What are the treatment options for retinoblastoma?
The aim of treatment in retinoblastoma, in order of priority, is to save the life, eye, sight and cosmesis of the child.
There are many treatment modalities for this tumor. These are:
Enucleation: This means removal of the eye. The eye with the tumor is removed and is sent for a pathology report. The space is replaced by an artificial implant made of plastic, rubber or coral. The child is fitted with prosthesis or artificial eye, made to match the other eye. This artificial eye, of course, does not have any vision.
External beam radiation: as an alternative to enucleation, this method of giving radiation treatment to the eye may treat the tumor while preserving the eye. As the tumor is very radiosensitive, this treatment method is very effective. Though the radiation may cause damage to the surrounding structures of the eye, e.g., lens (cataract), lacrimal system (dry eye), orbit (bone maldevelopment) etc. It also increases the chance of developing secondary tumor of the bone, especially in children with tumor involving both eyes.
Localized Plaque radiation therapy: This method involves applying radioactive plaque close to the tumor on the sclera, and thus gives the radiation therapy in a localized area. It significantly decreases the local complications associated with radiation therapy.
Photocoagulation: Laser treatment for the tumor is effective and safe for tumors that are smaller in size. In the right cases, this treatment may help in preserving eye as well as the sight of the child.
Cryotherapy: this involves freezing of the tumor by applying a special probe on the external surface of the eye (sclera). This treatment is done under direct observation and is effective in saving the eye and sight in patients with small tumor.
Chemotherapy: Treatment with anticancer drugs. There has been a recent preference towards treatment with systemic drugs as an additional treatment. The chemotherapy may decrease the size of the tumor and thus make it more amenable to local treatment like laser, cryotherapy and plaque radiation.
Which treatment option is the best?
The treatment of retinoblastoma is individualized for each patient. The treatment modality for a given child is decided based on many important factors. These are:
• Size of the tumor
• Location of the tumor
• Whether the tumor has spread
• Status of the other eye
• Associated complications like retinal detachment, glaucoma
• Family history
• The wishes and concerns of the parents
• Availability of the facilities
As this is a difficult decision made based on many factors, it is advised to discuss with the treating ophthalmologist about the best treatment option for the concerned child. All the advantages and disadvantages of each option must be weighed before taking a decision. It is also important to discuss the rehabilitation and the cosmetic correction after the surgery.
What is done if the child has tumor in both eyes?
In these cases, generally the worse eye is enucleated and the other eye is tried to salvage by using other methods of treatment. However, unfortunately in a few cases, both eyes may have to be removed.
Why is early detection important?
As mentioned earlier, the safer and less destructive procedures may be taken when the tumor is in its early stage. By detecting and treating the tumor early, we may save the life, sight and eye of the child.
What are the long-term consequences of retinoblastoma?
Even though retinoblastoma is a life threatening disease, it is rarely a fatal one if treated appropriately. With the correct treatment in the hands of an experienced ophthalmologist, the retinoblastoma patient has a very good chance of living a long, full, and happy life.
It is very important to have a proper follow up with the treating ophthalmologist for the eye tumor as well as for detection and treatment of possible other tumors. The frequency of follow up depends upon the type of tumor and the type of treatment given. Also in children with only one eye left, extra care must be taken to avoid injuries to the good eye.
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Retinoblastoma
