Retinoblastoma Management: Advances in Chemotherapy

Abstract

The treatment of children with retinoblastoma (RB) has evolved from primarily enucleation of the eye(s) to highly selective methods of chemotherapy administration and approach. Indulgent and comprehensive understanding of the multitude of factors including accurate classification and grading of disease, timing and response to therapy, when to consolidate with local methods of therapy, combination regimens to control systemic disease and prevent relapse while minimizing risk of secondary cancers are crucial factors in the management of children with retinoblastoma. Chemotherapy was introduced in the 1950s and has become an integral component in management of RB. Methods of administration range from systemic to locally directed therapy including; intravitreal, periocular and intraarterial chemotherapy. This chapter is intended to discuss the evolution and current chemotherapeutic agents with various routes of administration. The indications, adverse occurrences, short-and long-term complications of both local and systemic treatments will be elucidated.

Survival trends for patients with retinoblastoma between 2000 and 2018: What has changed?

“…Patients with bilateral RB have higher rates of other malignant neoplasms, such as pineoblastoma and osteosarcoma 32 . Moreover, treatment of bilateral RB aims to save at least one eye, increasing the risk of metastases and recurrence and subsequently resulting in high mortality rates, especially with highly selective chemotherapy 40–43 . Systemic chemotherapy is recommended to eradicate systemic micro‐metastases because targeted chemotherapy may permit cancer cell escape.…”

“… 32 Moreover, treatment of bilateral RB aims to save at least one eye, increasing the risk of metastases and recurrence and subsequently resulting in high mortality rates, especially with highly selective chemotherapy. 40 , 41 , 42 , 43 Systemic chemotherapy is recommended to eradicate systemic micro‐metastases because targeted chemotherapy may permit cancer cell escape. Highly selective treatments arose from collaborations between ophthalmology centers and interventional radiology centers to treat patients with RB, but this treatment strategy is less comprehensive than that provided at pediatric cancer centers.…”