Abstract
The management of retinoblastoma has evolved remarkably for the past century, and lately there is a drift towards focal conservative treatments. The challenge remains, however, in maintaining the eye and vision. Tumor reduction by diverse first-line chemotherapy protocols followed by local treatments like cryotherapy, laser photocoagulation, thermotherapy, and plaque radiotherapy is now accepted as treatment strategy for intraocular retinoblastoma with the goal of avoiding external beam radiotherapy (EBRT) or enucleation. However in most eyes with large tumors with diffuse vitreous and subretinal seeds, the EBRT or enucleation is eventually required. Chemoprophylaxis is necessary for preventing metastases in tumors with high-risk pathology features (tumor extending beyond lamina cribrosa of the optic nerve, tumor extending till the surgical margin of the optic nerve, massive choroidal invasion, scleral involvement or anterior segment involvement). Intensified chemotherapy with autologous stem cell rescue appears effective for patients with metastatic retinoblastoma. Recently, ophthalmic intra-arterial infusion with melphalan is proved as an excellent globe conserving treatment option in advanced retinoblastoma cases with minimal systemic side effects. Progress in the clinical recognition and management of retinoblastoma has led to high survival rates.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abramson DH, Frank CM (1998) Second nonocular tumors in survivors of bilateral retinoblastoma: a possible age effect on radiation-related risk. OphthalÂmology 105:573–579
Abramson DH, Dunkel IJ, Brodie SE, Kim JW, Gobin YP (2008) A phase I/II study of direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma initial results. Ophthalmology 115:1398–1404
Abramson DH, Dunkel IJ, Brodie SE, Marr B, Gobin YP (2010) Superselective ophthalmic artery chemotherapy as primary treatment for retinoblastoma (chemosurgery). Ophthalmology 117:1623–1629
Brodie SE, Pierre Gobin Y, Dunkel IJ, Kim JW, Abramson DH (2009) Persistence of retinal function after selective ophthalmic artery chemotherapy infusion for retinoblastoma. Doc Ophthalmol 119:13–22
Chantada G, Doz F, Antoneli CB, Grundy R, Clare Stannard FF, Dunkel IJ, Grabowski E, Leal-Leal C, RodrÃguez-Galindo C, Schvartzman E, Popovic MB, Kremens B, Meadows AT, Zucker JM (2006) A proposal for an international retinoblastoma staging system. Pediatr Blood Cancer 47:801–805
Christmas NJ, Van Quil IK, Murray TG, Gordon CD, Garonzik S, Tse D, Johnson T, Schiffman J, O’Brien JM (2000) Evaluation of efficacy and complications: primary pediatric orbital implants after enucleation. Arch Ophthalmol 118:503–506
Mohri M (1993) The development of a new system of selective ophthalmic arterial infusion for the patients of intraocular retinoblastoma (in Japanese). Keio Igaku (J Keio Med Soc) 70:679–687
Moscinski LC, Pendergrass TW, Weiss A, Hvizdala E, Buckley KS, Kalina RE (1996) Recommendations for the use of routine bone marrow aspiration and lumbar punctures in the follow-up of patients with retinoblastoma. J Pediatr Hematol Oncol 18:130–134
Murphree AL (2005) Intraocular retinoblastoma: the case for a new group classification. Ophthalmol Clin North Am 18:41–53
Reese AB, Hyman GA, Merriam GR Jr, Forrest AW, Kligerman MM (1954) Treatment of retinoblastoma by radiation and triethylenemelamine. AMA Arch Ophthalmol 53:505–513
Roarty JD, McLean IW, Zimmerman LE (1988) Incidence of second neoplasms in patients with retinoblastoma. Ophthalmology 95:1583–1587
Shields JA (1994) The expanding role of laser photocoagulation for intraocular tumors. The 1993 H. Christian Zweng Memorial Lecture. Retina 14:310–322
Shields JA, Shields CL (1999) Retinoblastoma. In: Atlas of intraocular tumors. Lippincott Williams & Wilkins, Philadelphia, pp 207–232
Shields JA, Shields CL (2008) Retinoblastoma. In: Atlas of intraocular tumors. Lippincott Williams & Wilkins, Philadelphia, pp 293–365
Shields JA, Parsons H, Shields CL, Giblin ME (1989) The role of cryotherapy in the management of retinoblastoma. Am J Ophthalmol 108:260–264
Shields CL, Shields JA, De Potter P, Singh AD (1993) Lack of complications of the hydroxyapatite orbital implant in 250 consecutive cases. Trans Am Ophthalmol Soc 91:177–189
Shields CL, Shields JA, Kiratli H, De Potter PV (1995) Treatment of retinoblastoma with indirect ophthalmoscope laser photocoagulation. J Pediatr Ophthalmol Strabismus 32:317–322
Shields CL, Santos MC, Diniz W, Gunduz K, Mercado G, Cater JR, Shields JA (1999) Thermotherapy for retinoblastoma. Arch Ophthalmol 117:885–893
Shields CL, Meadows AT, Shields JA, Carvalho C, Smith AF (2001a) Chemoreduction for retinoblastoma may prevent intracranial neuroblastic malignancy (trilateral retinoblastoma). Arch Ophthalmol 119:1269–1272
Shields CL, Shields JA, Cater J, Othmane I, Singh AD, Micaily B (2001b) Plaque radiotherapy for retinoblastoma: long-term tumor control and treatment complications in 208 tumors. Ophthalmology 108:2116–2121
Shields CL, Mashayekhi A, Au AK, Czyz C, Leahey A, Meadows AT, Shields JA (2006) The international classification of retinoblastoma predicts chemoreduction success. Ophthalmology 113:2276–2280
Shields CL, Palamar M, Sharma P, Ramasubramanian A, Leahey A, Meadows AT, Shields JA (2009) Retinoblastoma regression patterns following chemoreduction and adjuvant therapy in 557 tumors. Arch Ophthalmol 127:282–290
Shields CL, Bianciotto CG, Jabbour P, Griffin GC, Ramasubramanian A, Rosenwasser R, Shields JA (2011) Intra-arterial chemotherapy for retinoblastoma: report no. 2, treatment complications. Arch Ophthalmol 129:1407–1415
Suzuki S, Yamane T, Mohri M, Kaneko A (2011) Selective ophthalmic arterial injection therapy for intraocular retinoblastoma: the long-term prognosis. Ophthalmology 118:2081–2087
Tawansy KA, Samuel MA, Shammas M, Murphree AL (2006) Vitreoretinal complications of retinoblastoma treatment. Retina 26(7 Suppl):S47–S52
Yamane T, Kaneko A, Mohri M (2004) The technique of ophthalmic arterial infusion therapy for patients with intraocular retinoblastoma. Int J Clin Oncol 9:69–73
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Shah, P.K., Aurora, S., Narendran, V., Kalpana, N. (2012). Pediatric Intraocular Retinoblastoma: Treatment. In: Hayat, M. (eds) Pediatric Cancer, Volume 3. Pediatric Cancer, vol 3. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4528-5_21
Download citation
DOI: https://doi.org/10.1007/978-94-007-4528-5_21
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-007-4527-8
Online ISBN: 978-94-007-4528-5
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)