supply the tumor. This works for small tumors in the back of the eye. […] Radiation: There are two kinds of radiation therapy. For small tumors, a surgeon can sew a disc that has radioactive material inside it onto the eyeball near the tumor. Your child stays in the hospital a few days while it works, and then the disc is removed. Older technology uses a machine to focus beams of radiation on the tumor. This usually is used only if other strategies don’t work. […] Surgery: If the tumor is very large by the time it’s found, it may not be possible to save the child’s vision. In these cases, the eye may be removed.

• #47 The Evolution of Treatments for Retinoblastoma – Retina Today

  https://retinatoday.com/articles/2010-nov-dec/the-evolution-of-treatments-for-retinoblastoma

  As clinicians began to look for alternatives to radiation not because it did not work but because of these long-term complications the use of systemic chemotherapy was widely adopted. […] Systemic chemotherapy for retinoblastoma was first described by Kupfer in the 1950s, but interest grew starting in the 1990s, and there are now more than 150 publications on the subject. […] These publications have shown that three cycles of carboplatin-based chemotherapy over 3 months can reduce the size of tumors by almost 50%. […] Unfortunately, chemotherapy alone rarely cured the tumors, but if they were reduced to a small enough size, they could be treated with laser, cryo, plaques, or external radiation. […] The good news about systemic chemotherapy was that it worked against retinoblastoma, and it has worked in many investigators’ hands leading to the aforementioned 150-plus publications on the subject.

• #48 Retinoblastoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retinoblastoma/diagnosis-treatment/drc-20351013

  Laser therapy uses a laser light to heat up and damage the cancer cells. The medical term for this procedure is transpupillary thermotherapy. It’s typically used after chemotherapy to kill any cancer cells that are left. For very small retinoblastomas, laser therapy might be the only treatment needed. Treatments are typically repeated every few weeks until there are no signs of active cancer in the eye. […] Radiation therapy treats cancer with powerful energy. Types of radiation therapy used in treating retinoblastoma include: […] When other treatments haven’t worked or when the retinoblastoma is too large to be treated by other methods, surgery to remove the eye may be used. In these situations, eye removal may help prevent the spread of cancer to other parts of the body. […] Clinical trials are studies to test new treatments and new ways of using existing treatments. While clinical trials give your child a chance to try the latest in retinoblastoma treatments, they can’t guarantee a cure.

• #49 Radiation Therapy for Retinoblastoma | NYU Langone Health

  https://nyulangone.org/conditions/retinoblastoma-in-children/treatments/radiation-therapy-for-retinoblastoma

  Retinoblastoma is a radiosensitive tumor, meaning it responds well to radiation therapy. Radiation helps destroy retinoblastoma tumors with minimal effect on a childs vision. […] Because of its risk of long-term complications, however, it is usually avoided in children with retinoblastoma. When it is used, doctors at Hassenfeld Childrens Hospital at NYU Langone use targeted radiation to avoid damage to healthy tissue near the tumor. […] In plaque radiation therapy, radioactive seeds the size of grains of rice are placed on or near the tumor to deliver continuous, concentrated radiation while sparing other tissues in the eye. […] Plaque radiation can destroy the tumor with little risk to the macula, the central part of the retina responsible for clear and defined vision. […] During intensity modulated radiation therapy, or IMRT, X-ray beams are adjusted to match the shape of the tumor.

• #50 Retinoblastoma: Symptoms, causes, treatment, and more

  https://www.webmd.com/cancer/what-is-retinoblastoma

  Laser Therapy: A different kind of laser targets and destroys the blood vessels that supply the tumor. This works for small tumors in the back of the eye. […] Radiation: There are two kinds of radiation therapy. For small tumors, a surgeon can sew a disc that has radioactive material inside it onto the eyeball near the tumor. Your child stays in the hospital a few days while it works, and then the disc is removed. Older technology uses a machine to focus beams of radiation on the tumor. This usually is used only if other strategies don’t work. […] Surgery: If the tumor is very large by the time it’s found, it may not be possible to save the child’s vision. In these cases, the eye may be removed.

• #51 Retinoblastoma: Symptoms, causes, treatment, and more

  https://www.webmd.com/cancer/what-is-retinoblastoma

  Laser Therapy: A different kind of laser targets and destroys the blood vessels that supply the tumor. This works for small tumors in the back of the eye. […] Radiation: There are two kinds of radiation therapy. For small tumors, a surgeon can sew a disc that has radioactive material inside it onto the eyeball near the tumor. Your child stays in the hospital a few days while it works, and then the disc is removed. Older technology uses a machine to focus beams of radiation on the tumor. This usually is used only if other strategies don’t work. […] Surgery: If the tumor is very large by the time it’s found, it may not be possible to save the child’s vision. In these cases, the eye may be removed.

• #52 Treatment | Alex’s Lemonade Stand Foundation for Childhood Cancer

  https://www.alexslemonade.org/childhood-cancer/guides/childhood-cancer/chapter-5-retinoblastoma/treatment

  Retinoblastoma is very sensitive to radiation, which is sometimes used to destroy local disease while attempting to maintain vision. The use of radiation has decreased in recent decades because of the risk of damage caused by high doses of radiation to growing tissues in small children. Two methods of radiotherapy are used to treat retinoblastoma: external beam radiotherapy and plaque radiotherapy. […] External beam radiation therapy (also called EBRT) is generally required if the tumor has extended outside of the orbit, but it is sometimes used for retinoblastoma that is still contained within the eye. […] Plaque radiotherapy, also called brachytherapy, is a type of radiation therapy that places small pellets (sometimes called seeds) of radioactive material (iodine, cobalt, or ruthenium) near the tumor.

• #53 Retinoblastoma: Symptoms, causes, treatment, and more

  https://www.webmd.com/cancer/what-is-retinoblastoma

  Laser Therapy: A different kind of laser targets and destroys the blood vessels that supply the tumor. This works for small tumors in the back of the eye. […] Radiation: There are two kinds of radiation therapy. For small tumors, a surgeon can sew a disc that has radioactive material inside it onto the eyeball near the tumor. Your child stays in the hospital a few days while it works, and then the disc is removed. Older technology uses a machine to focus beams of radiation on the tumor. This usually is used only if other strategies don’t work. […] Surgery: If the tumor is very large by the time it’s found, it may not be possible to save the child’s vision. In these cases, the eye may be removed.

• #54 Radiation Therapy for Retinoblastoma | NYU Langone Health

  https://nyulangone.org/conditions/retinoblastoma-in-children/treatments/radiation-therapy-for-retinoblastoma

  Retinoblastoma is a radiosensitive tumor, meaning it responds well to radiation therapy. Radiation helps destroy retinoblastoma tumors with minimal effect on a childs vision. […] Because of its risk of long-term complications, however, it is usually avoided in children with retinoblastoma. When it is used, doctors at Hassenfeld Childrens Hospital at NYU Langone use targeted radiation to avoid damage to healthy tissue near the tumor. […] In plaque radiation therapy, radioactive seeds the size of grains of rice are placed on or near the tumor to deliver continuous, concentrated radiation while sparing other tissues in the eye. […] Plaque radiation can destroy the tumor with little risk to the macula, the central part of the retina responsible for clear and defined vision. […] During intensity modulated radiation therapy, or IMRT, X-ray beams are adjusted to match the shape of the tumor.

• #55 Retinoblastoma: Symptoms, causes, treatment, and more

  https://www.webmd.com/cancer/what-is-retinoblastoma

  Laser Therapy: A different kind of laser targets and destroys the blood vessels that supply the tumor. This works for small tumors in the back of the eye. […] Radiation: There are two kinds of radiation therapy. For small tumors, a surgeon can sew a disc that has radioactive material inside it onto the eyeball near the tumor. Your child stays in the hospital a few days while it works, and then the disc is removed. Older technology uses a machine to focus beams of radiation on the tumor. This usually is used only if other strategies don’t work. […] Surgery: If the tumor is very large by the time it’s found, it may not be possible to save the child’s vision. In these cases, the eye may be removed.

• #56 Retinoblastoma Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/1222849-treatment

  Medical therapy should be directed toward complete control of the tumor and the preservation of as much useful vision as possible. Treatment is usually individualized to the specific patient. […] Incidence of local control is high and retinal late effects are minimal with radiation doses of 4000-4500 cGy used with 200 cGy fractions. However, morbidity and mortality associated with external beam radiation therapy (EBRT) are significant. EBRT results in cessation of bone growth. Therefore, children with retinoblastoma who are treated with EBRT have significant midface hypoplasia. (The younger the child is when EBRT is instituted, the more dramatic the outcome.) More importantly, EBRT has been shown to increase the risk of developing second cancers almost 6-fold during the lifetime of these patients. Today, neoadjuvant chemotherapy (chemoreduction) has superseded EBRT in order to (hopefully) circumvent these terrible adverse effects of EBRT. Nevertheless, EBRT is still indicated in selected circumstances, as follows:

• #57 Retinoblastoma Treatment | Retinoblastoma | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/retinoblastoma/retinoblastoma-treatment/

  Intra-arterial chemotherapy (IAC) is a method for directly delivering chemotherapy to the eye. IAC has revolutionized the treatment of retinoblastoma and increased our ability to save eyes and reduce side effects. […] IAC is highly effective in treating retinoblastoma through Group D, and it can save the eyes of a significant percentage of Group E patients, all of whom previously would have undergone enucleation (removal of the eye). […] This procedure is performed by the ocular oncologist during the examination and while the patient is under anesthesia. It is most often used as a supplement to systemic or intra-arterial chemotherapy for treating vitreous tumor seeds. […] External beam radiation therapy (EBRT), in which a large machine outside the body delivers high-powered beams of radiation, was commonly used for treating retinoblastoma until the 1990s. However, EBRT has been largely replaced by chemotherapy due to the concerns of secondary cancers, arrested bone growth, and other side effects of radiation.

• #58 Radiation Therapy for Retinoblastoma | NYU Langone Health

  https://nyulangone.org/conditions/retinoblastoma-in-children/treatments/radiation-therapy-for-retinoblastoma

  Retinoblastoma is a radiosensitive tumor, meaning it responds well to radiation therapy. Radiation helps destroy retinoblastoma tumors with minimal effect on a childs vision. […] Because of its risk of long-term complications, however, it is usually avoided in children with retinoblastoma. When it is used, doctors at Hassenfeld Childrens Hospital at NYU Langone use targeted radiation to avoid damage to healthy tissue near the tumor. […] In plaque radiation therapy, radioactive seeds the size of grains of rice are placed on or near the tumor to deliver continuous, concentrated radiation while sparing other tissues in the eye. […] Plaque radiation can destroy the tumor with little risk to the macula, the central part of the retina responsible for clear and defined vision. […] During intensity modulated radiation therapy, or IMRT, X-ray beams are adjusted to match the shape of the tumor.

• #59 Radiation Therapy for Retinoblastoma | NYU Langone Health

  https://nyulangone.org/conditions/retinoblastoma-in-children/treatments/radiation-therapy-for-retinoblastoma

  Proton beam therapy delivers high doses of focused radiation directly to the tumor without damaging surrounding tissue in the eye and brain. […] Our doctors use of targeted radiation to treat retinoblastoma means that side effects are reduced. However, some children do experience side effects, depending on the radiation therapy and the location of the tumor.

• #60 Retinoblastoma – EyeWiki

  https://eyewiki.org/Retinoblastoma

  Retinoblastoma is an intraocular malignancy with primitive neuroendocrine origins that primarily affects young children. […] 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 many patients who present with unilateral disease. However, the loss of an eye is associated with significant social stigma in certain cultures. In addition, bilateral enucleation is a devastating option for bilaterally affected patients. Treatment modalities that may be successful in globe salvage include systemic chemotherapy with focal consolidation, intra-arterial chemotherapy, intravitreal chemotherapy, and focally destructive therapy (cryopexy, laser photocoagulation, hyperthermia and plaque irradiation).

• #61 Retinoblastoma Treatment | Retinoblastoma | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/retinoblastoma/retinoblastoma-treatment/

  Despite the availability of advanced treatment options, surgical removal of the eye (enucleation) is still the safest option for some children. […] Enucleation is usually recommended when the cancer fills most of the eye, invades the optic nerve or other structures, causes bleeding or high pressure (glaucoma) inside the eye, or otherwise creates a danger of cancer spreading if the eye is not removed.

• #62 Treatment | Alex’s Lemonade Stand Foundation for Childhood Cancer

  https://www.alexslemonade.org/childhood-cancer/guides/childhood-cancer/chapter-5-retinoblastoma/treatment

  Several types of procedures are used to treat retinoblastoma: enucleation, cryotherapy, laser thermotherapy, and laser photocoagulation. The ophthalmologist may also deliver chemotherapy locally to the tumor (see section about chemotherapy later in this chapter). The most appropriate treatment is chosen on an individual basis. An important component of treatment is support from psychologists, social workers, and genetic counselors to help families deal with the cancer, its treatment, the possible loss of an eye and vision, and the potential risk of other family members developing retinoblastoma. […] Enucleation is the surgical removal of an eye. It may be necessary if: The tumor is very large and there is no hope that the eye will have useful vision. The eye has glaucoma. The tumor has spread extensively within the eye, to the optic nerve or orbit. Other treatment methods have failed to destroy the disease. The retina cannot be examined because of vitreous hemorrhage or cataract.

• #63 Does retinoblastoma cause blindness? Effects and treatment

  https://www.medicalnewstoday.com/articles/does-retinoblastoma-cause-blindness

  Chemotherapy is the most common initial treatment for retinoblastoma. It can help to shrink tumors and may allow people to avoid surgery to remove the eye. […] Treatments for retinoblastoma include: Systemic chemotherapy, Intra-arterial chemotherapy, Intravitreal chemotherapy, Laser therapy, Cryotherapy, Radiation therapy, Surgery. […] Early diagnosis and treatment can help improve outcomes for people with retinoblastoma. […] The outlook for vision loss and blindness may depend on whether retinoblastoma affects one or both eyes. It can also depend on the type of treatment a person requires. A change or loss of vision in the treated eye may also occur in later life. […] Retinoblastoma can cause vision loss and blindness, although early treatment may help prevent this. […] If retinoblastoma only affects one eye, a person will still have vision in the unaffected eye. If retinoblastoma affects both eyes, treatment may help to prevent sight loss. In some cases, people will need surgery to remove the affected eye. […] With effective treatment, the overall survival rate is high.

• #64 Retinoblastoma – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/pediatric-cancers/retinoblastoma

  The goal of retinoblastoma treatment should be cure, but attempts to preserve as much vision as possible are appropriate. […] Advanced unilateral retinoblastoma (large tumor with evidence of disease extension) is managed by enucleation with removal of as much of the optic nerve as possible. […] For patients with bilateral cancer, vision can usually be preserved. Options include bilateral photocoagulation, intra-arterial chemotherapy, or unilateral enucleation and photocoagulation, cryotherapy, and irradiation of the other eye. […] Radiation therapy is by external beam or, for very small cancers, brachytherapy (attachment of a radioactive plaque to the eye wall near the cancer). […] Ophthalmologic re-examination of both eyes and retreatment, if necessary, are required at 2- to 4-month intervals.

• #65

  https://www.aao.org/salud-ocular/consejos/retinoblastoma-treatment

  A laser may be used to destroy blood vessels that feed the tumor, killing the cancer cells. […] An extremely cold substance (such as liquid nitrogen) is used to freeze cancer cells. Once the cells freeze, the substance is removed and the cells thaw out. This process of freezing and thawing is repeated, killing cancer cells. […] Extreme heat is targeted at cancer cells to kill them. […] If a tumor has grown too much for other treatments, surgery may be needed to remove the eyeball. This may help keep the cancer from spreading to other areas of the body. […] After removing the eyeball, the surgeon places an artificial eye implant in the eye socket. The eyes muscles are attached to this implant. Eventually the eyes muscles will move this eyeball just as they did with the natural eye. However, the implanted eyeball cannot see.

• #66 Children’s Retinoblastoma Eye Cancer Treatment | MSK Kids | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/pediatrics/cancer-care/types/retinoblastoma/treatment

  At MSK Kids, only a few children (5 out of every 100) need enucleation for retinoblastoma. […] Enucleation surgery takes less than 1 hour. […] Four weeks after enucleation, after your child has healed, they can be fitted for an ocular prosthesis. […] MSK is able to provide early treatment. […] The treatment is complex. It involves high-dose chemotherapy and often radiation therapy as well. […] Our ophthalmic oncologists (eye cancer doctors) will do an eye exam each year. […] We also encourage all survivors of retinoblastoma to get follow-up care through the MSK Kids long-term follow-up program.

• #67 Childhood Retinoblastoma | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-retinoblastoma

  Following the surgery, the eye is replaced with an orbital implant, and after the eye has healed, an artificial eye made to match your child’s healthy eye can be worn. […] While it is theoretically possible for the tumor to return even following this procedure, such cases would be extremely rare. […] An advantage of cryotherapy is that it may help prevent the need for enucleation or radiation therapy. […] Traditional forms of treatment for retinoblastoma carry the risk of injuring the eye or causing ongoing symptoms. For these reasons, our retinoblastoma treatment team uses intra-arterial chemotherapy whenever it is the appropriate treatment. […] We use surgery for children with advanced retinoblastoma that doesn’t respond to other treatments. In these cases, the eye may need to be removed during a procedure called enucleation.

• #68

  https://www.aao.org/salud-ocular/consejos/retinoblastoma-treatment

  Several weeks after surgery, a custom-made artificial eye can be made to match the healthy eye. This new eye clips onto the eye implant and sits right behind the eyelids just as the natural eye does. Again, this eye will not see. However, it will look and move like the healthy eye. […] Removing an eye will affect a childs vision. However, most children adapt very well over time. In many cases, it will not be obvious that the child has an artificial eye.

• #69 Retinoblastoma Treatment – NCI

  https://www.cancer.gov/types/retinoblastoma/patient/retinoblastoma-treatment-pdq

  Treatment of extraocular retinoblastoma may include systemic chemotherapy and external-beam radiation therapy, enucleation, or systemic chemotherapy followed by surgery (enucleation). […] For trilateral retinoblastoma, treatment may include systemic chemotherapy followed by surgery and high-dose chemotherapy with stem cell rescue. […] Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.

• #70 Retinoblastoma Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq

  Enucleation is also used as a salvage treatment in cases of disease progression or recurrence in patients receiving eye-salvage management. […] For patients with extraocular disease, systemic chemotherapy followed by myeloablative chemotherapy with stem cell rescue and radiation therapy is often required. […] The prognosis for patients with Group E eyes who are treated with systemic chemotherapy and local control measures is very poor without radiation therapy.

• #71 5 Innovative Retinoblastoma Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/retinoblastoma/retinoblastoma-treatment.html

  Doctors who treat retinoblastoma will tell you they have three goals, in order: Save the life. Save the eye. Save the vision. To achieve these goals, they may use the following treatments. […] Retinoblastoma chemotherapy is delivered in one of the following ways: Intra-arterial: A catheter is inserted into a blood vessel near the groin and then steered through the body up to the eye, where chemo is directly delivered. This avoids exposing the patient to systemic chemotherapy. Under certain circumstances, this is the preferred technique for delivering chemotherapy medications. […] High dose chemotherapy with stem cell rescue: This is a form of intravenous chemotherapy. It is an option for patients whose cancer has spread beyond the eye into areas like the liver or central nervous system. These patients are given a very powerful dose of chemotherapy to kill cancer cells.

• #72 Treatments for retinoblastoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/retinoblastoma/treatment

  If your child has retinoblastoma, the healthcare team will create a treatment plan just for your child. It will be based on your childs health and specific information about the cancer. The goals of treating retinoblastoma are to cure the cancer, preserve as much vision as possible and lower the risk of late side effects. […] Your childs treatment will be overseen by a pediatric oncologist. They will work with other specialists, such as a pediatric ophthalmologist, pediatric surgeon, radiation oncologist and genetic counsellor. […] Intraocular retinoblastoma is cancer that is contained within the eye and has not spread to other parts of the body. Treatment for smaller tumours usually consists of a local therapy (cryosurgery, thermotherapy or laser surgery). Treatment for larger tumours may use plaque brachytherapy or chemotherapy.

• #73 Treating Retinoblastoma | Treating Children’s Eye Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/retinoblastoma/treating.html

  If your child has been diagnosed with retinoblastoma, your child’s treatment team will discuss the options with you. Its important to weigh the benefits of each treatment option against the possible risks and side effects. […] The main types of treatment for retinoblastoma are: Surgery (Enucleation) for Retinoblastoma, Radiation Therapy for Retinoblastoma, Laser Therapy (Photocoagulation or Thermotherapy) for Retinoblastoma, Cryotherapy for Retinoblastoma, Chemotherapy for Retinoblastoma. […] Sometimes more than one type of treatment may be used. The treatment options are based on the extent (stage) of the cancer and other factors. […] The goals of treatment for retinoblastoma are: To get rid of the cancer and save the childs life, To save the eye if possible, To preserve as much vision as possible, To limit the risk of side effects later in life that can be caused by treatment, particularly second cancers in children with hereditary retinoblastoma.

• #74 A Simple Guide for Treating Retinoblastoma | Retinal Physician

  https://retinalphysician.com/issues/2023/june/a-simple-guide-for-treating-retinoblastoma/

  Focal consolidation therapy performed along with intravenous chemotherapy (IVC) or intra-arterial chemotherapy (IAC) include cryotherapy, transpupillary thermotherapy, and plaque brachytherapy. […] Intravenous chemotherapy involves delivering 6 cycles of chemotherapy (carboplatin, vincristine, and etoposide) through a systemic route to shrink or reduce the tumor size (chemoreduction) followed by focal consolidative therapy. […] Intravenous chemotherapy is one of the main globe-salvaging options for RB groups B and C, with excellent outcomes in salvaging group B and C eyes (100%). […] However, the globe salvage for group D and group E eyes is modest (24% to 59%). […] With the aim to avoid systemic toxicity with IVC and to achieve higher globe salvage rates, there has been a shift toward use of IAC.

• #75 Focal Treatment for Retinoblastoma | NYU Langone Health

  https://nyulangone.org/conditions/retinoblastoma-in-children/treatments/focal-treatment-for-retinoblastoma

  If your child has a small retinoblastoma thats contained within the eye, an eye cancer specialist at Hassenfeld Childrens Hospital at NYU Langone may recommend focal therapies. These procedures can shrink or eliminate eye tumors while preserving vision. […] There are several different types of focal therapies, all performed in the hospital using general anesthesia. Our anesthesiologists are experts in treating very young children, including infants. […] Laser therapy may be performed in conjunction with chemotherapy, which shrinks the tumor by destroying cancer cells. […] Cryotherapy can be used with chemotherapy or as a stand-alone treatment. […] Our eye cancer specialists carefully weigh the risks and potential benefits of each type of focal therapy before choosing one for your child.

• #76 A Simple Guide for Treating Retinoblastoma | Retinal Physician

  https://retinalphysician.com/issues/2023/june/a-simple-guide-for-treating-retinoblastoma/

  Focal consolidation therapy performed along with intravenous chemotherapy (IVC) or intra-arterial chemotherapy (IAC) include cryotherapy, transpupillary thermotherapy, and plaque brachytherapy. […] Intravenous chemotherapy involves delivering 6 cycles of chemotherapy (carboplatin, vincristine, and etoposide) through a systemic route to shrink or reduce the tumor size (chemoreduction) followed by focal consolidative therapy. […] Intravenous chemotherapy is one of the main globe-salvaging options for RB groups B and C, with excellent outcomes in salvaging group B and C eyes (100%). […] However, the globe salvage for group D and group E eyes is modest (24% to 59%). […] With the aim to avoid systemic toxicity with IVC and to achieve higher globe salvage rates, there has been a shift toward use of IAC.

• #77 A Simple Guide for Treating Retinoblastoma | Retinal Physician

  https://retinalphysician.com/issues/2023/june/a-simple-guide-for-treating-retinoblastoma/

  The standard regimen includes delivery of 1 or a combination of 2 drugs, given once monthly for 3 cycles. […] The overall globe salvage rate was 74% with IAC as a first-line treatment modality. […] Tumor seeding is one of the major predictive factors for failure of both IVC and IAC. […] Intravitreal chemotherapy (iVitC) is a targeted approach that delivers the highest concentration of drug into the vitreous cavity without systemic toxicity. […] The most common and expected toxicity is a localized salt-and-pepper retinopathy, particularly due to melphalan toxicity due to its high binding with retinal pigment epithelium (RPE). […] Advances in the understanding of the molecular drivers of RB pathway have provided opportunities to explore novel drugs with targeted effects, improved bioavailability, and reduced chemotoxicity. […] Considering global burden of retinoblastoma with predominance in lower-income and middle-income countries, innovative approaches in drug delivery and alternatives to chemotherapy that are inexpensive and accessible are needed.

• #78 Personalized medicine and retinoblastoma treatment

  https://www.retina-specialist.com/article/personalized-medicine-and-retinoblastoma-treatment

  Management of RB tumors requires a multidisciplinary approach that may include an ocular oncologist, pediatric oncologist, pediatric ophthalmologist, pediatrician, interventional radiologist and ocular pathologist. […] Globe salvage and preservation of vision are important secondary goals. […] Treatment of small tumors may only require transpupillary thermotherapy. […] The classic three-drug systemic treatment (carboplatin, vincristine and etoposide) has been associated with significant morbidity, and it routinely requires multiple cycles. […] The combination of systemic and/or intra-arterial chemotherapy with focal ablative treatments has been shown to have better globe salvage rates than chemotherapy alone in both early and advanced RB. […] Enucleation remains the standard treatment of group E RB tumors.

• #79 Retinoblastoma – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/pediatric-cancers/retinoblastoma

  Retinoblastoma is a cancer of the retina that occurs most commonly in children 2 years old. […] Treatment of small cancers and bilateral disease may include photocoagulation, cryotherapy, and radiation therapy. Treatment of advanced and some larger cancers is enucleation. Chemotherapy is sometimes used to reduce cancer volume and to treat cancers that have spread beyond the eye. […] For advanced unilateral cancer, enucleation. […] For less advanced unilateral cancer, sometimes chemotherapy and/or local-control treatments. […] For bilateral cancer, photocoagulation, intra-arterial chemotherapy, or unilateral enucleation with photocoagulation, cryotherapy and irradiation of the other eye. […] Systemic chemotherapy, such as carboplatin, etoposide, and vincristine or cyclophosphamide plus vincristine, may be helpful to reduce the size of large cancers to allow for the use of other additional therapies (eg, cryotherapy, laser hyperthermia), to treat bilateral tumors, or to treat cancer that has disseminated beyond the eye. However, chemotherapy alone can seldom cure this cancer.

• #80

  https://journals.lww.com/ijo/fulltext/2020/68110/modern_treatment_of_retinoblastoma__a_2020_review.9.aspx

  The treatment of choice for retinoblastoma depends largely on the International Classification of Retinoblastoma (ICRB) staging, the presence or absence of extraocular clinical factors, germline testing results, the family psychosocial situation, and available institutional resources. […] Current indications for IVC include patients with bilateral disease, confirmed germline mutation, family history of retinoblastoma, or cases with suspected optic nerve or choroidal invasion. […] Given the success of IAC for globe salvage in advanced cases and refractory tumors, this treatment modality has become more widely used over the past decade. […] Main indications for IAC include both first-line and globe salvage therapies. […] Despite localized delivery of chemotherapeutic agents, systemic toxicity has been observed following IAC.

• #81 Retinoblastoma | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/r/retinoblastoma

  If the exam shows a large amount of disease in one eye, treatment may include removal of that eye. […] If both eyes are involved, current treatment approaches make every effort to try to save at least one eye. […] Treatment depends on the size and location of the tumor and whether the tumor has spread. […] Several types of treatment are available. These include surgery, chemotherapy, cryotherapy and laser therapy, and radiation. […] Surgery and chemotherapy are the most common treatments for retinoblastoma. […] Cryotherapy and laser therapy are used for small tumors, less than 6mm in size. […] When surgery is finished, your child may be given chemotherapy to destroy any remaining traces of disease. […] Some of the chemotherapy medicines may be Carboplatin, Etoposide, Vincristine, Cyclophosphamide, Ifosfamide, doxorubicin and Topotecan.

• #82 Retinoblastoma – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/pediatric-cancers/retinoblastoma

  The goal of retinoblastoma treatment should be cure, but attempts to preserve as much vision as possible are appropriate. […] Advanced unilateral retinoblastoma (large tumor with evidence of disease extension) is managed by enucleation with removal of as much of the optic nerve as possible. […] For patients with bilateral cancer, vision can usually be preserved. Options include bilateral photocoagulation, intra-arterial chemotherapy, or unilateral enucleation and photocoagulation, cryotherapy, and irradiation of the other eye. […] Radiation therapy is by external beam or, for very small cancers, brachytherapy (attachment of a radioactive plaque to the eye wall near the cancer). […] Ophthalmologic re-examination of both eyes and retreatment, if necessary, are required at 2- to 4-month intervals.

• #83 Retinoblastoma – EyeWiki

  https://eyewiki.org/Retinoblastoma

  Systemic chemotherapy is administered with focal consolidative therapy with laser, thermotherapy, and/or cryotherapy. This treatment approach has been coined „chemoreduction” because the goal is to shrink the tumor. Shrinking the tumor increases the success of focal therapies, which are less successful with thicker tumors. […] In patients with advanced bilateral retinoblastoma, traditionally the more severely affected eye has been enucleated, while the less severely affected eye has undergone chemoreduction with or without external beam irradiation. […] More localized delivery of medication may help decrease the systemic side effects of chemotherapeutic agents while still allowing the success clinicians have seen with chemoreduction techniques. […] Eyes with refractory vitreous seeds after systemic intravenous chemotherapy or intra-arterial chemotherapy have been successfully treated with intravitreal chemotherapy (IVitC) by retinoblastoma experts around the world.

• #84 Retinoblastoma (Eye Cancer in Children) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/retinoblastoma

  Most children with eye cancer who begin treatment before the retinoblastoma has spread beyond the eye are cured. A major goal of treatment in children with retinoblastoma is preserving vision. Most children retain their vision and more than 95 percent of children with retinoblastoma can be cured. […] When only one eye is involved, and the eye is Group E, enucleation (removal of the involved eye) is usually the treatment of choice. Children adjust very well to the loss of one eye, and their vision does not suffer a great deal. […] Chemotherapy is medication used to destroy cancer cells. When tumors are too large to apply local measures, we may recommend chemotherapy to shrink the tumors so local therapy can be used successfully. […] Radiation therapy is no longer considered a front-line therapy for children with retinoblastoma. […] Although radiation therapy is not front-line therapy for retinoblastoma, except for Stage 2 patients, it can be used for patients with relapsed or refractory disease.

• #85 Retinoblastoma Treatment – NCI

  https://www.cancer.gov/types/retinoblastoma/patient/retinoblastoma-treatment-pdq

  Treatment of extraocular retinoblastoma may include systemic chemotherapy and external-beam radiation therapy, enucleation, or systemic chemotherapy followed by surgery (enucleation). […] For trilateral retinoblastoma, treatment may include systemic chemotherapy followed by surgery and high-dose chemotherapy with stem cell rescue. […] Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients.

• #86 Retinoblastoma – EyeWiki

  https://eyewiki.org/Retinoblastoma

  External beam radiation and plaque radiotherapy are secondary treatment options following the primary chemotherapy options delineated above in select cases where retinoblastoma remains uncontrolled. […] Eyes with large tumor burden (Group E eyes) and eyes that progress despite conservative treatments require enucleation. […] For extraocular retinoblastoma limited to the orbit, clinicians are finding success with neoadjuvant chemotherapy to shrink the tumor. This is followed by surgical debulking and post-operative chemotherapy and radiation if necessary. […] The treatment regimen for patients with PNET is similar to patients with CNS metastases. The prognosis is also dismal. As such, early detection and treatment of PNETs is recommended. […] Advancements in our understanding of molecular pathways involved in retinoblastoma and mechanisms underlying tumor resistance have provided opportunities to study novel targeted therapies with improved bio-availabilities and reduced chemotoxicity.

• #87 Retinoblastoma in Children

  https://www.nationwidechildrens.org/conditions/health-library/retinoblastoma-in-children

  Radiation therapy. Radiation may be used when another treatment doesn’t work well enough. Internal radiation (brachytherapy) may be done. A small container (plaque) with radioactive material is placed on the eye near the tumor. The plaque is placed and removed during surgery. This may be used to treat some smaller tumors. […] Thermotherapy. Laser light is used to destroy cancer cells using heat. This may be used for some small tumors. Or, it may be used with chemotherapy or radiation for larger tumors. […] Cryotherapy. A tool is used to freeze and kill the cancer cells. […] Bone marrow or stem cell transplantation. This treatment is used for children with stage IV extraocular retinoblastoma after high doses of chemotherapy, radiation therapy, or both. […] Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.

• #88 Retinoblastoma Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq

  Enucleation is also used as a salvage treatment in cases of disease progression or recurrence in patients receiving eye-salvage management. […] For patients with extraocular disease, systemic chemotherapy followed by myeloablative chemotherapy with stem cell rescue and radiation therapy is often required. […] The prognosis for patients with Group E eyes who are treated with systemic chemotherapy and local control measures is very poor without radiation therapy.

• #89 Retinoblastoma Treatment – NCI

  https://www.cancer.gov/types/retinoblastoma/patient/retinoblastoma-treatment-pdq

  Retinoblastoma is a disease in which malignant (cancer) cells form in the tissues of the retina. […] Treatment for retinoblastoma depends on whether it is intraocular (within the eye) or extraocular (outside the eye). […] Six types of standard treatment are used: Cryotherapy, Thermotherapy, Chemotherapy, Radiation therapy, High-dose chemotherapy with stem cell rescue, Surgery (enucleation). […] Children with retinoblastoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. […] Treatment for retinoblastoma may cause side effects. […] New types of treatment are being tested in clinical trials. […] Treatment of progressive or recurrent intraocular retinoblastoma may include external-beam radiation therapy or plaque radiotherapy, cryotherapy, thermotherapy, systemic chemotherapy or ophthalmic artery infusion chemotherapy, intravitreal chemotherapy, surgery (enucleation), or a clinical trial of targeted therapy with an oncolytic virus that targets the RB1 gene and is injected into the tumor.

• #90 Treating retinoblastoma | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/childrens-cancer/eye-cancer-retinoblastoma/treatment

  Most parents worry about whether their child will lose their sight. […] Whenever possible, the doctor will try to keep the sight of the eye. […] Removing the affected eye will not cause sight loss in the other eye. […] Almost all retinoblastomas are successfully treated. But some cancers can come back again (recurrence or relapse) or don’t go away (refractory). […] Your child’s healthcare team will explain the different treatment options. They will support you through this difficult time. […] Your child will have regular follow up appointments with their specialist. […] These appointments are to check: how they are recovering, their development, if they are having any problems following treatment, if there are any signs the retinoblastoma has come back.

• #91 Retinoblastoma | Vanderbilt-Ingram Cancer Center

  https://vicc.org/cancer-info/childhood-retinoblastoma

  Retinoblastoma is a disease in which malignant (cancer) cells form in the tissues of the retina. […] Treatment for retinoblastoma depends on whether it is intraocular (within the eye) or extraocular (outside the eye). […] Six types of standard treatment are used: Cryotherapy, Thermotherapy, Chemotherapy, Radiation therapy, High-dose chemotherapy with stem cell rescue, Surgery (enucleation). […] Children with retinoblastoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. […] New types of treatment are being tested in clinical trials. […] Treatment for retinoblastoma may cause side effects. […] Patients may want to think about taking part in a clinical trial. […] Follow-up tests may be needed. […] Treatment of progressive or recurrent intraocular retinoblastoma may include external-beam radiation therapy or plaque radiotherapy, cryotherapy, thermotherapy, systemic chemotherapy or ophthalmic artery infusion chemotherapy, intravitreal chemotherapy, surgery (enucleation), or a clinical trial of targeted therapy with an oncolytic virus that targets the RB1 gene and is injected into the tumor. […] Treatment of progressive or recurrent extraocular retinoblastoma may include systemic chemotherapy and external-beam radiation therapy for retinoblastoma that comes back after surgery to remove the eye.

• #92 Treatment of Retinoblastoma: What Is the Latest and What Is the Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9010858/

  The management of retinoblastoma, the most common intraocular malignancy in children, has changed drastically over the last decade. Landmark developments in local drug delivery, namely, safer techniques for intravitreal chemotherapy injection and ophthalmic artery chemosurgery, have resulted in eye globe salvages that were not previously attainable using systemic chemotherapy or external beam irradiation. […] Novel drugs, oncolytic viruses, and immunotherapy are promising approaches in the treatment of intraocular retinoblastoma. Importantly, emerging studies of the pattern of tumor dissemination and local drug delivery may provide the first steps toward new treatments for metastatic disease. […] Here, we review recent advances in retinoblastoma treatment, especially with regard to local drug delivery, that have enabled successful conservative management of intraocular retinoblastoma. We also review emerging data from preclinical and clinical studies on innovative approaches that promise to lead to further improvement in outcomes, namely, the mechanisms and potential uses of new and repurposed drugs and non-chemotherapy treatments, and discuss future directions for therapeutic development.

• #93 Retinoblastoma Treatment – NCI

  https://www.cancer.gov/types/retinoblastoma/patient/retinoblastoma-treatment-pdq

  Retinoblastoma is a disease in which malignant (cancer) cells form in the tissues of the retina. […] Treatment for retinoblastoma depends on whether it is intraocular (within the eye) or extraocular (outside the eye). […] Six types of standard treatment are used: Cryotherapy, Thermotherapy, Chemotherapy, Radiation therapy, High-dose chemotherapy with stem cell rescue, Surgery (enucleation). […] Children with retinoblastoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. […] Treatment for retinoblastoma may cause side effects. […] New types of treatment are being tested in clinical trials. […] Treatment of progressive or recurrent intraocular retinoblastoma may include external-beam radiation therapy or plaque radiotherapy, cryotherapy, thermotherapy, systemic chemotherapy or ophthalmic artery infusion chemotherapy, intravitreal chemotherapy, surgery (enucleation), or a clinical trial of targeted therapy with an oncolytic virus that targets the RB1 gene and is injected into the tumor.

• #94 Treatment of Retinoblastoma: What Is the Latest and What Is the Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9010858/

  Despite the changing paradigm of retinoblastoma treatment from systemic to OAC and IVi chemotherapy, eyes that relapse or that are initially refractory to conventional therapy are still difficult to treat with currently available drug options and most undergo enucleation. Thus, drug discovery in retinoblastoma is of paramount importance. Recent studies have used innovative multi-omics technology to identify deregulated pathways that could be targeted via novel treatment strategies in retinoblastoma. […] The aim in developing OAC was to deliver the drug directly into the artery that irrigates the ocular tissues to increase local bioavailability while minimizing systemic exposure. […] Intra-arterial delivery of chemotherapy was first achieved 70 years ago by Reese, who delivered a nitrogen mustard derivative to the eye by puncturing the internal carotid artery and injecting the drug into that artery. […] Key outcomes of the widespread adoption of OAC include: Eliminating the use of EBRT, which has decreased the incidence of second, non-ocular tumors and thereby improved long-term survival. […] Drastically increasing the rate of eye salvage. At MSKCC, this rate has increased from 5 to 95%.

• #95 Personalized medicine and retinoblastoma treatment

  https://www.retina-specialist.com/article/personalized-medicine-and-retinoblastoma-treatment

  Most recently, a study published this year by Dr. Abramson and colleagues showed that intravitreal chemotherapy may be effective in primary treatment non-vitreous disease, including subretinal seeding, anterior segment dissemination and select retinal tumors. […] Prospective studies are needed to assess the role of periocular chemotherapies for the treatment of RB. […] The majority of these changes in management have happened without clinical trials.

• #96 Retinoblastoma Treatment – NCI

  https://www.cancer.gov/types/retinoblastoma/patient/retinoblastoma-treatment-pdq

  Retinoblastoma is a disease in which malignant (cancer) cells form in the tissues of the retina. […] Treatment for retinoblastoma depends on whether it is intraocular (within the eye) or extraocular (outside the eye). […] Six types of standard treatment are used: Cryotherapy, Thermotherapy, Chemotherapy, Radiation therapy, High-dose chemotherapy with stem cell rescue, Surgery (enucleation). […] Children with retinoblastoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. […] Treatment for retinoblastoma may cause side effects. […] New types of treatment are being tested in clinical trials. […] Treatment of progressive or recurrent intraocular retinoblastoma may include external-beam radiation therapy or plaque radiotherapy, cryotherapy, thermotherapy, systemic chemotherapy or ophthalmic artery infusion chemotherapy, intravitreal chemotherapy, surgery (enucleation), or a clinical trial of targeted therapy with an oncolytic virus that targets the RB1 gene and is injected into the tumor.

• #97 Treatment of Retinoblastoma: What Is the Latest and What Is the Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9010858/

  The management of retinoblastoma, the most common intraocular malignancy in children, has changed drastically over the last decade. Landmark developments in local drug delivery, namely, safer techniques for intravitreal chemotherapy injection and ophthalmic artery chemosurgery, have resulted in eye globe salvages that were not previously attainable using systemic chemotherapy or external beam irradiation. […] Novel drugs, oncolytic viruses, and immunotherapy are promising approaches in the treatment of intraocular retinoblastoma. Importantly, emerging studies of the pattern of tumor dissemination and local drug delivery may provide the first steps toward new treatments for metastatic disease. […] Here, we review recent advances in retinoblastoma treatment, especially with regard to local drug delivery, that have enabled successful conservative management of intraocular retinoblastoma. We also review emerging data from preclinical and clinical studies on innovative approaches that promise to lead to further improvement in outcomes, namely, the mechanisms and potential uses of new and repurposed drugs and non-chemotherapy treatments, and discuss future directions for therapeutic development.

• #98 A Simple Guide for Treating Retinoblastoma | Retinal Physician

  https://retinalphysician.com/issues/2023/june/a-simple-guide-for-treating-retinoblastoma/

  The standard regimen includes delivery of 1 or a combination of 2 drugs, given once monthly for 3 cycles. […] The overall globe salvage rate was 74% with IAC as a first-line treatment modality. […] Tumor seeding is one of the major predictive factors for failure of both IVC and IAC. […] Intravitreal chemotherapy (iVitC) is a targeted approach that delivers the highest concentration of drug into the vitreous cavity without systemic toxicity. […] The most common and expected toxicity is a localized salt-and-pepper retinopathy, particularly due to melphalan toxicity due to its high binding with retinal pigment epithelium (RPE). […] Advances in the understanding of the molecular drivers of RB pathway have provided opportunities to explore novel drugs with targeted effects, improved bioavailability, and reduced chemotoxicity. […] Considering global burden of retinoblastoma with predominance in lower-income and middle-income countries, innovative approaches in drug delivery and alternatives to chemotherapy that are inexpensive and accessible are needed.

• #99 Retinoblastoma – Wikipedia

  https://en.wikipedia.org/wiki/Retinoblastoma

  Retinoblastoma is a rare form of cancer that rapidly develops from the immature cells of a retina. It is the most common primary malignant intraocular cancer in children, and 80% of retinoblastoma cases are first detected in those under 3 years old. […] The priority of retinoblastoma treatment is to preserve the life of the child, then to preserve vision, and then to minimize complications or side effects of treatment. The exact course of treatment depends on the individual case and is decided by the ophthalmologist in discussion with the paediatric oncologist. […] The various treatment modalities for retinoblastoma includes: Enucleation of the eye, External beam radiotherapy (EBRT), Brachytherapy, Thermotherapy, Laser photocoagulation, Cryotherapy, Systemic chemotherapy, Intra-arterial chemotherapy, Nanoparticulate chemotherapy, Chemoreduction. […] In the developed world, retinoblastoma has one of the best cure rates of all childhood cancers (95-98%), with more than 90% of sufferers surviving into adulthood. Good prognosis depends upon early presentation of the child in health facility. Late presentation is associated with a poor prognosis.

• #100 Treatment of Retinoblastoma: What Is the Latest and What Is the Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9010858/

  Vitreous seeding may occur in eyes with endophytic features or after conservative therapy. Until the advent of OAC in combination with IVi, vitreous seeding was extremely difficult to control with systemic chemotherapy or EBRT, and thus most of those eyes were enucleated. […] Importantly, melphalan was undetectable in plasma, probably explaining the lack of hematologic toxicity associated with IVi chemotherapy. […] In summary, retinoblastoma treatment has evolved over the last century, resulting in a striking change in the treatment paradigm of this ocular tumor. Advances in the knowledge of its tumor biology and drug response and the development of new routes of drug delivery promise to lead to additional new, more effective, and less toxic therapies in retinoblastoma.

• #101 Retinoblastoma Treatment | St. Jude Care & Treatment

  https://www.stjude.org/care-treatment/treatment/childhood-cancer/solid-tumors/retinoblastoma.html

  We are working to improve ocular salvage (saving the eye) and preserve vision for our patients. Our researchers are also focused on finding new strategies to treat rare diseases such as retinoblastoma. […] St. Jude scientists have found possible targeted therapies that kill retinoblastoma cells better than compounds used in the past. These drugs may dramatically impact the treatment of this type of cancer in children. […] Cancer survivors, especially those cured at a young age (such as retinoblastoma patients), face medical and psychosocial challenges as they age. The After Completion of Therapy (ACT) Clinic provides close monitoring and resources for managing late effects of disease and therapy. Clinic services are available to St. Jude patients until they are 18 years of age or until 10 years after diagnosis, whichever is later.

• #102 Retinoblastoma | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/retinoblastoma

  Surgery is usually reserved for children with advanced retinoblastoma that doesn’t respond to other treatments. […] Cryotherapy is often used together with chemotherapy, or it may be used after radiation therapy. […] Thermotherapy is a method of delivering heat to the eye using ultrasound, microwaves, or infrared radiation. […] Photocoagulation, also called light coagulation, is another method for treating small tumors. […] Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells. […] All treatment types have side effects associated with them. […] Through our Retinoblastoma Program, children with retinoblastoma receive treatment from a multidisciplinary team of oncologists, ophthalmologists, interventional radiologists, and other subspecialists with expertise in retinoblastoma. […] We offer the full range of multidisciplinary treatment options for retinoblastoma, including intra-arterial chemotherapy a recently-developed treatment option that often can provide the most effective retinoblastoma treatment with the fewest side effects.

• #103 Late effects of treatments for retinoblastoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/retinoblastoma/treatment/late-effects

  Recovering from retinoblastoma and adjusting to life after treatment is different for each child, depending on the type and dose of treatment, the childs age at the time of treatment and many other factors. […] Your childs healthcare team will watch for late side effects and can help to prepare you for what to expect. They can also suggest ways to help your child. […] Retinoblastoma or its treatment can cause eye problems. […] Surgery or radiation therapy to treat retinoblastoma may change the way a child looks. The amount and type of change that may occur will depend on the type of treatment or eye surgery that is done. […] Certain chemotherapy drugs, such as doxorubicin (Adriamycin), may cause heart problems, including weakening of the heart muscles. […] Children treated with radiation therapy to the brain are at risk for growth hormone (GH) deficiency.

• #104 Chemotherapy for Retinoblastoma | American Cancer Society

  https://www.cancer.org/cancer/types/retinoblastoma/treating/chemotherapy.html

  In this newer approach, a tiny needle is used to inject a chemo drug (typically melphalan or topotecan) directly into the vitreous humor, the jelly-like substance inside the eye. […] Chemo can be used as the first treatment to shrink some tumors that have not spread outside the eye. This is called chemoreduction. […] Systemic chemo is also used to treat children whose retinoblastoma has spread outside the eye, a much more critical situation. […] The side effects of chemo depend on the types and doses of drugs used, and how long they are given. […] Much lower doses of chemo are used in this approach, so the side effects tend to be limited to the eye area. […] As with intra-arterial chemo, the side effects from this newer technique seem to be limited to the eye and nearby areas. Each treatment might damage the retina slightly, which might affect vision.

• #105 Late effects of treatments for retinoblastoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/retinoblastoma/treatment/late-effects

  Recovering from retinoblastoma and adjusting to life after treatment is different for each child, depending on the type and dose of treatment, the childs age at the time of treatment and many other factors. […] Your childs healthcare team will watch for late side effects and can help to prepare you for what to expect. They can also suggest ways to help your child. […] Retinoblastoma or its treatment can cause eye problems. […] Surgery or radiation therapy to treat retinoblastoma may change the way a child looks. The amount and type of change that may occur will depend on the type of treatment or eye surgery that is done. […] Certain chemotherapy drugs, such as doxorubicin (Adriamycin), may cause heart problems, including weakening of the heart muscles. […] Children treated with radiation therapy to the brain are at risk for growth hormone (GH) deficiency.

• #106 Retinoblastoma | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/r/retinoblastoma

  Local chemotherapy is used for large tumors. […] Chemotherapy can be delivered to the tumor by a more direct route through the arteries within the eye. […] Side effects of this chemotherapy include swelling of the eyelid, bleeding into the eye, eye muscle dysfunction, drooping of the upper eyelid, or harm to the artery. […] After the treatment is completed, your child will have regular check-ups, including eye exams under anesthesia and follow up with an oncologist (cancer doctor).

• #107

  https://journals.lww.com/ijo/fulltext/2020/68110/modern_treatment_of_retinoblastoma__a_2020_review.9.aspx

  The treatment of choice for retinoblastoma depends largely on the International Classification of Retinoblastoma (ICRB) staging, the presence or absence of extraocular clinical factors, germline testing results, the family psychosocial situation, and available institutional resources. […] Current indications for IVC include patients with bilateral disease, confirmed germline mutation, family history of retinoblastoma, or cases with suspected optic nerve or choroidal invasion. […] Given the success of IAC for globe salvage in advanced cases and refractory tumors, this treatment modality has become more widely used over the past decade. […] Main indications for IAC include both first-line and globe salvage therapies. […] Despite localized delivery of chemotherapeutic agents, systemic toxicity has been observed following IAC.

• #108 A Simple Guide for Treating Retinoblastoma | Retinal Physician

  https://retinalphysician.com/issues/2023/june/a-simple-guide-for-treating-retinoblastoma/

  The standard regimen includes delivery of 1 or a combination of 2 drugs, given once monthly for 3 cycles. […] The overall globe salvage rate was 74% with IAC as a first-line treatment modality. […] Tumor seeding is one of the major predictive factors for failure of both IVC and IAC. […] Intravitreal chemotherapy (iVitC) is a targeted approach that delivers the highest concentration of drug into the vitreous cavity without systemic toxicity. […] The most common and expected toxicity is a localized salt-and-pepper retinopathy, particularly due to melphalan toxicity due to its high binding with retinal pigment epithelium (RPE). […] Advances in the understanding of the molecular drivers of RB pathway have provided opportunities to explore novel drugs with targeted effects, improved bioavailability, and reduced chemotoxicity. […] Considering global burden of retinoblastoma with predominance in lower-income and middle-income countries, innovative approaches in drug delivery and alternatives to chemotherapy that are inexpensive and accessible are needed.

• #109 Retinoblastoma Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/1222849-treatment

  Medical therapy should be directed toward complete control of the tumor and the preservation of as much useful vision as possible. Treatment is usually individualized to the specific patient. […] Incidence of local control is high and retinal late effects are minimal with radiation doses of 4000-4500 cGy used with 200 cGy fractions. However, morbidity and mortality associated with external beam radiation therapy (EBRT) are significant. EBRT results in cessation of bone growth. Therefore, children with retinoblastoma who are treated with EBRT have significant midface hypoplasia. (The younger the child is when EBRT is instituted, the more dramatic the outcome.) More importantly, EBRT has been shown to increase the risk of developing second cancers almost 6-fold during the lifetime of these patients. Today, neoadjuvant chemotherapy (chemoreduction) has superseded EBRT in order to (hopefully) circumvent these terrible adverse effects of EBRT. Nevertheless, EBRT is still indicated in selected circumstances, as follows:

• #110 Retinoblastoma Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/1222849-treatment

  Medical therapy should be directed toward complete control of the tumor and the preservation of as much useful vision as possible. Treatment is usually individualized to the specific patient. […] Incidence of local control is high and retinal late effects are minimal with radiation doses of 4000-4500 cGy used with 200 cGy fractions. However, morbidity and mortality associated with external beam radiation therapy (EBRT) are significant. EBRT results in cessation of bone growth. Therefore, children with retinoblastoma who are treated with EBRT have significant midface hypoplasia. (The younger the child is when EBRT is instituted, the more dramatic the outcome.) More importantly, EBRT has been shown to increase the risk of developing second cancers almost 6-fold during the lifetime of these patients. Today, neoadjuvant chemotherapy (chemoreduction) has superseded EBRT in order to (hopefully) circumvent these terrible adverse effects of EBRT. Nevertheless, EBRT is still indicated in selected circumstances, as follows:

• #111 The Evolution of Treatments for Retinoblastoma – Retina Today

  https://retinatoday.com/articles/2010-nov-dec/the-evolution-of-treatments-for-retinoblastoma

  It was soon recognized that occasionally retinoblastoma could be treated with photocoagulation alone, without enucleation or radiation, and that this could preserve eyes with some vision. […] Until the late 1980s, these were the tools available for treatment of retinoblastoma, and with these tools, by that time, the survival rate for retinoblastoma in the Western world exceeded 90%. […] As survival improved in patients treated with radiation, however, clinicians began to recognize that in the long term, these patients often developed second nonocular cancers in the irradiated field. […] Because these secondary cancers occurred at a rate of 0.5 to 1% per year, and because half of the children who developed these other cancers died, by the 1990s, the most common cause of death in retinoblastoma patients was not the retinoblastoma itself but secondary cancers related to the patients’ genetics or to their radiation treatment.

• #112 Retinoblastoma Treatment and Vision – The Double-Edged Sword – WE C Hope

  https://wechope.org/medical-care/retinoblastoma-treatment-and-vision-the-double-edged-sword/

  Delivering such a high dose of a toxic chemical directly to the eye will also have a toxic effect on not only the tumour cells, but overall, to the healthy retinal cells. […] There is still much to understand about the long-term effects of IAC, and we now need to wait and see what happens to children treated with IAC over time. […] Radiation can indirectly affect vision by damaging the very sensitive corneal tissues. […] Although radiation was an effective treatment for retinoblastoma, it can also damage the blood supply to the retina and cause ischaemia resulting in radiation retinopathy. […] We know that some treatments used to control retinoblastoma can also cause cataracts. […] Timing of the surgery is also critical, as it would be very unwise to do cataract surgery in a child with active retinoblastoma disease.

• #113 Retinoblastoma Treatment and Vision – The Double-Edged Sword – WE C Hope

  https://wechope.org/medical-care/retinoblastoma-treatment-and-vision-the-double-edged-sword/

  Delivering such a high dose of a toxic chemical directly to the eye will also have a toxic effect on not only the tumour cells, but overall, to the healthy retinal cells. […] There is still much to understand about the long-term effects of IAC, and we now need to wait and see what happens to children treated with IAC over time. […] Radiation can indirectly affect vision by damaging the very sensitive corneal tissues. […] Although radiation was an effective treatment for retinoblastoma, it can also damage the blood supply to the retina and cause ischaemia resulting in radiation retinopathy. […] We know that some treatments used to control retinoblastoma can also cause cataracts. […] Timing of the surgery is also critical, as it would be very unwise to do cataract surgery in a child with active retinoblastoma disease.

• #114 Retinoblastoma Treatment and Vision – The Double-Edged Sword – WE C Hope

  https://wechope.org/medical-care/retinoblastoma-treatment-and-vision-the-double-edged-sword/

  Vision has already been lost. […] It can be very difficult to predict how much vision will be restored if eye-saving treatments are used, or how much the vision will be affected by the treatment itself, especially if the tumour has caused the retina to become detached. […] Laser and cryotherapy are commonly used to directly treat retinoblastoma tumours. […] If the tumour is too large, it may first need to be shrunk with systemic or intra-arterial chemotherapy. […] The cryotherapy or laser will also invariably damage some of the healthy surrounding retinal cells as well. […] Depending on the actual location on the retina, these tumours will determine the extent of the effect on the vision. […] Long-term, when there are extensive areas of laser or cryotherapy, the retina may become very damaged and detach.

• #115 Retinoblastoma Treatment and Vision – The Double-Edged Sword – WE C Hope

  https://wechope.org/medical-care/retinoblastoma-treatment-and-vision-the-double-edged-sword/

  Vision has already been lost. […] It can be very difficult to predict how much vision will be restored if eye-saving treatments are used, or how much the vision will be affected by the treatment itself, especially if the tumour has caused the retina to become detached. […] Laser and cryotherapy are commonly used to directly treat retinoblastoma tumours. […] If the tumour is too large, it may first need to be shrunk with systemic or intra-arterial chemotherapy. […] The cryotherapy or laser will also invariably damage some of the healthy surrounding retinal cells as well. […] Depending on the actual location on the retina, these tumours will determine the extent of the effect on the vision. […] Long-term, when there are extensive areas of laser or cryotherapy, the retina may become very damaged and detach.

• #116 Retinoblastoma Treatment and Vision – The Double-Edged Sword – WE C Hope

  https://wechope.org/medical-care/retinoblastoma-treatment-and-vision-the-double-edged-sword/

  Delivering such a high dose of a toxic chemical directly to the eye will also have a toxic effect on not only the tumour cells, but overall, to the healthy retinal cells. […] There is still much to understand about the long-term effects of IAC, and we now need to wait and see what happens to children treated with IAC over time. […] Radiation can indirectly affect vision by damaging the very sensitive corneal tissues. […] Although radiation was an effective treatment for retinoblastoma, it can also damage the blood supply to the retina and cause ischaemia resulting in radiation retinopathy. […] We know that some treatments used to control retinoblastoma can also cause cataracts. […] Timing of the surgery is also critical, as it would be very unwise to do cataract surgery in a child with active retinoblastoma disease.

• #117

  https://journals.lww.com/ijo/fulltext/2020/68110/modern_treatment_of_retinoblastoma__a_2020_review.9.aspx

  Despite great advances in retinoblastoma management, globe enucleation still remains a current treatment in the modern era. […] Known complications include chemosis, conjunctival cysts, pyogenic granuloma, blepharoptosis, lagophthalmos, superior sulcus defect, enophthalmos, symblepharon, implant exposure, and infection. […] After the first treatment has been instated, follow-up visits are generally scheduled every 4 weeks to evaluate response to therapy, identify side effects, and make decisions accordingly. […] Proper management of retinoblastoma is complex. Each case is unique, and treatment regimens must be carefully customized for varying disease presentations, available equipment, and regional culture or traditions.

• #118

  https://journals.lww.com/ijo/fulltext/2020/68110/modern_treatment_of_retinoblastoma__a_2020_review.9.aspx

  Despite great advances in retinoblastoma management, globe enucleation still remains a current treatment in the modern era. […] Known complications include chemosis, conjunctival cysts, pyogenic granuloma, blepharoptosis, lagophthalmos, superior sulcus defect, enophthalmos, symblepharon, implant exposure, and infection. […] After the first treatment has been instated, follow-up visits are generally scheduled every 4 weeks to evaluate response to therapy, identify side effects, and make decisions accordingly. […] Proper management of retinoblastoma is complex. Each case is unique, and treatment regimens must be carefully customized for varying disease presentations, available equipment, and regional culture or traditions.

• #119

  https://journals.lww.com/ijo/fulltext/2020/68110/modern_treatment_of_retinoblastoma__a_2020_review.9.aspx

  Despite great advances in retinoblastoma management, globe enucleation still remains a current treatment in the modern era. […] Known complications include chemosis, conjunctival cysts, pyogenic granuloma, blepharoptosis, lagophthalmos, superior sulcus defect, enophthalmos, symblepharon, implant exposure, and infection. […] After the first treatment has been instated, follow-up visits are generally scheduled every 4 weeks to evaluate response to therapy, identify side effects, and make decisions accordingly. […] Proper management of retinoblastoma is complex. Each case is unique, and treatment regimens must be carefully customized for varying disease presentations, available equipment, and regional culture or traditions.

• #120

  https://journals.lww.com/ijo/fulltext/2020/68110/modern_treatment_of_retinoblastoma__a_2020_review.9.aspx

  Despite great advances in retinoblastoma management, globe enucleation still remains a current treatment in the modern era. […] Known complications include chemosis, conjunctival cysts, pyogenic granuloma, blepharoptosis, lagophthalmos, superior sulcus defect, enophthalmos, symblepharon, implant exposure, and infection. […] After the first treatment has been instated, follow-up visits are generally scheduled every 4 weeks to evaluate response to therapy, identify side effects, and make decisions accordingly. […] Proper management of retinoblastoma is complex. Each case is unique, and treatment regimens must be carefully customized for varying disease presentations, available equipment, and regional culture or traditions.

• #121 Retinoblastoma – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retinoblastoma/symptoms-causes/syc-20351008

  Retinoblastoma is a kind of eye cancer that starts as a growth of cells in the retina. […] There are several treatments for retinoblastoma. For most children, treatment doesn’t require removing the eye to get rid of the cancer. The outlook for children diagnosed with retinoblastoma is quite good. […] After treatment, there is a risk that the cancer might come back in the eye or near it. […] Your child’s healthcare team might recommend tests to screen for these other types of cancers. […] If retinoblastoma runs in your family, tell your healthcare professional. Together you might consider genetic testing to look for variations in your DNA that increase the risk of retinoblastoma. […] If your children have an increased risk of retinoblastoma, care can be planned to manage that risk. For instance, eye exams may begin soon after birth. That way, retinoblastoma may be diagnosed very early. These screening tests could find the cancer when it is small and has a greater chance of being cured.

• #122 Treating retinoblastoma | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/childrens-cancer/eye-cancer-retinoblastoma/treatment

  Most parents worry about whether their child will lose their sight. […] Whenever possible, the doctor will try to keep the sight of the eye. […] Removing the affected eye will not cause sight loss in the other eye. […] Almost all retinoblastomas are successfully treated. But some cancers can come back again (recurrence or relapse) or don’t go away (refractory). […] Your child’s healthcare team will explain the different treatment options. They will support you through this difficult time. […] Your child will have regular follow up appointments with their specialist. […] These appointments are to check: how they are recovering, their development, if they are having any problems following treatment, if there are any signs the retinoblastoma has come back.

• #123 Retinoblastoma Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/1222849-treatment

  Patients with retinoblastoma should be evaluated and treated by a team of medical professionals, including an ophthalmologist (preferably an ocular oncologist), pediatrician, oncologist, radiologist, and pathologist. […] Secondary nonocular tumors can develop in survivors of retinoblastoma. In order of decreasing frequency, they are as follows: osteosarcoma, various soft tissue sarcomas, malignant melanoma, various carcinomas, leukemia and lymphoma, and various brain tumors. […] Frequent ophthalmologic examination is indicated for children at elevated risk. […] Patients with treated retinoblastoma as well as siblings who are at risk of inheriting the tumor need to be monitored indefinitely.

• #124 Treatments for retinoblastoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/retinoblastoma/treatment

  Follow-up is an important part of care for retinoblastoma. It often involves regular tests and visits with the healthcare team. […] Supportive care helps children and their parents meet the physical, practical, emotional and spiritual challenges of retinoblastoma. It is an important part of cancer care.

• #125 Children’s Retinoblastoma Eye Cancer Treatment | MSK Kids | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/pediatrics/cancer-care/types/retinoblastoma/treatment

  At MSK Kids, only a few children (5 out of every 100) need enucleation for retinoblastoma. […] Enucleation surgery takes less than 1 hour. […] Four weeks after enucleation, after your child has healed, they can be fitted for an ocular prosthesis. […] MSK is able to provide early treatment. […] The treatment is complex. It involves high-dose chemotherapy and often radiation therapy as well. […] Our ophthalmic oncologists (eye cancer doctors) will do an eye exam each year. […] We also encourage all survivors of retinoblastoma to get follow-up care through the MSK Kids long-term follow-up program.

• #126

  https://journals.lww.com/ijo/fulltext/2020/68110/modern_treatment_of_retinoblastoma__a_2020_review.9.aspx

  Despite great advances in retinoblastoma management, globe enucleation still remains a current treatment in the modern era. […] Known complications include chemosis, conjunctival cysts, pyogenic granuloma, blepharoptosis, lagophthalmos, superior sulcus defect, enophthalmos, symblepharon, implant exposure, and infection. […] After the first treatment has been instated, follow-up visits are generally scheduled every 4 weeks to evaluate response to therapy, identify side effects, and make decisions accordingly. […] Proper management of retinoblastoma is complex. Each case is unique, and treatment regimens must be carefully customized for varying disease presentations, available equipment, and regional culture or traditions.

• #127 Retinoblastoma Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/1222849-treatment

  Patients with retinoblastoma should be evaluated and treated by a team of medical professionals, including an ophthalmologist (preferably an ocular oncologist), pediatrician, oncologist, radiologist, and pathologist. […] Secondary nonocular tumors can develop in survivors of retinoblastoma. In order of decreasing frequency, they are as follows: osteosarcoma, various soft tissue sarcomas, malignant melanoma, various carcinomas, leukemia and lymphoma, and various brain tumors. […] Frequent ophthalmologic examination is indicated for children at elevated risk. […] Patients with treated retinoblastoma as well as siblings who are at risk of inheriting the tumor need to be monitored indefinitely.

• #128 Retinoblastoma | Texas Children’s

  https://www.texaschildrens.org/content/conditions/retinoblastoma

  Prognosis greatly depends on the following: The extent of the disease; The size and location of the tumor; Presence or absence of metastasis; The tumor’s response to therapy; The age and overall health of your child; Your child’s tolerance of specific medications, procedures, or therapies; New developments in treatment. As with any cancer, prognosis and long-term survival can vary greatly from child to child. Every child is unique and treatment and prognosis is structured around the child’s needs. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with retinoblastoma. In hereditary retinoblastoma, new tumors may form in either eye until the child is 3 to 4 years old. Children will need very close follow-up by an ophthalmologist. Children with hereditary retinoblastoma and those treated with some chemotherapies, radiation therapies, and some other therapies, are at higher risk for new cancers later in life and should have regular medical and eye exams.

• #129 Late effects of treatments for retinoblastoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/retinoblastoma/treatment/late-effects

  Radiation therapy to the brain and some chemotherapy drugs used to treat retinoblastoma can cause problems in the reproductive system. […] Retinoblastoma survivors have a higher risk of developing a second cancer later in life, especially if they received radiation therapy or have the inherited form of retinoblastoma.

• #130 The Evolution of Treatments for Retinoblastoma – Retina Today

  https://retinatoday.com/articles/2010-nov-dec/the-evolution-of-treatments-for-retinoblastoma

  After decades of advances, superselective chemotherapy alone can now destroy tumors and result in useful vision in the majority of patients. […] The management of intraocular retinoblastoma has changed dramatically over the past century, and as a result, so have the outcomes in terms of saving the lives, eyes, and vision of our patients. […] Treatment algorithms for retinoblastoma advanced periodically during the 20th century, and as a result, outcomes in terms of survival and the preservation of eyes and vision steadily improved. […] Successful treatment of retinoblastoma with radiation was first reported in 1903. […] And it cured the cancer; retinoblastoma was, and still is, one of only a few malignancies in children that can be cured by radiation alone. […] In the 1950s, Meyer-Schwickerath in Germany introduced the concept of photocoagulation with white light to destroy small tumors.

• #131 Retinoblastoma Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/retinoblastoma/hp/retinoblastoma-treatment-pdq

  Retinoblastoma is a pediatric cancer that requires careful integration of multidisciplinary care. Treatment of retinoblastoma aims to save the patient’s life and preserve useful vision. For patients presenting with extraocular retinoblastoma, treatment with systemic chemotherapy and radiation therapy is likely to be curative. However, extraorbital disease requires intensive chemotherapy and may include consolidation with high-dose chemotherapy and autologous hematopoietic stem cell rescue with or without radiation therapy. While a large proportion of patients with systemic extracentral nervous system (CNS) metastases can be cured, the prognosis for patients with intracranial disease is dismal. […] Treatment planning by a multidisciplinary team of cancer specialists including a pediatric oncologist, ophthalmologist, and radiation oncologist with experience treating ocular tumors of childhood is required to optimize treatment outcomes.

• #132 Treatment of Retinoblastoma: What Is the Latest and What Is the Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9010858/

  In high-income countries, eye-sparing treatments have been used for decades. In the late 1990s there was an evolution in conservative treatment from local, eye-directed therapies such as external beam radiotherapy (EBRT) toward systemic chemotherapy combined with aggressive focal therapies. This change in approach aimed to reduce the use of EBRT, which has been consistently associated with a higher risk of second malignancies. […] The introduction of ophthalmic artery chemosurgery (OAC) led to remarkable success in treating eyes with more advanced disease in which systemic chemotherapy had poorer results. In the 2010s intravitreous chemotherapy (IVi) was added as another eye-directed therapy, which in conjunction with OAC became the current standard therapy utilized by many centers in high- and middle-income countries, achieving unprecedented success in eye preservation and completely eliminating the use of EBRT.

• #133 Retinoblastoma – EyeWiki

  https://eyewiki.org/Retinoblastoma

  Retinoblastoma is an intraocular malignancy with primitive neuroendocrine origins that primarily affects young children. […] 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 many patients who present with unilateral disease. However, the loss of an eye is associated with significant social stigma in certain cultures. In addition, bilateral enucleation is a devastating option for bilaterally affected patients. Treatment modalities that may be successful in globe salvage include systemic chemotherapy with focal consolidation, intra-arterial chemotherapy, intravitreal chemotherapy, and focally destructive therapy (cryopexy, laser photocoagulation, hyperthermia and plaque irradiation).

• #134 Treatment of Retinoblastoma: What Is the Latest and What Is the Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9010858/

  The management of retinoblastoma, the most common intraocular malignancy in children, has changed drastically over the last decade. Landmark developments in local drug delivery, namely, safer techniques for intravitreal chemotherapy injection and ophthalmic artery chemosurgery, have resulted in eye globe salvages that were not previously attainable using systemic chemotherapy or external beam irradiation. […] Novel drugs, oncolytic viruses, and immunotherapy are promising approaches in the treatment of intraocular retinoblastoma. Importantly, emerging studies of the pattern of tumor dissemination and local drug delivery may provide the first steps toward new treatments for metastatic disease. […] Here, we review recent advances in retinoblastoma treatment, especially with regard to local drug delivery, that have enabled successful conservative management of intraocular retinoblastoma. We also review emerging data from preclinical and clinical studies on innovative approaches that promise to lead to further improvement in outcomes, namely, the mechanisms and potential uses of new and repurposed drugs and non-chemotherapy treatments, and discuss future directions for therapeutic development.

• #135 The Evolution of Treatments for Retinoblastoma – Retina Today

  https://retinatoday.com/articles/2010-nov-dec/the-evolution-of-treatments-for-retinoblastoma

  The proof of a technique lies in its replication by other centers, and superselective ophthalmic artery chemotherapy is now being done successfully in 20 countries. […] Experience to date suggests that superselective ophthalmic artery chemotherapy is more effective, faster, better, and safer than conventional treatments for this cancer, which already had good success rates.

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